It is noted quite often, especially in at a young age, women are twice as likely to suffer. Usually occurs without a previous disease of the upper or lower urinary tract, and occurs in two variants - focal and diffuse.
Focal pyelonephritis is characterized by local echohomogeneous or anechoic expansion of the parenchyma zone, which sometimes leads to protrusion of the contours of the kidney. Recovery usually takes place without any traces. For echography, this form of pyelonephritis presents a certain diagnostic difficulty in differentiating from a number of pathological conditions, such as a fresh hematoma, a fresh cavity, an acute abscess, an acute carbuncle, and other formations that have acute stage similar echographic picture. The correct interpretation of the echographic picture depends on whether the echographer has a rich clinical experience. It should be noted that diagnosis of the focal form of acute pyelonephritis is possible only with the help of echography.
With diffuse acute pyelonephritis the kidney is enlarged due to the involvement of the parenchyma zone in the process, which is expanded and has low echogenicity. The pyelocalyceal system is differentiated, however, in cases of significant swelling of the parenchyma due to the erasure of the border between the zones, the pyelocalyceal system is poorly differentiated or does not differentiate at all, and then the kidney loses its echographic specificity of structure and is located as an oval-elongated structureless tumor-like formation. At the initial stage of the disease, the contours of the kidneys are clear, their clarity is expressed due to the low, almost anechoic, edematous parenchyma, and become blurred when the perinephric fat capsule is involved in the process.
Very rarely, an emphysematous form of pyelonephritis can occur, which is caused by anaerobic bacteria (E. Coli Proteus), and is characterized by the identification of gas bubbles in the collecting-pelvic area in the form of clear round highly echogenic formations that leave an acoustic shadow.
Sonography helps determine asymmetry and calculate renal volume using the ellipsoid formula. why you need to know the maximum longitudinal and transverse dimensions, which is a valuable diagnostic criterion in the differential diagnosis of upper and lower urinary tract infections.
According to Dinkel et al. (1985), the volume of the kidney in acute pyelonephritis increases by an average of 175% compared to the original. Average kidney volume for a given body weight healthy child taken as 100%.
Asymmetry of the kidneys in acute pyelonephritis is detected in 50% of cases.
Echography allows you to effectively trace the dynamics of the active evolution of acute pyelonephritis - the development of infiltrates and the formation of small abscesses, visualized as small round formations of weak echogenicity with unclear contours and a delicate capsule, as well as involution - the process of resorption inflammatory process and restoration of the specificity of the echographic structure of the kidney.
Secondary acute pyelonephritis
The development of secondary pyelonephritis is based on obstruction of the urinary tract, most often caused by renal stone disease, anomalies in the development of the urinary tract, pregnancy, infections of the lower urinary tract, prostatitis, adenoma, tumor, etc.
Due to the fact that with secondary pyelonephritis clinical picture expressed more clearly, echographic signs also undergo changes associated with the manifestation of the causes that caused secondary pyelonephritis, that is, along with the low-echoic zone of the parenchyma, poorly contoured, enlarged, sharply painful when located with a kidney probe, there are stones, dilatation of the pelvis, ureteropelvic segment, calyces (hydronephrosis and hydrocalycosis).
The water load test due to urinary tract obstruction has little effect on the change in the volume of the dilated pelvis. The kidney with secondary pyelonephritis is more often exposed to purulent complications.
Pyelonephritis in pregnant women
The development of pyelonephritis in pregnant women is based on two factors: decreased tone of the upper urinary tract due to neurohumoral changes and mechanical - pressure of the enlarged uterus on the ureters. The disease occurs only in the second half of pregnancy, affecting 93% right kidney. Detection of abnormalities in the parenchyma and pelvicalyceal system of the kidneys in the first half of primiparas is signs of previous primary pyelonephritis, and detection in multiparas is traces of previous pyelonephritis of a previous pregnancy or a combination of both.
According to a number of authors, this disease affects from 2.5 to 5% of pregnant women. In our observations, signs of pyelonephritis in pregnant women were identified in 87% of subjects. It should be noted that pyelonephritis in pregnant women can occur in two forms: acute and latent.
