Abstract
The kidneys are highly vascularized organs. Each kidney receives the highest blood flow per gram of organ weight in the body (1.2 L/min corresponding to 20 % of the cardiac output and a perfusion value of 400 mL/min/100 g). The most employed indicator of the renal function is the glomerular filtration rate (GFR), which can be estimated according to different formulas. The calculation of the GFR is essential for a correct employment of iodinated and gadolinium-based contrast agents. The most widely used equations for estimating GFR are the Cockcroft–Gault and the Modification of Diet in Renal Disease Study Group (MDRD) formulas.
The modern radiological imaging techniques allow a detailed depiction of the renal anatomy and of the anatomical variants. Ultrasound, computed tomography, and magnetic resonance imaging define accurately the anatomy and anatomical variants of the renal parenchyma, arteries, and intrarenal urinary tract.
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Appendix: Basic Morphological Changes of the Intrarenal Urinary Tract Visible on Intravenous Excretory Urography and Multidetector CT Urography
Appendix: Basic Morphological Changes of the Intrarenal Urinary Tract Visible on Intravenous Excretory Urography and Multidetector CT Urography
The anatomical variants of the normal renal urinary tract (see Fig. 58) must be differentiated from the pathologic morphological changes visible on renal calyces, infundibula, and renal pelvis on intravenous excretory urography, multidetector computed tomography urography (CTU), or MR urography due to specific renal pathologies.
(a–c) Normal intrarenal urinary tract. (a) Scheme with the evidence of the ideal line (Hodson’s line) connecting the apex of the renal papillae; (b) intravenous excretory urography; (c) multidetector computed tomography urography (CTU)
Essentially, two fundamental pathologic morphological changes of the renal calices may be identified by intravenous excretory urography or multidetector CTU corresponding to plus (contrast agent projecting outside the renal calyx profile) and minus (contrast filling defects within the renal calyx or pelvis profile) images. To identify the fundamental alterations of the renal urinary tract, and particularly of the renal calyces, it is useful to consider an ideal interpapillary line connecting the apex of the renal papillae (Hodson’s line). Plus images include calyceal deformities and cavitations (Fig. 59), calyceal deformities due to parenchymal scarring (Fig. 60), urinary tract dilatation (Fig. 61), and calyceal deformities due to papillary atrophy (Fig. 62).
(a–h) Appearances of plus images of the renal calyces manifesting as calyceal deformities or cavitations. (a) Scheme with the evidence of the ideal line connecting the apex of the renal papillae – Hodson’s line: (1) renal medullary necrosis; (2–3) renal papillary necrosis from initial detachment of necrotic papillae to the triangular filling defect due to the sloughing of the necrotic papilla; (4) calyceal deformity and clubbing due to parenchymal scarring in chronic renal infection; (5) calyceal deformity with convexity of the calyceal profile in initial renal hydronephrosis; (6) calyceal ulceration; (7) cavitation; (8) hydrocalyx. (b) Intravenous excretory urography. Calyceal diverticulum (arrow) connects to the calyceal fornix and projecting into the renal cortex. (c, d) Intravenous excretory urography (c) and CT urography (d). Renal medullary necrosis at the tip of the papilla appearing as microcavities (arrows) surrounded by the papilla fornices. (e, f) Intravenous excretory urography (e) and CT urography (f). Renal papillary necrosis (arrow) with blunted calyx and preservation of the renal profile. On image (f) there is also evidence of hypodense blood coagula at the level of the pyeloureteral junction. (g) Intravenous excretory urography. Ulcerations (arrows) of the upper renal calyces due to renal tuberculosis. (h) Intravenous excretory urography. Hydrocalycosis (arrow) due to tubercular infundibular stenosis
