Dr/ ABD ALLAH NAZEER. MD.

Imaging of the Upper urinary tract (part 1).

Imaging of the Urinary system.

Plain kidney, ureters and bladder (KUB) testingIntravenous urogramUltrasonographyNuclear medicine - including mercaptoacetyltriglycine (MAG3) and dimercaptosuccinic acid (DMSA) scansCystographyComputed tomography (CT) scanMagnetic resonance imaging (MRI) scanMore invasive tests.

Stones.

Bladder mass.Bladder diverticulum.

UltrasonographyGenerally ultrasonography is an excellent imaging modality as it is noninvasive, reliable and affordable.It can be used to investigate the kidney, bladder, and prostate gland. It can also be combined with voiding, providing an indication of the residual volume. This gives an indirect measure of bladder function.

Computed tomography scanning of the urinary tract.

CT Advantage.

Detection of radio-opaque and radio-lucent calculi.Diagnosis of urinary obstruction and its level.Congenital anomalies.Detection and staging of urinary system neoplasm.Differentiation between cystic and solid urinary neoplasm.CT Urography.CT Angiography in renal stenosis and vascular anomalies.

Radioisotope renography is a form of kidney imaging involving radioisotopes The two most common radiolabelled pharmaceutical agents used are Tc99m-MAG3 (Mercaptoacetyltriglycine) and Tc99m-DTPA (Diethylene Triamine Pentacaetic Acid). Some other radiolabelled pharmaceuticals are EC (Ethyl Cysteine) and 131-Iodine labelled OIH (Ortho Iodo Hippurate). MAG3 is by far a better diagnostic agent than Tc-99m-DTPA, particularly in neonates, patients with impaired function, and patients with suspected obstruction. The MAG3 clearance is highly correlated with the effective renal plasma flow (ERPF), and the MAG3 clearance can be used as an independent measure of renal function. After intravenous administration, about 40-50% of the MAG3 in the blood is extracted by the proximal tubules with each pass through the kidneys; the proximal tubules then secrete the MAG3 into the tubular lumen. DTPA is the second most commonly used renal radiopharmaceutical in the United States, primarily because it is the least expensive. Tc-99m-DTPA is filtered by the glomerulus and may be used to measure the glomerular filtration rate (GFR). The extraction fraction of DTPA is approximately 20%, less than half that of MAG3. However, EC is preferred when the serum Creatinine is high.

Items should be assessed.Congenital anomalies.Urinary stones.Inflammatory disease.Renal neoplasm(cystic and solid masses).Renal trauma.

Urinary tract pathology.

I-Congenital anomalies:1.Renal agenesis. Absence of the kidney usually

the left one2.Renal hypoplasia.3.Horse shoe kidney. Fused kidneys at their

poles.4.Ectopic Kidney.5.Aberrant renal artery.

6-Persisteuce of fetal lobulation.7-Congenital polycystic kidney.8-Congenital solitary cyst.9-Double ureters and pelvis.10-Megaureter. Due to absence of ganglion cells11-Congenital stricture of the ureter.

Renal agenesis refers to a congenital absence of one or both kidneys. If bilateral (traditionally known as the classic Potter syndrome) the condition is fatal, whereas if unilateral, patients can have a normal life expectancy.

Radiographic featuresAntenatal ultrasound.

Absent kidneyabsent ipsilateral renal arterycompensatory hypertrophy of the contralateral (opposite) kidney

Postnatal ultrasound, CT and MRI.All imaging modalities will demonstrate the absence of a kidney, with associated hypertrophy of the single kidney. Again, care must be taken not to misinterpret cross-fused renal ectopia for renal agenesis.

CT Scan of right renal agenesis.

Right renal hypoplasia.

Horse shoe kidneys.

Horse shoe kidneys.

Ectopic thoracic Kidney and contra-lateral ureteral duplication.

Ectopic pelvic kidney.

Congenital mega ureter.

Pathogenesis: failure of fusion between secretory and excretory parts of the nephrons. due defective PKD 1 or PKD 2 genes

Complications: Secondary hypertension Chronic renal failure Hematuria

Congenital polycystic kidney disease.

Congenital polycystic kidney disease.

Persistent fetal lobulation is a normal variant seen occasionally in adult kidneys. It occurs when there is incomplete fusion of the developing renal lobules. Embryologically, the kidneys originate as distinct lobules that fuse as they develop and grow.

Congenital Double left ureter and pelvis.

Left megaureter

Renal and ureteric stones.

Stag-horn renal stones. Left renal stone.

IVP with ureteric stones.

right renal stone. Left renal stone.

Left renal stag-horn stone.Bilateral staghorn stones.

Ureteric stricture.

MRU images.

Bilateral obstructed megaureter.

Bilateral PUJ obstruction.

ureteric stone with hydronephrosis.

Thank You.