X-ray signs of kidney disease

Tactics of radiation research, i.e. The choice of radiation methods and the sequence of their application, are developed taking into account the history and clinical data. To a certain extent, it is standardized, since in most cases the doctor deals with typical clinical syndromes: pain in the kidney, macrogemuria, urination disorders, etc. This circumstance justifies the use of typical schemes for examining patients, and such schemes are given below. However, the duty of the doctor is a thoughtful analysis of the features of the course of the disease in a particular patient and the introduction of the necessary adjustments into the general schemes.

Renal colic

The patient's condition is difficult. He has an attack of cramping pain in the kidney, often radiating to the lower abdominal cavity and pelvic region. Pain syndrome is often accompanied by nausea or vomiting, paresis of the intestine. Sometimes there is frequent urination. The patient shows thermal procedures, painkillers. The attending physician, the urologist or the surgeon, determines the indications for the radiation study and the time of its conduct.

Renal colic is caused by a dilated pelvis due to a violation of the outflow of urine, which can be caused by blockage or compression of the upper urinary tract. In most cases, the cause of blockage is a stone, but it can be caused by a clot of blood or mucus. The contraction of the ureter can cause a tumor. The research tactics used in such cases are shown in the diagram.

Examination of a patient with renal colic should start with sonography. Colic is characterized by an enlargement of the pelvis on the side of the pain attack. In the pelvis or ureter, a stone is usually found. It is easier to detect a stone in the pelvis. Concrements of more than 0.5 cm are visualized as echopositive formations with clear outlines. Behind the stone there is an acoustic shadow. Stones measuring less than 0.5 cm do not give such a shadow, and they are difficult to distinguish from clumps of mucus or purulent masses. In such a situation, repeated sonography helps. It is difficult to diagnose a stone in the ureter. Usually this is possible only when it is localized in the pelvic part of the ureter within 4-5 cm from its mouth.

With obscure sonography results, an overview X-ray of the kidneys and urinary tracts is performed. Most kidney stones consist of inorganic salts - oxalates or phosphates, which intensively absorb X-rays and give a distinctive shadow in the pictures. Analyzing the roentgenogram, determine the number of stones, their location, shape, size, structure. In 2-3% of cases kidney stones consist mainly of protein substances - fibrin, amyloid, cystine, xanthine, bacteria. They poorly absorb radiation and are not visible on radiographs.

The amount of urinary stones can be different. The large stone sometimes repeats the shape of cups and pelvis and resembles coral ("coral" stone). Small stones have a rounded, polygonal, ovoid or irregular shape. In the bladder, the stone gradually assumes a spherical shape. It is important not to confuse urinary calculi with stones and petrifications of a different nature - with gallstones, calcified small cysts, lymph nodes in the abdominal cavity, etc. Often there are doubts in the detection of vaginal stones (phlebolitis) in the pelvis. It should be taken into account that they have a regular spherical shape, small size, a transparent center and a clear concentric structure, are located mainly in the lower lateral parts of the pelvis.

The next step in the examination of a patient with renal colic is urography. With its help confirm the presence of a stone in the urinary tract and specify its location. Simultaneously, urography makes it possible to assess the anatomic state of the kidneys, the type of pelvis, the degree of expansion of the calyces, the pelvis, the ureter.

With X-ray negative stones on urograms, the defect of filling the urinary tract with clear contours is revealed. Sometimes, with a sharply disturbed outflow of urine, on urograms an enlarged kidney with an enhanced nephrographic effect is detected without contrasting the cupping-and-pelvic system - the so-called large white kidney. A similar urogram shows that the kidney function is preserved. If the function is lost, then the strengthening of the shadow of the kidney during urography does not occur.

Renography is important in determining the functional state of the kidneys and especially in assessing their reserve capacity. On the side of the affected kidney, the renographic curve has a constantly rising character, the obstructive type of the curve. The steeper the curve, the more the kidney function is preserved. In order to distinguish obstructive uropathy from functional (dilated), in renography use the above-described trial with the introduction of a diuretic.

When planning surgery - surgical removal of occlusion - it is advisable to produce renal angiography. This method allows you to study the architectonics of blood vessels, which is important for kidney resection, nephrotomy. If the renal artery is narrowed by more than 50% of its normal diameter, then the loss of kidney function, as a rule, is irreversible.

Radiation studies are widely used to monitor the effectiveness of various interventions on the kidneys. In recent years, the method of crushing stones in the body develops - extracorporeal shock wave lithotripsy.

