Renal Volume Loss Renal Atrophy

Kidney Chronic Atrophy Exam

Fig. 10.13a The right kidney is deformed by the tumor and shifted anteriorly. The renal perfusion is reduced (compare the density of the left kidney). The renal pelvis is markedly dilated secondarily to ureteric obstruction. b In a different patient both kidneys are affected by Wilms tumors (arrows).

Checklist:

Renal Volume Loss

Is there focal or generalized loss of renal tissue?

Is it unilateral or bilateral?

Is there any preexisting renal failure?

Is there known arteriosclerosis?

Is there any past or present renal disease?

A Close Shave

Jaqueline Tebbits (75) only recently moved from the south of the country to the city to be near her children. She regularly attends the oncology clinic for follow-up after excision of a breast cancer two years ago. When looking at the films of the abdominal CT that was requested, Paul noticed an abnormality of the right kidney (Fig. 10.14).

Fig. 10.13a The right kidney is deformed by the tumor and shifted anteriorly. The renal perfusion is reduced (compare the density of the left kidney). The renal pelvis is markedly dilated secondarily to ureteric obstruction. b In a different patient both kidneys are affected by Wilms tumors (arrows).

^ Diagnosis: Because of the abnormal US result, Paul was mainly thinking about a renal cell carcinoma. CT confirmed the diagnosis and showed the extent of the tumor with invasion into the inferior vena cava. This is a typical feature in advanced renal cell carcinoma. If Mr. Drip were 50 years younger, Paul would also have had to consider Wilms tumor in addition to some inflammatory diseases (Fig. 10.13). Wilms tumor often occurs bilaterally and at diagnosis is often large enough to be palpated on abdominal examination. Hemorrhage and central necrosis are common. Fortunately, it is quite responsive to treatment.

CT of the kidneys consists of an unenhanced scan as well as an arterial (corticomedullary) and parenchymal (nephrographic) contrast phase. If a tumor of the collecting system is suspected, a CT scan during the excretory phase is also indicated.

• What is Your Diagnosis?

Renal infarction: Renal infarction predominantly occurs in patients with preexisting arteriosclerotic changes of the renal arteries. Most of the time it is clinically insignificant and is an incidental finding on CT (Fig. 10.15a). Infarction causes tissue loss and results in scarring. The appearance of a scar is nonspecific, however, and does not necessarily indicate the underlying disease process.

Atrophic kidney: Atrophic kidneys show generalized loss of volume (Fig.10.15b) with marked cortical thinning , the patient develops renal failure over time. Causes include glomerulonephritis, arteriosclerosis of the renal arteries, or chronic obstruction.

• Diagnosis: Paul can see only focal scarring of the renal parenchyma. His correct diagnosis is an old renal infarct, probably secondary to an embolus on the background of arteriosclerosis. Renal function may be adequate. The liver

I The Interesting Case of Jaqueline Tebbits

Fig. 10.14 This is the essential image of Mrs. Tebbits' CT. What do you notice?

Renal Diseases with Loss of Volume a Renal infarction a Renal infarction

Normal And Atrophic Kidney Pictures
Fig. 10.15a The anterior part of the parenchyma (arrow) of the left kidney is atrophic and barely accumulates contrast. There has been an infarct in the past. Compare with the normal features of the right kidney. Do you notice anything else?

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Left Kidney Atrophic

b The left kidney is significantly smaller than the right and also takes up less contrast. This is what an atrophic kidney looks like. The origin of the left renal artery (arrow) is clearly visible and shows marked plaque formation. This suggests that renal atrophy is secondary to renal artery stenosis in this case. Additionally we see a renal cyst on the right.

b The left kidney is significantly smaller than the right and also takes up less contrast. This is what an atrophic kidney looks like. The origin of the left renal artery (arrow) is clearly visible and shows marked plaque formation. This suggests that renal atrophy is secondary to renal artery stenosis in this case. Additionally we see a renal cyst on the right.

looks OK, too, and so Mrs. Tebbits can join her friends at the cafe, much to her relief.

I The Case of Lydia Peacock

If there is bilateral renal atrophy, the patient is either on dialysis or has a transplanted kidney. You might want to take a peek at the left or right iliac fossa.

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Responses

  • TUULI
    What is bilateral renal cortical atrophy?
    5 years ago
  • Mikko
    What is causing atrophic kidney?
    2 years ago

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