Acute form with clinical and laboratory manifestations
The echographic signs are the same as for primary pyelonephritis: the kidney area is painful when pressed with a probe, the size may be normal or slightly enlarged, the contours are blurred, the parenchyma zone is somewhat expanded, of low echogenicity (hydrophilic), although it may have different echogenicity. Sometimes the perinephric region is also involved in the process - the zone expands and becomes low echogenicity, and rarely foci of necrosis may appear.
Changes in the pyelocaliceal system occur gradually; At first, the pelvis expands somewhat, the process can progress and lead to the formation varying degrees hydronephrosis with subsequent expansion of the calyces and the formation of hydrocalycosis. It should be noted that these symptoms may persist long time and after childbirth. After a few months, a slight dilation of the pelvis is detected, which can remain for life. Due to prolonged stagnation of urine, it is almost always possible to identify signs of uric acid diathesis (accumulation of salts, small and large stones).
Latent form
It is not clinically manifested, only some laboratory abnormalities may be present (if urine collection for analysis is carried out using a catheter).
Echographically, the kidney is of normal size, the contours are smooth, the parenchyma zone rarely expands, but is of low echogenicity, changes in the collecting system are insignificant, hydronephrosis and hydrocalycosis sometimes develop, usually not higher than 1-2 degrees.
Apostematous pyelonephritis
Apostematous pyelonephritis is characterized by pustular lesions of the renal cortex, with the pustules located directly under the capsule. It can occur as a complication or be a stage of acute secondary pyelonephritis.
On the echogram, the kidney is unevenly enlarged due to the parenchyma zone, and if there are many pustules on the surface of the kidney, then its contours may be uneven and intermittent. If the pustules are very small, then it is impossible to differentiate them, and the echogenicity of the parenchyma zone is unevenly low. With larger sizes, they are located as small rounded formations of weak echogenicity with unclear contours and a delicate echogenic capsule. The process may stop at this stage, or the pustules, merging, form larger abscesses.
Ultrasonography pyelonephritis is not so clear, and doctors rely on laboratory research biomaterial.
How to do an ultrasound of the kidneys
Kidney ultrasound requires preparation. A few days before the test, doctors will advise you to take anti-flatulence medications and follow a diet. Immediately before the test, an hour before the procedure, the patient drinks a liter of water.
When conducting ultrasound diagnostics The patient is placed on his side or stomach. The surface of the body in the projection to the kidneys is thickly lubricated with a special gel.
Ultrasonic waves are transmitted through the surface of the body and reflected from obstacles of varying densities.
Decoding is done based on the picture, the organ is visible on the monitor screen. Echogenicity is distinguished by shades of gray, by which the doctor judges the normality or pathology of the organ structure.
It is possible to make a diagnosis immediately during the examination; the patient receives a conclusion about the condition of the organ on the same day.
Such a study receives mobile data on the patient’s health status and begins therapeutic measures as soon as possible.
Diagnosis of acute pyelonephritis
Acute inflammation of the renal pelvis is focal or diffuse. In the focal type, inflammation has clear boundaries within which the pathological process occurs.
The diffuse type of disease is diffuse in nature, and pathology will not show clear boundaries.
The acute form of the disease is characterized by the fact that the kidney affected by the pathology becomes less mobile when inhaling.
Doctors ask the patient to take a deep breath, as a result of which the organ moves slightly, whereas normally the mobility is pronounced.
Also, a focal lesion provokes an increase in echo density in a certain area, this is the focus of infiltration. At the same time, the kidney retains normal sizes.
With the diffuse type, the picture is different. The kidney is larger than it should be. The echo density of the organ with pyelonephritis is reduced, and diffuse signs of damage can be clearly identified on the device’s monitor. With an extensive pathological process, the organ loses the distinctness of its layers.
Echo signs of pustular pyelonephritis
If acute pyelonephritis can still be seen using ultrasound, then pustular damage to the organ, or, is difficult to diagnose.
Using ultrasound diagnostics, signs of advanced chronic pyelonephritis, in which nephrosclerosis has already developed.
On ultrasound it will look like thinned parenchyma, the echo density is increased. The contours acquire lumpy outlines, and the kidneys themselves decrease in size compared to the norm.
