1887

The kidneys and ureters

image of The kidneys and ureters
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Abstract

Plain radiographic evaluation of the feline and canine kidneys is limited, but renal size, shape and opacity may be adequately assessed. Surrounding retroperitoneal fat is necessary for visualization because the more radiolucent fat contrasts with the renal soft tissue silhouette and separates it from adjacent viscera. Visualization of the kidneys in a thin patient, or in patients with retroperitoneal fluid, is nearly impossible because of lack of contrast. In many patients, superimposition of intestinal gas or faecal material prevents complete evaluation of the kidneys. The chapter addresses the following: Normal radiographic anatomy; Contrast radiography; Ultrasonography; Additional imaging modalities; Renal disease; and Ureteral diseases.

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Figures

Image of 16.1
16.1 Left lateral view of the canine abdomen. The right kidney (RK) is located slightly cranial to the left kidney (LK) in the retroperitoneal space. The caudal pole of the right kidney is superimposed on the cranial pole of the left kidney. Hepatomegaly is present. VD view of the canine abdomen. The 13th rib crosses the cranial pole of the right kidney. The left kidney is located slightly more caudally, adjacent to L2–L4. Superimposed small opacities represent nipple shadows.
Image of 16.2
16.2 Left lateral view of the feline abdomen. The kidneys are superimposed and surrounded by retroperitoneal fat. A focal area of fat opacity is present at the superimposed renal hilus. VD view of the feline abdomen. The left kidney (LK) is adjacent to L3 and L4, and is well visualized. The right kidney (RK) is slightly cranial to the left kidney and is less well visualized owing to superimposed small bowel loops.
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16.3 The cranial–caudal dimension of the left kidney is compared with the cranial–caudal length of L2. This kidney measures approximately 3.5 times the length of L2.
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16.4 VD view of a normal feline abdomen taken 1 minute following intravenous contrast medium injection. A uniform nephrogram is present bilaterally. VD view of a normal canine abdomen taken immediately after intravenous contrast medium injection. There is a more pronounced opacity in the renal cortex relative to the medulla during this nephrogram phase.
Image of 16.5
16.5 VD view of a normal canine abdomen taken 10 minutes after intravenous contrast medium injection. A normal contrast medium-filled renal pelvis and diverticula are present bilaterally. Both ureters are also visualized. Gaps in the contrast medium-filled ureters are caused by ureteral peristalsis.
Image of 16.6
16.6 VD view of a normal canine abdomen taken 10 minutes after intravenous contrast medium administration. The ureters are visualized extending caudally and entering the caudodorsal aspect of the bladder. Lateral view of a normal canine abdomen taken 3 minutes after intravenous contrast medium administration. The ureters are visible coursing caudally to the minimally distended bladder.
Image of 16.7
16.7 VD view of a feline abdomen taken 1 minute after intravenous contrast medium administration. A normal nephrogram is present. A radiopaque calculus is present in the right renal pelvis. VD and lateral views taken 15 minutes later. A persistent nephrogram is present and no contrast medium is visible in the renal pelvis, ureters or bladder lumen (contrast medium is visible enhancing the bladder wall). Contrast medium-induced renal failure was diagnosed.
Image of 16.8
16.8 Fluoroscopic image of the left kidney taken immediately after ultrasound-guided contrast medium injection directly into the dilated renal pelvis. The renal pelvis and dilated diverticula are visible. Fluoroscopic image of the left kidney taken 1 minute after injection of contrast medium into the renal pelvis. Some positive contrast medium has leaked into the perirenal area (arrowed).
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16.9 Greyscale and contrast ultrasonograms of the left and right kidneys with metastatic histiocytic sarcoma. (a) On the greyscale image the left kidney appeared normal but a hypoechoic nodule was seen in the caudal pole of the right kidney (arrowhead). (b) Fifteen seconds after administration of intravenous contrast medium, additional poorly perfused wedge-shaped lesions were seen in the left kidney (white arrows) and discrete nodule-shaped lesions were seen in the right (black arrowhead) and left (black arrowhead and black arrow) kidneys. The lesion in the right kidney corresponded to the lesion seen on the greyscale image. (c) Thirty seconds after contrast administration the same lesions were still seen in the left kidney and an additional lesion was seen in the right kidney (arrowhead).
Image of 16.10