(a–d) Appearances of plus images manifesting as pelvis, or calyceal deformities. (a) Scheme with the evidence of the ideal line representing the normal renal profile. Calyceal deformities due to reflux nephropathy with cortical loss over dilated deformed calyx with a calviform shape. (b, c) Intravenous excretory urography. Reflux nephropathy with typical calyceal deformities (arrowheads) and alteration of the renal profile. (d) CT urography. Reflux nephropathy with clubbing deformation of the renal calyces and parenchymal scarring with alteration of the renal profile (large arrow). A solid renal tumor (small arrow) is also identified on the lower renal pole
(a–e) Appearances of plus images due to dilatation of the urinary tract. (a) Scheme with the evidence of the ideal line connecting the external renal calyx profiles: (1) normal calyx; (2–3) reflux nephropathy; (4–5) hydronephrosis; (6–7) sponge kidney with linear striations (6) and small round contrast collections (7). (b) Intravenous excretory urography. Hydronephrosis of the left urinary tract. (c) CTU. Hydronephrosis of the right urinary tract. (d) Intravenous excretory urography. Medullary sponge kidney with the evidence of linear striations and small round contrast collections (arrows). (e) CT urography. Medullary sponge kidney. Linear striations at the level of renal papillae (arrows)
(a, b) Appearances of plus images manifesting as calyceal deformities due to papillary atrophy. (a) Scheme with the evidence of the ideal line representing the normal renal parenchyma profile; (b) intravenous excretory urography. Papillary atrophy with the absence of the normal concave calyceal profile and the evidence of convex calyceal profile (arrow) due to benign prostatic hypertrophy
Minus images include calyceal defects or amputations (Fig. 63), changes of the infundibulum or calyceal profile (Fig. 64), or renal pelvis or calyceal displacement (Fig. 65).
(a–e) Appearances of minus images corresponding to renal pelvis or calyceal defects or amputations. (a) Scheme with the evidence of the ideal line connecting the external renal calyx profiles: (1) vascular notching; (2) filling defect due to a tumor, stone, or clot; (3) calyceal erosion due to tumor; (4) normal calyx; (5) calyceal deformity due to tumor; (6) calyceal amputation due to tumor; (7) calyceal amputation due to tuberculosis; (b) intravenous excretory urography. Notching at the level of the left pyeloureteral junction (arrow) due to a peripheral vessel. Vascular notches may determine minus images also at the level of renal calyces. (c, d) Filling defects (arrows) of the renal pelvis or renal calyces due to urothelial carcinoma. (e) Multidetector CTU. Coronal reformation. Filling defect on the renal pelvis with infundibula amputation due to renal lymphoma (arrow). (f) intravenous excretory urography–nephrotomography. Upper calyceal amputation (arrow) due to renal fibrosclerosing tuberculosis
(a, b) Appearances of minus images corresponding to changes of the infundibulum or calyceal profile. (a) Scheme with evidence of the ideal line connecting the external renal calyx profiles; (b, c) intravenous excretory urography. Urography–nephrotomography (b) and intravenous urography (c). Narrowing of the renal calyces (arrow in b, and arrows in d) due to renal sinus lipomatosis. (d) CT urography. Narrowing of the renal upper calyx (arrow) due to renal sinus lipomatosis in a 65-year-old man. Renal sinus lipomatosis may determine also minus images with the alteration of the calyx morphology with the elongation of the infundibulum profile. (e) CT urography. Narrowing of the renal upper and middle calyces and of the pyeloureteral junction (arrow) due to parapyelic cysts
(a) Appearances of minus images corresponding to renal pelvis or calyceal displacement due to renal cyst or solid mass of different size and location determining renal pelvis or calyceal displacement (numbered from 1 to 4). (a) Scheme with the evidence of the ideal line connecting the external renal calyx profiles; (b) intravenous excretory urography. Calyceal displacement (arrow) due to renal cysts; (c) intravenous excretory urography. Calyceal displacement (arrowheads) due to a solid renal mass; (d, e) multidetector CTU. Calyceal displacement (arrow) due to renal cysts
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Quaia, E., Martingano, P., Cavallaro, M., Premm, M., Angileri, R. (2014). Normal Radiological Anatomy and Anatomical Variants of the Kidney. In: Quaia, E. (eds) Radiological Imaging of the Kidney. Medical Radiology(). Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-54047-9_2
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