There is an expansion of the renal pelvis. In some cases, nodular tumor formations are visible, the boundaries of which extend beyond the kidney area - doctors suspect kidney tuberculosis or the presence of helminthic infestations.
Conclusion
Identifying complications
A complication of the disease is glomerulonephritis. This process takes place in two kidneys. In this case, an ultrasound examination shows signs of swelling of the organs, thickening of the walls of the parenchyma, and an increase in size.
At the same time, the edges are clearly visualized, smooth and even. If glomerulonephritis becomes chronic course, then patients develop renal failure.
On ultrasound, symptoms are manifested by a decrease in organ size, tuberous contours, wrinkling of organs, and thinning of the parenchyma.
In this case, the ultrasound diagnostic conclusion contains a diagnosis diffuse changes.
Ultrasound of the kidneys for pyelonephritis is not always informative, it diagnostic event helps to see other pathologies of the organ, which is important for assessment pathological process and the patient's health status.
For example, an ultrasound scan shows stones in the kidneys. This can be both a consequence of a pathological process and a cause.
Formidable pathologies such as an abscess and carbuncle are also visualized. It is worth recognizing that ultrasound examination of the kidneys is extremely valuable for a patient with pyelonephritis.
Video
Ultrasound diagnostics - modern method disease detection internal organs, including kidneys. This type of research has a number of significant advantages for both the doctor and the patient. By assessing the results, the specialist will be able to correctly determine the stage and type of disease, as well as prescribe adequate treatment. The method is as safe as possible for the patient and does not require hospitalization. Ultrasound examination of the kidneys for pyelonephritis is a mandatory step in making the correct diagnosis.
Features of pyelonephritis
Pyelonephritis is the most common kidney disease. The pathology is based on the inflammatory process occurring in the upper sections urinary tract. Most common reason- penetration of pathogenic bacteria into the kidney tissue.
Pyelonephritis can occur in two various options: V acute form with pronounced symptoms and in chronic with a series of exacerbations and subsidence of the pathological process. Inflammation of the kidneys is quite often combined with their anomalies anatomical structure, occurs during pregnancy and urolithiasis.
In pyelonephritis, the focus of inflammation is in the calyces and pelvis of the kidneys
Diagnostic ultrasound: principle of the method
The human body is a collection of organs and tissues that have different densities. The kidneys contain a cortex, fluid-filled pelvises, and a large amount of blood vessels. The only way to assess the condition of all these anatomical components of an organ is to do an ultrasound.
The method is based on high-frequency mechanical waves produced by an ultrasonic sensor. They spread at different speeds in structures human body, after which they return back to the sensor. The received signals are converted to inverted visual picture on the device screen.
Ultrasound - sound vibrations with a frequency of more than 20,000 Hertz
Depending on their density (echogenicity), tissues look different during the study. The liquid is reflected on the screen in the form of dark areas, dense structures have a lighter shade. White color indicates stones located inside the urinary tract.
A separate type of ultrasound is Doppler examination of blood flow in vascular bed kidney The device's sensor sends a signal that is reflected from moving blood cells and returned back. In this case, on the device screen, the specialist sees a picture of blue and red areas. The first denotes the blood flow moving in the direction away from the sensor. In the second case, the blood in the vessels flows towards the ultrasound source.
Doppler study allows you to evaluate blood flow in the vessels
Indications for the study
For pyelonephritis, the study can be performed several times. The doctor will prescribe an ultrasound in the following cases:
Kidney ultrasound - video
Advantages and disadvantages of the method
Ultrasound diagnostics various forms pyelonephritis has many advantages:
- simple preparation for the study;
- holding in outpatient setting without hospitalization;
- absence painful sensations when performing research;
- the possibility of performing ultrasound at any age, including newborns;
Ultrasound examinations can be performed on children of any age.
- availability of kidney research for a patient in any condition, including after surgery;
- no punctures or cuts;
- informative in the diagnosis of kidney inflammation, abnormalities of their structure, urolithiasis;
- no need for pain relief;
- informative value in diagnosing complications of pyelonephritis;
- the possibility of conducting the study repeatedly during the treatment of the disease;
- absence side effects and harmful influences;
- the possibility of conducting research during pregnancy.