Sonograms and radiographs help evaluate the results of the intervention and identify possible complications, in particular, the intrarenal hematomas. With surgical removal of stones, ultrasonic location is directly beneficial on the operating table.

Occlusion or compression of the upper urinary tract leads to the expansion of the cup-and-pelvis system. Initially there is an increase in the pelvis - pielectasia, then an extension of the calyx is attached to it - hydrocalicosis, but it is also possible to have an isolated expansion of one or more cups. If the cause of the disturbance of the outflow of urine is not eliminated, there is a persistent and increasing expansion of the entire cup-and-pelvic system, resulting in atrophy of the kidney parenchyma. This condition is called hydronephrosis transformation, or hydronephrosis.

Hydronephrotic transformation of the kidney is determined by means of ray methods - sonography, urography, scintigraphy. Signs of hydronephrosis are an increase in the kidney, an expansion of the cup-and-pelvic complex up to turning it into a large cavity with an even or undulating inner surface, atrophy of the renal parenchyma, a sharp decrease or loss of kidney function.

The cause of hydronephrosis is usually a stone that clogs the ureter. If a stone is not found, then an angiopathy is prescribed to rule out other causes, especially an additional renal artery that compresses the ureter.

Injury of the kidney and bladder and macrohematuria

Damage to the kidney is often combined with trauma of neighboring organs and bones, therefore it is advisable to begin the examination of the victim with an overview of fluoroscopy and X-rays, in which the condition of the lungs, diaphragm, spine, ribs, abdominal organs is determined. Isolated injuries of the kidney include her bruising with the formation of subcapsular hematoma, violation of the integrity of the cup-and-pelvic system, rupture of the renal capsule with the formation of a retroperitoneal hematoma, crushing or detachment of the kidney.

On a survey radiograph, subcapsular kidney hematoma is manifested by an increase in the shadow of the organ. Sonogram allows you to detect hematoma and judge its location and magnitude. With a relatively small injury to the kidney, the primary study, in addition to the survey images, is intravenous urography. It first of all makes it possible to establish the degree of impairment of the function of the damaged kidney. On urograms it is possible to reveal volumetric education (hematoma), the presence of urinary leakage, indicative of rupture of the calyx-pelvis system.

However, the most informative method of examining patients with kidney injuries is still a computer tomography. It makes it possible to assess the condition of all the organs of the abdominal cavity and to reveal the perineal hematoma, rupture of the capsule of the kidney, violation of the integrity of the fascia, accumulation of blood in the abdominal cavity. A rupture of the kidney with the discharge of blood and urine into the pericardial tissue leads to the disappearance of the shadow of the kidney on the overview radiograph and the contour of the large lumbar muscle on the side of the lesion. At a roentgenography metal foreign bodies are distinctly defined.

If, based on the results of sonography and tomography can not determine the condition of the calyx and pelvis, then resort to urography. With the intact cups and pelvis their contours are even. In case of an obstruction of the wall of the pelvis or calyx, clusters of contrast material outside them, in the thickness of the kidney tissue, as well as deformation of the cup-and-pelvic complex are observed. In addition, a weak and later release of contrast medium is noted. If there is a suspected damage to the ureteropelvic junction, a combination of CT and urography is especially valuable. They make it possible to distinguish the total ureteral laceration from its tearing, in which it is possible to conduct the stenting of the ureter and thereby confine itself to conservative therapy.

In macrohematuria and questionable results of urography and CT, angiography is shown, in which direct signs of damage to the blood vessels and extravasation of the contrast medium are revealed during their rupture. On the nephrogram, the area of the lesion can be specified.

With trauma of the bladder, the leading role is played by X-ray examination. Pelvic survey images are especially important for extraperitoneal ruptures of the bladder, since they are usually associated with fractures of the pelvic bones. However, the main importance is the artificial contrast of the bladder - cystography. Contrast substance is injected into the bladder through a catheter in an amount of 350-400 ml. With intraperitoneal rupture, ooo flows into the side channels of the abdominal cavity and changes its position when the patient's position changes. For the extraperitoneal rupture, the transition of contrast medium to peri-bubble cellulose is characteristic, where it creates formless accumulations anteriorly and laterally from the bladder. Injury of the pelvis and perineum can be accompanied by rupture of the urethra.

Direct method to quickly and reliably recognize this damage and establish the place of rupture is urethrography. Contrast substance, injected through the external opening of the urethra, reaches the point of rupture, and then forms a lump in the paraurethral tissues.

