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Description: The right kidney was 10.8x4.7x5.4cm, and the left kidney was 10.8x5.4x5.8cm. The patient's both kidneys showed increased echotextures. No evidence of renal stones or hydronephrosis was found. What is your opinion?
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Description: The right kidney was 10.8x4.7x5.4cm, and the left kidney was 10.8x5.4x5.8cm. The patient's both kidneys showed increased echotextures. No evidence of renal stones or hydronephrosis was found. What is your opinion?
16 comments:
Hi Hye,
Given the history and the relatively normal kidney I am leaning toward ARF (acute renal failure) given the diabetes and other symptoms. In the beginning stages of renal failure the kidneys will appear echogenic. The build up of toxins in the body could cause the headaches and nausea.
The symptoms are associated with acute renal failure. However,as I know, acute renal failure may appear normal in size or enlarged and hypoechoic with parenchema disease. Is that true kidny can be echogenic in the beginning nancy?
Wow, these kidneys don't look normal at all to me. They are very echogenic. Renal failure would make sense because diabetes is the main cause for renal failure, and hypertension is another contributor.
When comparing the kidney tissue to the liver tissue it is apparent that the right kidney’s cortex is echogenic, however, the pyramids still appear normal. The liver is concerning as well, I am not seeing very many hepatic vessels that could lead me to believe that this patient may have portal hypertension, so, I would look thoroughly through the liver to look for hepatics and do a portal venous doppler to rule out reverse flow. The left kidney appears to resemble the right kidney in echotexture, but I would have like to have seen an image of the left kidney and spleen in order to compare echotextures. Is that the spleen above the left kidney? If so, it looks pretty bad would need further investigation. I would also look around the kidneys because the image of the left kidney kind of looks like there is fluid around it. Very interesting.
I believe this individual has Diabetic Kidney Disease. This is based on the the patient history of diabetes and high blood pressure with accompanying, fatigue, nausea and headaches. "About 1 in 3 people with Type 1 diabetes will develop kidney disease and when left untreated leads to renal failure. These individuals generally have high blood pressure. The symptoms of Diabetic kidney disease include: high blood pressure, nausea and vomiting among others." http://www.brighthub.com/health/diabetes/articles/27491.aspx. Sonographically, these kidneys are very echogenic although they do not appear small for size as kidneys in renal failure can appear.
I see that kidney are more echogenic then liver. It is abnormal. At my clinical site we put color Doppler and if needed PD on thoes kind of kidney to see if they are functional. I think it is renal failure.
This is definitely a case of acute renal failure. With acute renal failure, the cortex can be very echogenic and have irregular borders.Acute renal failure is often reversible and the damage is not long lasting. Acute renal failure is most commonly found in people who are hospitalized especially those in intensive care unit.
Thank you for all your comments. You are right. It is a medical kidney disease.
Hye
Hi Hye,
The patient's history of diabetes, high blood pressure and symptoms of fatigue, headaches, weight loss and nausea are all suggestive of chronic renal failure. The kidneys are very echogenic compared to the liver. With the measurment of 10 cm of the right kidney, it appears to be enlarged. However, I'm a little confused. With chronic renal disease, the kidneys become smaller which is not the case for this study. Could you please be a little bit more specific on what type of medical renal disease this is?
The size of these echogenic kidneys also struck me as peculiar, I am definitely used to seeing small echogenic kidneys in renal failure. One of my CIs said today that patients with HIV tend to have "plump" echogenic kidneys instead of small ones, which was an interesting thing to consider.
"Treatment for acute kidney failure involves identifying the illness or injury that originally damaged your kidneys...
...Treatments that help prevent complications include:
■Treatments to balance the amount of fluids in your blood. Acute kidney failure is sometimes caused by a lack of fluids in your blood. In this case, your doctor may recommend intravenous fluids. In other cases, acute kidney failure may cause you to have too much body fluid, leading to swelling in your arms and legs. In these cases, your doctor may recommend medications (diuretics) to cause your body to expel extra fluids.
■Medications to control blood potassium...Too much potassium in the blood can cause dangerous irregular heartbeats (arrhythmias).
■Medications to restore blood calcium levels. If the levels of calcium in your blood drop too low, your doctor may recommend an infusion of calcium.
■Dialysis to remove toxins from your blood. If toxins build up in your blood, you may need to undergo temporary hemodialysis... Dialysis may also help remove excess potassium from your body.."
Source: http://www.mayoclinic.com/health/kidney-failure/DS00280/DSECTION=treatments-and-drugs
Zouliath Said
Both kidneys are very hyperechogenic that means it is an acute renal failure.
Acute kidney injury (AKI), previously called acute renal failure (ARF),[1] is a rapid loss of kidney function. Its causes are numerous and include low blood volume, exposure to toxins, and prostate enlargement. AKI is diagnosed on the basis of clinical history, such as decreased urine production, and characteristic laboratory findings, such as elevated blood urea nitrogen and creatinine. Depending on its severity, AKI may lead to a number of complications, including metabolic acidosis, high potassium levels, changes in body fluid balance, and effects to other organ systems. Management includes supportive care, such as renal replacement therapy, as well as treatment of the underlying disorder.
by looking at the picture i think that kidney echogenicity has change and it is suggestive of Acute kidney failure which is the sudden loss of your kidneys' ability to perform their main function of eliminating excess fluid and salts as well as waste material from your blood. When your kidneys lose their filtering ability, dangerous levels of fluid, electrolytes and wastes accumulate in your body.
I scanned a patient with HIV and he had echogenic kidneys which were not small. According to the patient history he has diabetes and hypertension which correlates to symptoms of mild kidney disease, often called renal insufficiency.
With loss of kidney function, there is an accumulation of water; waste; and toxic substances, in the body, that are normally excreted by the kidney. Loss of kidney function also causes other problems such as anemia, high blood pressure, acidosis (excessive acidity of body fluids), disorders of cholesterol and fatty acids, and bone disease.
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