Ultrasound examination during pregnancy is a diagnostic method safe for mother and fetus
Ultrasound does not have any effect harmful influence on body tissue, so this research method has virtually no contraindications. However, there are a number of diagnostic features:
Preparation and conduct of the study
When examining the kidneys using ultrasound, the doctor gets a good picture even without special preparatory activities. However, for a more accurate result, a number of requirements must be met:
If simultaneous examination of organs is planned abdominal cavity and kidneys, the procedure is performed on an empty stomach.
The kidney examination is carried out in several positions: lying, on the side, standing. To improve contact of the device sensor with the skin, use special gel, which can then be removed using a regular napkin.
Ultrasound picture of various types of pyelonephritis
The image obtained using ultrasound on the device screen may differ depending on the type, stage of the disease and the presence of complications.
Acute pyelonephritis
In case of acute inflammatory process in the kidneys, the doctor, when conducting an examination, will first of all note an increase in the size of the affected organ. However, it must be remembered that normal indicators are determined using special tables based on the patient’s gender and age. In addition, in some cases, pyelonephritis occurs without changes in the size of the kidneys.
Normal kidney sizes in adults depending on height - table
| Height | Length, mm | Width, mm | Parenchyma thickness, mm | |||
| Left | Right | Left | Right | Left | Right | |
| 150 | 85 | 82 | 33 | 29 | 13 | 13 |
| 160 | 92 | 90 | 35 | 33 | 14 | 13 |
| 180 | 105 | 100 | 38 | 37 | 17 | 15 |
| 200 | 110 | 105 | 43 | 41 | 18 | 17 |
Normal kidney sizes in children depending on age - table
| Age | Right | Left | ||||
| thickness, mm | length, mm | width, mm | thickness, mm | length, mm | width, mm | |
| 1-2 months | 18,0-29,5 | 39,0-68,9 | 15,9-31,5 | 13,6-30,2 | 40,0-71,0 | 15,9-31,0 |
| 3-6 months | 19,1-30,3 | 45,6-70,0 | 18,2-31,8 | 19,0-30,6 | 47,0-72,0 | 17,2-31,0 |
| 1-3 years | 20,4-31,6 | 54,7-82,3 | 20,9-35,3 | 21,2-34,0 | 55,6-84,8 | 19,2-36,4 |
| up to 7 years | 23,7-38,5 | 66,3-95,5 | 26,2-41,0 | 21,4-42,6 | 67,0-99,4 | 23,5-40,7 |
Normal when moving from horizontal position In the vertical, the organ can move up to one and a half centimeters. The mobility of the kidney with pyelonephritis is significantly limited.
The ultrasound picture of the elements of the inflamed kidney differs from normal. Usually, in the cortical layer, the pyramids that turn into cups stand out in a darker color. An acute inflammatory process erases these differences. As you recover, they reappear.
In acute pyelonephritis, there is no discernible difference between the cortex and pyramids
When examining the renal vessels using the Doppler method, the absence of blue or red color in the peripheral areas of the cortical layer is noted. Such changes indicate a pronounced decrease in blood flow in the kidney against the background of an acute inflammatory process.
The blood supply to the kidney with pyelonephritis is significantly impaired
Local inflammation in the kidney
Apostematous (pustular) nephritis looks very peculiar on ultrasound examination. The size of the kidneys in this disease may be increased or normal. In the cortex of the organ there are multiple dark areas in which an inflammatory purulent process occurs. Pyramids in apostematous nephritis are not clearly defined. The contour of the kidney is blurred, tuberosity is noted.
With apostematous nephritis, ultrasound reveals many dark areas - abscesses
Kidney carbuncle is another type of acute pyelonephritis, which is characterized by a special ultrasound picture. In the cortex there is an area of increased density of a lighter shade - a carbuncle. As it develops, it acquires more dark color compared to surrounding tissues. When examining the area of the carbuncle using the Doppler method, it is found complete absence blood flow in this area.
A kidney carbuncle appears as a dark area on an ultrasound image.
Chronic pyelonephritis
Chronic inflammation leads to many significant changes. With this type of pyelonephritis, the size of the organ tends to decrease, and gradual shrinkage of the kidney occurs (nephrosclerosis). This situation is characterized by expansion of the pelvis. The thickness of the renal cortex decreases. The extreme degree of expansion of the pelvis, in which the latter has gigantic size, is called hydronephrosis.