Inflammatory Kidney Disease

Pyelonephritis is a nonspecific inflammatory process with a predominant lesion of the interstitial tissue of the kidney and its bowel-and-pelvis system. On radiographs and sonograms there is a slight increase in the affected kidney.

On computer tomograms it is possible to determine the thickening of the renal fascia and the accumulation of exudate in perirenal space. With dynamic scintigraphy, the decrease in the rate of elimination of RFP is almost constant, i.e. Decrease in the slope of the third segment of the renogram curve. Later, a flattening of the renographic peak is revealed, the stretching of the first and second segments.

Patients with pyelonephritis perform urography. Contrast substance is excreted by the affected kidney, usually weakly and slowly. Initially, a slight deformation of the cups can be noted. Then their expansion (hydrocalicosis) is observed. There is also dilatation of the pelvis. Its dimensions more than 2-3 cm indicate pielektasiasis, but unlike pyelectasia and hydrocalicosis when the ureter or the pelvis is blocked by a stone, the outlines of the calyx and pelvis become uneven. The process can go to the phase of pionephrosis. At first glance, its urographic pattern resembles that of hydronephrosis deformity of the kidney, but here the distinctive feature is the erosion of the contours of the cavities formed.

Pyelonephritis can be complicated by the development of abscess, carbuncle, parainfrit. Sonography and angiography allow us to identify directly the cavity of an abscess or carbuncle. Contours of the cavity at first uneven, in the lumen there are scraps of necrotic tissue, and around - a zone of compacted tissue. With paranephritis, an infiltrate is observed in the perineal area. It should be noted that the upper posterior paranephritis is actually a subdiaphragmatic abscess, so when X-ray and lung radiography it is possible to see the deformation and limitation of the diaphragm mobility on the side of the lesion, the blurriness of its outlines, the appearance of small atelectasis and infiltration sites at the base of the lung and fluid in the pleural cavity. On the overview radiograph of the abdominal cavity organs, the contour of the large lumbar muscle disappears.

Among nephrologic diseases, glomerulonephritis is most important, and less diffuse lesions of the renal parenchyma are less common: cortical necrosis, nodular periarteritis, systemic lupus erythematosus, etc. The primary method of investigation for lesions of this kind is sonography. With it, it is possible to detect a change in the size of the kidneys (increase or decrease), enlargement and consolidation of the cortical layer. As a rule, the lesion is bilateral, relatively symmetrical, and there are no signs of hydronephrosis, so characteristic of pyelonephritis. Other methods of radiation research for lesions of the kidneys of this group are of limited importance. An exception is renography. In this case, it is necessary to pay attention to the following: since glomerulonephritis primarily affects the glomeruli, the study should be performed with ^{99 m} Tc-DTPA, which is secreted by the glomeruli, whereas in the case of pyelonephritis, preference is given to hippuran and ^{99 m} Tc-MAG-3, tubular epithelium. In patients with glomerulonephritis, the rhinogram curve gradually flattenes as the severity of the kidney lesion increases.

Chronic pyelonephritis, glomerulonephritis, long-term arterial hypertension and atherosclerosis of the renal artery lead to nephrosclerosis - replacement of the kidney parenchyma with a connective tissue. The kidney decreases, wrinkles, its surface becomes uneven, its function sharply decreases. Reduction of the kidney is recorded on radiographs, urograms, sonograms. CT shows that the decrease is mainly due to the parenchyma. Radionuclide studies show a decrease in renal plasma flow. A flattened, almost horizontal line can be seen on the rhenogram. Angiography demonstrates a picture of depleted renal blood flow with reduction of small arterial kidney vessels (a picture of a "charred tree").

Thus, the tactics of radiation research for diffuse lesions of the kidneys is reduced to a combination of radionuclide studies of renal function with sonography or CT. Urography and angiography are performed as additional studies to clarify the status of the cup and pelvis complex and the kidney vessels.

To specific inflammatory lesions is tuberculosis of the kidneys. In the period of fresh seeding of the kidney with tuberculosis granulomas, radiation methods do not bring real benefits, only renal dysfunction in renography can be determined. Later, there are fibrotic changes and cavities in the kidney parenchyma. On sonograms, the cavern resembles the cyst of the kidney, but its contents are not uniform, and the surrounding tissue is compacted. With the transition of inflammation to the cup-pelvis system, uneven contour of the cups arises. Later there is scar scarification of the calyx and pelvis. If changes are indistinct in urography, retrograde pyelography should be performed. Contrast substance from the cups penetrates into the cavities located in the tissue of the kidney. The defeat of the ureters leads to unevenness of their contours and shortening. If the process has passed to the bladder, then its image also changes: its asymmetry, decrease, flow of contrast medium back into the ureter (vesicoureteral reflux).

