초음파 자격증 ARDMS ABDOMEN KIDNEY1편

the urinary tract[비뇨기계]

신장의 해부학

 

the most common location of an ectopic kidney is within the pelvis

 

the functional unit of the kidney is the nephron.

 

adult kidneys are bean-shaped organs that are retroperitoneal in location.

the kidneys are made up of two parts; the renal parenchyma and the renal sinus.

the parenchyma of the kidney consists of the renal medulla and renal cortex. the renal medulla, the inner part of the parenchyma, is responsible for absorption. it includes the renal pyramids.

 

출처 : 의학백과사전 서울대학교병원

 

 

the renal sinus contains the renal collecting system that is composed of the minor calices, major calices, renal pelvis.

 

 

신장 관련 혈관

the renal arteries are branches of the abdominal aorta that are located just below the level of the superior mesenteric artery.

the right renal artery travels posterior to the IVC, and is therefore longer than the left renal artery.

the left renal vein has to travel across the abdomen between the superior mesenteric artery and abdominal aorta, and is therefore longer than the right renal vein.

 

신장 초음파

the most common congenital anomaly of the urinary tract is the duplex or duplicated collecting system.

 

정상 변이 및 위치 설명
정상변이	설명
compensatory hypertrophy	enlargement of the unaffected contralateral kidney with unilateral renal agenesis or compromised renal function
dromedary hump	bulge in the lateral border of the kidney(often on the left kidney)
	will have the same echogenicity as the adjacent renal cortex
duplex(duplicated) collecting system (the most common congenital anolmaly of the urinary tract)	division of the renal sinus. in this variant, there are two separate renal sinuses; they are referred to as an upper pole moiety and lovwer pole moiety
	obstruction to one or both of these collecting systems can occur
	two ureters drain separate portions of the kidney
	kidney with duplex collecting system will typically measure longer tan a normal size kidney
ectopic kidney	pelvic kidney : one or both kidneys may be located within the pelvis; the pelvis is the most common location of an ectopic kidney
	crossed fused ectopia : both kidneys are fused and on the same side of the body
	thoracic kidney : kidney sits partially or completely in the chest
extrarenal pelvis	the renal pelvis is located outside of the renal hlium
horseshoe kidneys	two kidney that cross the midline and connect at their lower poles by an isthmus
	the isthmus of the horseshoe kidneys travels anterior to the abdominal aorta and IVC
hypertrophic column of bertin	enlargement of a renal column seen as an indentation of the renal sinus
	actually are double layers of renal cortex
malrotated kidney	the kidney sits in the renal fossa but is positioned off of the normal axis
renal agenesis	congenital absence of the kidney
	bilateral renal agenesis is typically not consistent with life
renal hypoplasia	the underdevelopment of the kidney in which there are too few nephrons
	kidney will be smaller than normal

 

신장 병리학

■ renal failure ■[신부전]

 

1. acute renal failure

the most common cause of ARF is acute tubular necrosis

henoch-schonlein purpura is an autoimmune, inflammatory vascular disease that mostly affects children and can permanently damage the kidneys. clinical findings of ARF include elevated BUN elevated creatinie, oliguria(핍뇨), hypertention, leukocytosis, hematuria, edema, and hypovolemia

 

2. chronic renal failure

the most common cause of CRF is diabetes mellitus

sonographically, the kidneys will have cortical thinning, appear small and echogenic and may contain cyst.

 

 

3. renal failure and dialysis

dialysis may be either in the form of hemodialysis, hemofiltration or peritoneal dialysis.

 

 

■ renal cystic disease ■

1. simple renal cyst

a simple renal cyst should appear sonographically as an anechoic mass that is spherical, has smooth walls, posterior acoustic enhancement, and no internal echoes.

 

simple cyst 의 특징

1. anechoic mass

2. smooth walls(including a well definded posterior wall)

3. posterior acoustic enhancement 4. no internal echoes

 

2. autosomal dominant polycystic kidney disease(ADPKD)

ADPKD is a hereditary disorder that may also be referred to as adult polycystic kidney disease.

cysts may also be found in other organ. including the pancreas liver, and spleen

 

임상적 특징

1. asymptomatic until third or fourth decade of life

2. decreased renal function 3. urinary tract infections

4. renal calculi 5. flank pain 6. hematuria(혈뇨)

7. palpable abdominal mass

 

 

3. autosomal recessive polycystic kidney disease(ARPKD)

ARPKD is a hereditary disorder that may also be referred to as autosomal recessive polycystic renal disease or infantile polycystic kidney disease. ARPKD is characterized by dilation of the renal collecting tubules. this disorder is often recognized in the fetus and can be confirmed with a postnatal sonographic examination.

 

임상적 특징

1. clinical findings of renal failure

2. abnormal liver function tests because of hepatic disease

 

 

4. multicystic dysplastic kidney disease(MCDK)

MCDK is thought to be caused by an early, first-trimester obstruction of the ureter.

간 기능 검사가 정상적이고, 무증상이다.

 

임상적 특징

1. asymptomatic 2. normal renal function

 

초음파적 특징

1. unilateral, smooth-walled, noncommunicating cysts of varying sizes located within the renal fossa

2. compensatory hypertrophy of the contralateral kidney

 

5. von hippel-lindau syndrome

von hippel-lindau syndrome is an inherited disorder characterized by tumors of the central nervous system and orbits. patients with this syndrom also have the propensity to develop cysts within the kidneys, RCC, and pheochromocytomas(크롬친화성세포)

 

 

6. tuberous sclerosis

tuberous sclerosis is a systemic disorder that leads to the development of tumors within various organs. it is also seen in association with renal cystic disease and the accumulation of angiomyolipomas in the kidneys.

 

tuberous sclerosis is associated with multiple, bilateral renal angiomyolipomas.

 

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