Hydronephrosis - extreme degree of dilation of the renal pelvis
The kidney pyramids also change against the background of long-term inflammation. Their echogenicity gradually increases, and therefore they acquire a lighter shade on the device screen. A peculiar white rim appears around the pyramids - calcium deposition (nephrocalcinosis).
Doppler examination reveals a marked decrease in blood flow in the affected organ. This process especially concerns the renal cortex.
Abnormalities of the kidney structure
Quite often, pyelonephritis occurs against the background of congenital anatomical abnormalities of the kidney structure. Ultrasound diagnostics will provide information about the presence of predisposing factors for the development of the disease.
Quite often there is a situation where there are two kidneys in the body, but their placement differs significantly from the norm. An organ that is usually located in the lumbar region can be localized by a specialist at a much lower level - in the area sacral region spine.
Pyelonephritis can occur against the background of kidney duplication. In this case, the specialist sees a picture of the presence of two pyelocaliceal systems, supplied with blood by independent vessels. One of the types of structural anomalies is a horseshoe kidney. Such an organ is more susceptible to pyelonephritis, hydronephrosis and urolithiasis.
Horseshoe kidney - congenital anomaly, which consists in the fusion of the lower or upper poles of both kidneys with each other to form an isthmus
Cysts in the kidneys are another common anomaly in the structure of the organ, implying the appearance of cavities containing fluid in it. The ultrasound picture in this case is characterized by the presence of dark areas against the background of a lighter cortical substance. Such formations can fill the entire kidney. This disease is hereditary and is called polycystic disease.
Cysts in the kidneys appear as dark areas on an ultrasound image.
Pyelonephritis with urolithiasis
Kidney stones (calculi) are a frequent companion to the inflammatory process. They have a high density, so they look like light-colored areas on the ultrasound machine screen. A specialist may detect one or more stones in the kidney. In rare cases, the calculus occupies the entire pelvis and is called coral-shaped. Using a modern ultrasound machine, a specialist can identify stones larger than three millimeters in size.
Coral stone occupies the entire space renal pelvis
) is diagnosed both by instrumental methods and with the help of tests. One of the most common and painless instrumental methods Ultrasound examination is used to determine kidney pathology.
Why is an ultrasound performed?
The method of diagnosing pyelonephritis using ultrasound is widespread due to the advantages:
- painlessness and absence of contraindications;
- gives a complete picture of clinical manifestations;
- the ability to evaluate the results of therapy;
Due to the absence of radiation exposure, ultrasound is recommended for pregnant women and children. Diagnostics to identify early stage kidney pathologies, is carried out for patients at risk: patients with arterial hypertension and diabetes mellitus.
Kidney ultrasound is a widely used method for diagnosing pyelonephritis.
The method is not always informative. If there is uncertainty or suspicion of tumor formations, carry out computed tomography or MRI. CT and MRI have the ability to reveal finer details.
The ultrasound method eliminates the disadvantages of being cheap and lacking radiation exposure.
When is an ultrasound performed?
Ultrasound examination kidneys with suspected pyelonephritis are prescribed in the presence of clinical manifestations:
- pain in the lumbar region and back;
- disturbance of urinary rhythm ( frequent urge at night, with pronounced pain during urine output);
- the temperature is elevated and does not return to normal for a long time, for no apparent reason;
- blood test shows destructive changes in its composition: general reveals leukocytosis, anemia, increased erythrocyte sedimentation rate (ESR); reveals an increase from the norm in potassium, serum, urea, .
- urine analysis reveals pathological changes in the composition: an increase in leukocytes, protein, bacteria, phosphate and urate salts are present.
- decreases specific gravity urine.
If you experience pain in the kidney area, an ultrasound scan should be performed.
When performing an ultrasound experienced doctor The nephrologist will identify it immediately and then prescribe appropriate treatment.
What does pyelonephritis look like on ultrasound?
There are a number of parameters that are used to determine infection in the collecting system. Changes in kidney parameters indicate the presence of the disease.
Ultrasound diagnostic pyelonephritis is recorded according to the following parameters:
- Kidney proportion: size and contour. Changes in one of the paired organs indicate asymmetry in size and unilateral kidney damage. Enlargement of organs indicates bilateral damage. The deformed appearance of the contour means infiltration of the tissues of the paired organ.