The volume and localization of tuberculous lesions in the kidney can best be determined with CT. When planning an operative intervention, arteriography is of great benefit. In the arterial phase, deformation of small arteries, their clipping, uneven contours are detected. On the nephrogram, clearly visible areas that do not function. To get an idea of the nature of the vascularization of the kidney, instead of angiography, energy Doppler mapping is increasingly being used instead of angiography, although the doctor receives similar data when performing CT with amplification.

Nephrogenic arterial hypertension

A high and easily detectable manifestation of this syndrome is high blood pressure. It is stable and does not give in to medical effects, until the cause of hypertension is eliminated. And there can be two reasons. The first is the violation of the influx of arterial blood to the organ. It can be caused by narrowing of the renal artery due to fibromuscular dysplasia, atherosclerosis, thrombosis, inflexion with nephroptosis, aneurysm. This form of nephrogenic hypertension is called vasorenal, or renovascular. The second reason is a violation of the intrarenal blood flow with glomerulonephritis or chronic pyelonephritis. This form of the disease is called parenchymal.

The basis for the radiation study is high arterial hypertension, resistant to drug exposure (diastolic pressure above 110 mm Hg), young age, positive pharmacological tests with captopril. The tactics of radiation research in general form is presented in the diagram below.

Duplex sonography allows to determine the position and magnitude of the kidneys, to study the pulsation of their arteries and veins, to detect lesions (cysts, tumors, scars, etc.). Renography provides an investigation of blood flow in the kidneys and a comparative evaluation of the function of glomeruli and tubules of the right and left kidneys. One should also remember the possibility of a renin secretant tumor (pheochromocytoma). It is detected by sonography, AGG and L and MRI.

Arteriography of the kidneys most vividly reflects the lesions of the renal artery - its constriction, inflection, aneurysm. Arteriography is mandatory in the planning of surgical, including radiological intervention, intervention. It is performed mainly with the use of DSA. Thanks to venous access, this study can be carried out even on an outpatient basis. After therapeutic interventions on the renal artery (transluminal angioplasty), DSA is used.

In recent years, ultrasonic examination of renal blood flow by the method of energy Doppler mapping, which allows in some cases to avoid such an invasive study as X-ray angiography, is rapidly developing and successfully used in the examination of patients with vasorenal hypertension. MR-angiography performed in several projections, especially with the use of paramagnetics and three-dimensional image reconstruction, allows to accurately determine the narrowing of the renal artery during the first 3 cm from its mouth and assess the degree of occlusion of the vessel. However, it is difficult to judge the state of the more distal parts of arteries by the results of MRA.

Tumors and cysts of the kidneys, bladder, prostate

Volumetric formation in the kidney, bladder or prostate is one of the most frequently detected syndromes of damage to these organs. Cysts and tumors for a long time can develop secretly, without causing severe clinical symptoms. Laboratory tests of blood and urine are very relative due to their nonspecificity and heterogeneity of the results. It is not surprising that radial methods are the decisive factor in determining and establishing the character of the volumetric process.

The main methods of radiation diagnosis, used in patients who are suspected of volume formation, are sonography and CT. The first is simpler, cheaper and more affordable, and the second is more accurate. Additional data can be obtained with MRI, Doppler mapping and scintigraphy. When planning surgery for the kidney, angiography may be useful. It is also used as the first stage of intravascular research in the embolization of the renal artery before nephrectomy.

On sonograms, the solitary cyst emerges as a round echo-negative formation devoid of internal echostructures. This education is sharply outlined, it has even outlines. Only occasionally, with a hemorrhage into the cyst cavity, it can reveal delicate structural formations. A large cyst or cyst located near the sinus of the kidney may cause deformity of the calyx or pelvis. The proximal cyst sometimes resembles an enlarged pelvis, but in the latter one can see the rupture of the contour at the site of the pelvis transition into the ureter. Retention cyst and echinococcus in some cases are indistinguishable. In favor of a parasitic cyst, internal echostructures and lime deposits in the fibrous capsule testify. The cyst is distinguished as a uniform and relatively low density rounded formation with smooth sharp contours. You can establish the localization of the cyst in the parenchyma, under the capsule, near the pelvis. The paraplevikalnaya cyst is located in the area of the gate of the kidney and usually grows outside. Parasitic cysts are visible capsule. CT, like ultrasound, is used for puncture of cysts and kidney tumors.