16.10 Longitudinal ultrasonogram of the right kidney taken at the renal hilus. The renal sinus is a bright, echogenic structure at the centre of the kidney. Cranial is to the left and ventral is at the top of the image. Longitudinal ultrasonogram of the right kidney taken lateral to the renal hilus. The hypoechoic medullary portions of the kidney are more prominent and are separated by echogenic diverticula and interlobar vessels. Cranial is to the left and ventral is at the top of the image. Transverse ultrasonogram of the right kidney taken at the level of the renal hilus. Ventral is at the top of the image and right is on the left side. Longitudinal ultrasonogram of the spleen and left kidney. The spleen is hyperechoic compared with the renal cortex. C = Cortex; M = Medulla; S = Renal sinus.
Image of 16.11
16.11 Longitudinal ultrasonogram of the left kidney. The renal pelvis (P) is visualized as a thin anechoic slit at the renal hilus. Cranial is to the left and ventral is at the top of the image.
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16.12 Pre-contrast and post-contrast transverse CT scans of a normal dog showing the left renal pelvis. Post-contrast dorsal planar reconstruction CT image of a normal dog showing the left and right kidneys and ureters.
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16.13 Lateral and VD views of a 10-year-old Domestic Shorthaired cat with renal lymphosarcoma. Both kidneys are symmetrically enlarged. There is ventral displacement of the abdominal viscera by the enlarged kidneys on the lateral view. Lateral and VD views of a 3-year-old Domestic Shorthaired cat with left-sided hydronephrosis. The left kidney is markedly enlarged, resulting in right-sided and ventral visceral displacement.
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16.14 VD view of the cat in Figure 16.13cd taken 10 minutes after intravenous contrast medium administration. The hydronephrotic left kidney is non-functional and no pyelogram is present. No nephrogram was seen earlier in the study.
Image of 16.15
16.15 VD view of a 7-year-old Persian cat with polycystic kidney disease, taken 5 minutes after intravenous contrast medium administration. There are multiple poorly defined radiolucent filling defects within the renal silhouette where the renal cysts are located. VD view of an 8-year-old mixed breed dog taken 2 minutes after intravenous contrast medium administration. A large non-opacified defect is present in the caudal pole of the left kidney. A large renal cortical cyst was diagnosed on ultrasound examination.
Image of 16.16
16.16 Longitudinal ultrasonogram of the right kidney in a dog with glomerulonephritis. The renal cortex is hyperechoic to the liver (L) and there is marked corticomedullary distinction. Cranial is to the left and ventral is at the top of the image.
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16.17 Longitudinal ultrasonogram of the left kidney in a normal dog. A hyperechoic rim (medullary rim sign) is present at the corticomedullary junction (arrowed).
Image of 16.18
16.18 Longitudinal ultrasonogram of the left kidney in a 6-year-old Domestic Shorthaired cat with renal lymphosarcoma. The kidney is enlarged, irregular and has a hyperechoic cortex. A hypoechoic rim is present surrounding the renal cortex (arrowed). Cranial is to the left and ventral is at the top of the image.
Image of 16.19
16.19 Longitudinal ultrasonogram of the right kidney in a 5-year-old Persian cat with polycystic kidney disease. Multiple anechoic cysts are present. Cranial is to the left and ventral is at the top of the image. L = Liver.
Image of 16.20
16.20 Longitudinal ultrasonogram of the left kidney in an 8-year-old Shetland Sheepdog. There is an irregular cystic mass in the caudal pole, containing some echogenic debris. A fine-needle aspirate of the mass revealed an abscess. Cranial is to the left and ventral is at the top of the image.
Image of 16.21
16.21 VD views of the abdomen in a 12-year-old Golden Retriever taken before and 20 minutes after intravenous contrast medium administration. The survey film shows an irregular, enlarged left kidney with a mass effect on the cranial pole. The pyelogram demonstrates distortion of the renal pelvis and the cranial pole mass. Longitudinal ultrasonogram of the left kidney. A non-homogenous echogenic mass is present in the cranial pole (arrowed). The caudal pole is normal. Cranial is to the left and ventral is at the top of the image.
Image of 16.22
16.22 Longitudinal ultrasonogram of the left kidney in a 12-year-old Schnauzer with renal carcinoma. The renal architecture is unrecognizable owing to replacement by neoplastic tissue. Cranial is to the left and ventral is at the top of the image. Longitudinal ultrasonogram of the left kidney in a 10-year-old mixed breed dog with primary pulmonary carcinoma. A focal hypoechoic mass (between calipers) is present in the cranial pole. Metastatic carcinoma was diagnosed on fine-needle aspiration. Cranial is to the left and ventral is at the top of the image. S = Spleen.
Image of 16.23
16.23 VD view of a 10-year-old Domestic Shorthaired cat with chronic renal failure. The kidneys are small, measuring approximately the same as the length of the vertebral body of L2. LK = Left kidney; RK = Right kidney. Longitudinal ultrasonogram of the right kidney of a 9-month-old Golden Retriever with congenital renal dysplasia. The kidney is small (approximately 2.5 cm) and hyperechoic, with poor renal architecture. Cranial is to the left and ventral is at the top of the image.