- Echogenicity is a parameter of the density of kidney tissue, which is determined by its ability to reflect ultrasound. About the occurrence pathological changes on the kidneys it signals different ability fabrics. Homogeneous echogenicity indicates healthy tissue kidney The occurrence of inhomogeneities - increased and decreased echogenicity will indicate the presence of kidney disease.
- Mobility is a parameter, a decrease in which, in combination with an increased size of the paired organ, indicates the occurrence of pyelonephritis.
- Condition of the pyelocaliceal system. With pyelonephritis, the zone enlarges and becomes deformed. Such a deviation may indicate abnormalities: hydronephrosis, renal anomalies.
Pyelonephritis on ultrasound
Using ultrasound diagnostics, it is easy to determine the presence of pyelonephritis and various tumor formations. The appearance of neoplasms is indicated by the presence of hyperechoic areas.
Kidney parameters on ultrasound for pyelonephritis
Parameters of acute pyelonephritis:
Focal form:
- during breathing, the mobility of the kidney decreases;
- an area with increased echogenicity indicates the presence of an infiltration zone.
Diffuse form:
- increase in kidney size;
- decreased echogenicity;
- there is no division of the layers of the kidney;
- the parenchyma increases in size.
Parameters of chronic pyelonephritis:
- increased echogenicity;
- reduction in parenchyma size;
- superiority in renal sinus area;
- increased echo density of the parenchyma is observed;
- the contour of the organ has a pronounced tuberosity;
- the kidney tends to shrink;
- enlargement of the pyelocaliceal system.
If a kidney infection lasts more than six months, pyelonephritis becomes chronic.
Chronic pyelonephritis is the result of an infection lasting more than six months. If ultrasound diagnostics gives signs, then a full diagnosis is carried out using urine and blood tests. Infection can cause nephrosclerosis.
Pustular pyelonephritis is difficult to determine on ultrasound. He has no signs on the ultrasound diagram. The echo density will be similar to the parameters of diffuse pyelonephritis. The therapy will not lead to results, and the patient’s condition will worsen.
The pustular form of the disease can be detected on ultrasound if the following parameters are available:
- purulent formations are connected to each other;
- a carbuncle is identified at the site of the abscesses;
- an area of reduced echogenicity is observed in the pustular zone;
- lack of clear contours at the site of the carbuncle.
Cure will be signaled by the presence of the following parameters: the size of the kidney returns to its normal state, a decrease in the size of the parenchyma, it is possible to distinguish the differentiation of the layers of the kidney.
A scar appears at the site of the abscess, with renal tissue being absorbed. An ultrasound of the kidneys for acute pyelonephritis, after recovery, will not show signs of the disease.
Ultrasonography kidney is currently the most widely used method for diagnosing any form of pyelonephritis. Due to:
low invasiveness; high diagnostic significance; absence of contraindications to the study.
Evaluation of the results should be carried out by a specialist in the field.
Ultrasound kidney has better specificity in detecting pyelonephritis compared to urine tests, but less resolving power (see small details) compared to NMR or CT examination of the kidneys.
This aspect is compensated by the comparatively lower cost of the ultrasound method and the absence of radiation exposure. As a result, ultrasound is the method of choice for pregnant women and children.
In screening diagnostics of kidney diseases or examination of persons at risk ( arterial hypertension, diabetes) method takes leading value . In pregnant women, ultrasound is especially useful throughout all trimesters of pregnancy to assess the structure and function of a woman’s kidneys and monitor treatment.
Indications for ultrasound
Availability pain syndrome in the lumbar or abdominal area. Detection of prolonged, unexplained, persistent low-grade fever(high temperature). Changes in blood tests: in the general blood test - leukocytosis, increased ESR, shift of the leukocyte formula to the left, anemia; in biochemical analysis - an increase in creatinine, urea, potassium in blood serum. Especially when of unknown origin violations. Urinary dysfunction kidneys (night urges, frequent and painful urination, decrease or increase in the volume of urine excreted per day, the appearance of edema). An increase or decrease in the amount of urine, decreased specific gravity of urine. Changes in urine tests(presence of blood, appearance of protein, detection of bacteria, phosphate and urate salts, increased number of leukocytes).