On urograms, mainly indirect symptoms of the cyst are found: squeezing, squeezing, deforming the calyx and pelvis, sometimes amputation of the calyx. The cyst can cause a semicircular depression on the wall of the pelvis, lead to lengthening of the cups, which, as it were, round the neoplasm. In the nephrographic phase, linear tomograms can be used to display the cyst in the form of a circular defect in contrasting the parenchyma. The possibilities of radionuclide research in the diagnosis of cystic disease are limited. On scintigrams of the kidneys, only large enough cysts are visualized, larger than 2-3 cm.

The tactics of examining patients with kidney tumors at first does not differ from that of cysts. At the first stage, it is advisable to perform sonography. Its resolving power is quite high: it reveals a tumor node 2 cm in size. It stands out as a round or oval formation of an irregular shape, not completely uniform in echogenic density. The outline of the node, depending on the type of its growth, can be quite clear or uneven and blurred. Hemorrhages and necrosis causes hypo- and anechogenous areas within the tumor. This is especially true for Wilms tumor (a tumor of embryonic nature in children), which is characterized by a cystic transformation.

The further course of the examination depends on the results of sonography. If she does not receive data confirming the presence of a tumor, then CT is justified. The fact is that some small tumors by echogenicity differ little from the surrounding parenchyma. On a computer tomogram, a small tumor is visible as a node at a size of 1.5 cm or more. In terms of density, this node is close to the renal parenchyma, therefore, it is necessary to carefully analyze the image of the kidney on a number of sections, revealing the heterogeneity of its shadow in any area. This heterogeneity is due to the presence in the tumor of denser sites, foci of necrosis, sometimes lime deposits. The presence of a tumor is also evidenced by such signs as deformation of the contour of the kidney, depression on the calyx or pelvis. In unclear cases resort to the technique of amplification, since the tumor node is more clearly defined.

Large neoplasms are clearly visible in CT, especially performed by an enhanced technique. At the same time, the criteria for the malignancy of the tumor are the heterogeneity of pathological formation, the unevenness of its contours, the presence of calcification foci, and the phenomenon of enhancing the shadow of the tumor after intravenous administration of contrast medium. The sine of the kidney is deformed or not detected: one can register the spread of tumor infiltration along the vascular pedicle. With MRI, tumors and cysts of the kidneys receive similar pictures, but its resolution is somewhat higher, especially when using a contrast medium. Magnetic resonance tomograms more clearly outlines the transition of the tumor to vascular structures, in particular, to the lower vena cava.

If a tumor is not detected with computer and magnetic resonance imaging, but there is a small deformity of the pelvis and the patient has hematuria, then there are grounds to apply retrograde pyelography to exclude a small tumor of the renal pelvis.

With tumors of medium and large sizes after sonography, it makes sense to perform urography. Already on a survey radiograph, an increase in the kidney and deformation of its contour, and sometimes also small deposits of lime in the tumor, can be detected. On urogramm the tumor causes a number of symptoms: deformity and crowding of cups and pelvis, and sometimes amputation of calyxes, uneven contours of the pelvis or defect of filling in it, deviation of the ureter. On the nephrotomogram, the tumor mass gives an intense shadow with uneven outlines. This shadow can be inhomogeneous due to separate clusters of contrast medium.

Even in the presence of these symptoms, it is recommended to continue the study by applying CT and then DSA. These methods allow not only to confirm the diagnosis, but also to differentiate benign and malignant neoplasms, to detect small tumors in the cortical layer, to assess the state of the renal and inferior vena cava (in particular, whether they have a tumor clot), to reveal tumor germination into adjacent tissues and metastases in the opposite kidney, liver, lymph nodes. All these data are extremely important for the selection of treatment activities.

Radionuclide methods can play a role in the diagnosis of tumors. On the scintigram, the tumor site is defined as the zone of reduced accumulation of RFP.

Tumors of the bladder - papillomas and cancer - are recognized in cystoscopy with biopsy, but two circumstances determine the need and value of radiation research. Malignant transformation of the papilloma occurs primarily in the depth of the neoplasm, and it is not always possible to establish it when studying the biopsy specimen. In addition, with cystoscopy it is impossible to detect tumor germination in adjacent tissues and metastases in regional lymph nodes.