Image of 16.24
16.24 VD view of a dog taken 20 minutes following intravenous contrast medium administration. The left renal pelvis is slightly dilated, the diverticula are poorly defined and blunted, and the proximal ureter is dilated. These findings are all consistent with pyelonephritis. The right kidney is normal. VD view of a dog taken 20 minutes following intravenous contrast medium administration. Both renal pelves are slightly dilated with indistinct diverticula. These changes are consistent with bilateral pyelonephritis.
Image of 16.25
16.25 Longitudinal ultrasonogram of the left kidney of an 8-year-old Dobermann. The renal pelvis and proximal ureter are slightly dilated (arrowed), consistent with pyelonephritis. Cranial is to the left and ventral is at the top of the image.
Image of 16.26
16.26 Longitudinal ultrasonogram of the left kidney in a cat with moderate hydronephrosis. The renal pelvis is dilated and anechoic (arrowed). Cranial is to the left and ventral is at the top of the image. Transverse ultrasonogram of the left kidney in the cat in (a). The renal pelvis (arrowed) is dilated and anechoic. Right is to the left and ventral is at the top of the image. Longitudinal ultrasonogram of the right kidney in a dog with severe hydronephrosis. The renal pelvis is completely dilated with echogenic fluid, with minimal renal parenchyma remaining. Cranial is to the left and ventral is at the top of the image.
Image of 16.27
16.27 VD and lateral abdominal radiographs of a 7-year-old Schnauzer. Radiopaque calculi are visible in both renal pelves, extending into the proximal ureters. Multiple small radiopaque calculi are also present in the urinary bladder.
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16.28 Longitudinal ultrasonogram of the left kidney in a dog with renal calculi. A curvilinear echogenic interface with distal shadowing is present.
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16.29 Lateral radiograph of the skull. The bone density in the skull is poor, with only the teeth showing any bone opacity. This dog had renal secondary hyperparathyroidism, which was secondary to congenital renal dysplasia.
Image of 16.30
16.30 Lateral, VD and VD oblique views of a cat with renal pelvic and ureteral calculi. Multiple radiopaque calculi are visible in the left renal pelvis, as well as the more peripheral diverticula. Multiple left-sided ureteral calculi are seen best on the VD oblique view (arrowed). VD and lateral views of a cat with ureteral and renal pelvic calculi. A left renal pelvic calculus (small arrow) and two right ureteral calculi are visible (large arrows). A more ventral radiopacity on the lateral view is likely to represent mineralized material in the colon.
Image of 16.31
16.31 Lateral abdominal radiograph of a dog with an enlarged, irregular left kidney secondary to a large renal cyst (large arrow). The deep circumflex iliac artery is visible as a radiopaque end-on vessel immediately ventral to L6 (small arrow). This should not be mistaken for a ureteral calculus.
Image of 16.32
16.32 Lateral and VD abdominal radiographs of the cat in Figure 16.30de , taken 20 minutes after intravenous contrast medium administration. The right renal pelvis and diverticula are dilated secondary to partial obstruction by ureteral calculi.
Image of 16.33
16.33 Lateral and VD abdominal radiographs of a 5-month-old bitch taken 10 minutes after intravenous contrast medium administration. The left ureter is dilated and tortuous and extends beyond the bladder trigone, entering in the area of the urethra (arrowed).
Image of 16.34
16.34 Lateral and VD oblique abdominal radiographs of a 6-month-old bitch with incontinence. These radiographs were taken 10 minutes following intravenous contrast medium injection. The right renal pelvis is dilated and the right ureter is dilated and tortuous. It appears to terminate in a contrast mediumfilled sac located at the bladder neck (arrowed). A ureterocele was diagnosed at surgery.
Image of 16.35
16.35 Lateral abdominal radiograph of a cat taken 10 minutes after intravenous contrast medium injection. The left ureter is slightly dilated and very tortuous, terminating in a pool of free contrast medium. The ureter was ruptured at the level of the bladder trigone.
Image of 16.36
16.36 Transverse ultrasonogram of the kidney and proximal ureter of a cat with ureteral calculi. The renal pelvis and ureter are dilated. Right is to the left and ventral is at the top of the image. Longitudinal ultrasonogram of the distal portion of the same ureter. An echogenic calculus (between calipers) is present within the fluid-filled ureter, resulting in ureteral obstruction. Cranial is to the left and ventral is at the top of the image.
Image of 16.37
16.37 Longitudinal ultrasonogram of the urinary bladder of a healthy dog. The ureteral papilla is seen as a small echogenic protrusion into the bladder lumen (arrowed).

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