Ultrasound diagnostics is carried out by doctors in several positions of the sensor and the patient(polypositional). This is due anatomical feature location of the kidneys. The study is carried out at the height of inspiration or during deep breathing. This achieves the most complete picture.
Main settings
The main parameters of the kidneys assessed by ultrasound are:
contour; dimensions; echogenicity of the parenchyma; homogeneity; mobility; structure of the pyelocaliceal system; presence of stones or inclusions.
U healthy person normal kidney length is 7.5–12 cm, width about 4.5–6.5 cm, thickness 3.5–5 cm, parenchyma from 1.5–2 cm. Ultrasound examination of the kidneys is used to diagnose any form of pyelonephritis. The expansion of the pyelocaliceal system indicates the obstructive nature of the disease.
For pyelonephritis:
Uneven contour of the kidneys. Indicates infiltration of renal tissue. Dimensions. With unilateral lesions, size asymmetry is noted due to inflammatory edema. When both organs are involved, their sizes significantly exceed normal values. Density kidney tissue, uniformity in an acute process it can be unevenly reduced due to focal or diffuse inflammation of the tissue; in a chronic process, on the contrary, an increase in echogenicity is observed. Deterioration of kidney mobility, as well as combined enlargement of the organ - significant sign acute pyelonephritis according to ultrasound data. Parenchyma condition, expansion of the pyelocaliceal system or its deformation indicates the obstructive nature of the disease, but can also occur in other diseases (hydronephrosis, congenital anomalies). Restriction of respiratory mobility speaks of swelling of the perinephric tissue.
Most common conclusion based on kidney ultrasound data: asymmetry of kidney sizes, diffuse acoustic heterogeneity renal parenchyma, expansion and deformation of the pelvis, shadows in the renal pelvis, compaction of the renal papillae, uneven contour of the kidneys or an increase in the thickness of the parenchyma.
For acute pyelonephritis The ultrasound picture changes depending on the stage of development of the pathological process and the degree of obstacles to the outflow of urine.
Acute primary (without obstruction) pyelonephritis, especially at the beginning of the disease, in the phase of serous inflammation, can give a normal ultrasound picture on the echogram. As the pathological inflammatory process develops and interstitial edema increases, the echogenicity of the organ tissue increases. Its cortical layer and the structure of the pyramids become better visible. In secondary (complicated or obstructive) forms of the disease, it is possible to identify only signs of blockage of the urinary tract (such as dilation of the calyces and pelvis, an increase in the size of the kidney). With apostematous nephritis, ultrasound results may be the same as as in serous inflammation. Other signs: the mobility of the organ is usually reduced or absent, the cortical and medulla layers are less distinguishable, the boundaries of the kidney lose clarity, sometimes shapeless structures with heterogeneous echogenicity are found. With a carbuncle, bulging of the external contour of the organ is often noted, lack of differentiation between the cortical and medulla layers, heterogeneous hypoechoic structures .When an abscess forms at the site of destruction, anechoic formations are revealed, sometimes the fluid level and abscess capsule are observed. When paranephritis forms or an abscess breaks through the boundaries of the fibrous capsule of the organ - picture heterogeneous structure with a predominance of echo-negative structures. The external contours of the kidneys are clear and uneven. With various obstructions (stones, tumors, strictures, congenital obstructions, etc.), in the area of the upper urinary tract there is an expansion of the calyces, pelvis, up to the upper third of the ureter.
Exacerbation of pyelonephritisDiet for pyelonephritisRules for collecting and evaluating urine analysis for pyelonephritis
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An experienced doctor will immediately notice signs of pyelonephritis on an ultrasound. The disease is common. Occurs due to infection, inflammation in the renal collecting system.
At chronic form There are exacerbations with remissions. The reason for the transition to chronic form, bad treatment illness at the acute stage. The kidney tissues degenerate and do not perform their functions; the kidneys work much worse. This can lead to severe complications.
Acute pyelonephritis. Primary
Doctors often see the disease on ultrasound. It affects older and younger people. Most of them are women. The kidneys usually get sick directly, and not through inflammation of the lower or upper urinary tract. The disease occurs in two types: in patches or in a diffuse state.
