Renal

Learning Objectives:

  1. Describe the indications and limitations of US of the kidneys and bladder

  2. Perform US to evaluate the urinary tract

  3. Identify relevant US anatomy including the renal cortex, renal pelvis, ureter, bladder, liver, spleen, and uterus or prostate

  4. Recognize the relevant findings and pitfalls when evaluating for hydronephrosis, renal calculi, renal masses, bladder volume, pregnancy, and Foley catheter evaluation

Indications:

  • Flank pain

  • Back pain

  • Abdominal pain

  • Hematuria

  • Acute Urinary Retention 

  • Acute Renal Failure/Acute Kidney Injury

Extended Indications:

  • Infection/abscess of the kidney

  • Gross bladder/prostate abnormalities

  • Foley cather placement/confirmation/evaluation

Required Views:

R/L kidney In transverse

R/L kidney In sagittal

Bladder in transverse

Bladder in sagittal

 

How to Scan:

ACEP Sonoguide: Renal Ultrasound

Core Ultrasound: Genitourinary

POCUS 101: Renal Ultrasound Made Easy

Tips/Tricks/Pitfalls:

  • Hydronephrosis is commonly seen in the 3rd trimester of pregnancy

  • Hydronephrosis can be masked by dehydration - a fluid bolus can make assessment easier

  • Mimics of hydronephrosis - vasculature and prominent medullary pyramids 

    • Use color doppler to distinguish vasculature from hydronephrosis

  • Use color doppler over the ureteral jets to check for obstruction 

  • Consider scanning the aorta in older patients with flank pain

Pathology:

Hydronephrosis

Twinkling Artifact

Cyst

Renal Mass