With focal pyelonephritis in the parenchyma zone, the local expansion is anechoic or echohomogeneous. The contours of the kidney sometimes bulge. After treatment and recovery, no traces of the disease remain.
Ultrasound diagnosis of the kidneys will be difficult if the organ has a current or, for example, three-day hematoma, acute inflammation of the cavity (also fresh), an acute carbuncle, or other formations that look similar on an echogram in the acute stage.
"Advice. For diagnosis, look for an experienced specialist. Only an ultrasound specialist who has worked for a sufficient amount of time in a hospital and has seen many ultrasound screenshots will correctly decipher the data.”
Foci of inflammation in the kidneys can only be diagnosed using ultrasound; doctors do not use any other diagnostic method. This one is safe and informative.
When pyelonephritis is diffuse in the acute stage, the kidney becomes larger, capturing the area of the parenchyma. It expands and has low echogenicity. If the disease is initial stage, then the kidney on ultrasound will have clear contours. And with severe swelling of the parenchyma, the specialist will see on the screen that the contours are blurred and the capsule located near the kidneys and consisting of fat is inflamed.
Pyelonephritis in the emphysematous form is extremely rare. With this disease, gas bubbles form in the area of the renal pelvis. They are black, round and highly echogenic. They leave an acoustic shadow.
An ultrasound helps determine whether the kidneys are asymmetrical and will show their volume. To do this, use the formula for calculating epilepsoid. You will need given - the largest dimensions: transverse with longitudinal. These data are also used to establish the diagnosis of an abscess in the lower or upper urinary tract.
What are the symptoms that a woman has chronic pyelonephritis?
The apparent reasons are varied. If you have chronic pyelonephritis, you may not know about it for some time (before diagnosis). Pain is felt in the lumbar region. Aching or dull and weak. When it's cold or damp outside, they get worse. Women experience frequent urination and even urinary incontinence. Blood pressure increases in patients. Women feel pain when urinating.
How intense will the disease manifest itself? It depends on whether it is 1 kidney or both and how long ago? If a woman has chronic pyelonephritis, then during the period of remission she will not feel much pain and will decide that she is healthy. Painful sensations will become noticeable during the acute stage of the disease.
What causes the exacerbation? Apparent reasons: in humans weak immunity. It happens after eating spicy foods, if you often drink alcohol in any form, or if you get hypothermic somewhere. Symptoms of the disease:
Your temperature is above +38 °C; You feel it in your lower back nagging pain. There are also pains in the peritoneal area, but less often. If you stand somewhere for a long time or play sports, they will remind you of themselves. You get tired faster than usual and often feel weak; Headache; Muscle pain is felt; You feel sick; The face and limbs swell; Urination becomes more frequent, persistent frequent urge; You feel pain when urinating; Urine is cloudy; There was blood in the urine.
Who is more likely to be prescribed an ultrasound by a doctor?
For what symptoms will the doctor give you a referral for an ultrasound examination:
If you feel pain in the abdomen and lower back. Without apparent reason you last long enough heat bodies. General analysis blood shows leukocytosis, increased ESR, leukoformula is shifted to the left, anemia is observed; Biochemical analysis indicates that creatinine has increased, as has urea, potassium, and blood serum. These indicators are especially important for making a diagnosis if you do not yet know exactly which organ is affected? The kidneys' ability to remove urine is impaired. At night you have a frequent urge to urinate. At the same time, you feel pain. Over the course of a day, there was less or more urine, and swelling appeared. There is more or less urine, but its specific gravity is less than it was before. Blood with a high protein content, a lot of bacteria, urate salts, with phosphates, and a lot of leukocytes appeared in the urine.
How is an ultrasound examination of the kidneys performed? The patient is asked to take off his clothes. expose your back. They put sensors on the place where the kidneys are located, move them and look on the screen in what condition is the organ?
"Advice. Take a deep breath and continue to breathe deeply. Then the picture of the kidney examination will be most complete and clear.”
Now you know how the kidneys are examined and that pyelonephritis is visible on ultrasound. It can be in acute or chronic form. All that remains is to be examined using ultrasound equipment and treated. How long will the course take? It's different for everyone.
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