Radiation examination with a tumor of the bladder is advisable to start with sonography or CT. On a sonogram, the tumor is clearly visible in the filled bladder. To judge its nature, i.e. About good quality or malignancy, it is possible only in the event that the invasion of a tumor in the wall of the bladder and peri-vesical fiber is detected. Early stages of tumor growth are convincingly detected in endovezic sonography.

No less clearly, the tumor is excreted on computer and magnetic resonance tomograms, the latter especially valuable in detecting the tumor of the bottom and the roof of the bladder. The advantage of MRI is the ability not only to see metastatic lymph nodes, but also to distinguish them from the blood vessels of the pelvis, which is not always possible with CT. On the cystograms, the tumor is visible when the bladder is double contrasted. It is not difficult to determine the position, magnitude, shape and condition of the surface of the tumor. With infiltrating growth, the deformation of the wall of the bladder in the tumor region is established.

The main method of radial examination of the prostate gland is transrectal sonography. Valuable information about the nature of the tumor can be obtained using color Doppler mapping. CT and MRI are important refinement methods, allowing to judge the extent of the spread of the tumor process.

With transrectal sonography clearly visible congenital and acquired cysts of the prostate gland. Nodular hyperplasia leads to an increase and deformation of the gland, the appearance in it of adenomatous nodes and cystic inclusions. Cancer in most cases causes a diffuse increase and a change in the structure of the gland with the formation of hypo- and hyperechoic areas in it, as well as changes in the magnitude, shape, and structure of the seminal vesicles. The detection of any form of reduction in prostate echogenicity is considered an indication for a diagnostic puncture under the supervision of an ultrasound study.

Malignant tumors of the kidney and prostate are known for their propensity to metastasize to the bone of the skeleton. For the first, osteolytic metastases are characteristic, whereas for prostate cancer - osteoplastic, primarily in the ribs, spine and pelvic bones. In this regard, for all malignant lesions of the urinary and prostatic system, a radionuclide study (scintigraphy) of the skeleton is shown, in a number of cases supplemented with the radiography of a suspicious bone site.

Malformations of the kidneys and urinary tract

Kidney anomalies do not always manifest themselves as specific clinical symptoms, but they need to be remembered, since these anomalies are observed frequently and, moreover, are not so rarely complicated by infection or stone formation. Of particular danger are the anomalies, in which the tumor is palpable tumor-like formations. It is clear that a doctor can suspect a tumor in the event that in fact it is not.

Radiation studies play a major role in identifying and establishing the nature of kidney and urinary tract anomalies. We indicate the most common developmental defects and methods for their detection. Aplasia of the kidney is very rare, but the doctor's responsibility for its detection is exceptionally high. With all radiation studies, the image of the kidney is absent in this case, but the direct evidence of congenital absence of the kidney is only the complete absence of the renal artery on the side of the anomaly (and not its amputation at one level or another).

Somewhat more often, there are anomalies of magnitude-large and small kidneys. In the first case, there is a kidney with a doubling of the pelvis and two groups of cups. There are also two ureters, but they could melt at a distance of 3 - 5 cm from the kidney. Occasionally, two ureters that depart from one kidney enter the bladder by separate mouths. One of the options for doubling the ureter is its splitting in the distal part. It is more difficult to recognize a small kidney. The very fact of detecting a small kidney is not yet evidence of a birth defect, i.e. Hypoplasia, as the kidney may decrease as a result of nephrosclerosis. However, these two states can be differentiated. At a hypoplasia the kidney keeps a correct form and equal outlines, in it the cup-lohan complex of the usual form looms. The function of the hypoplastic kidney is lowered, but preserved. The second kidney is usually large in size and functions normally

Numerous variants of kidney dystopia, i.e. Anomalies of their position. The kidney can be at the level of the lumbar vertebrae - lumbar dystopia, at the level of the sacrum and iliac bone - ileal dystopia, in the small pelvis - pelvic dystopia, on the opposite side - cross dystopia. In cross dystopia, various variants of adnation of the kidneys are observed. Two of them - L- and S-shaped kidneys - are shown in the same figure. The dystopic kidney has a short ureter than it differs from a lowered kidney. In addition, it is usually turned around the vertical axis, so the pelvis is located laterally, and the calyx is medial. Dystopic kidneys can be spliced by their upper or, more often, lower poles. This is a horseshoe kidney.

To anomalies also include polycystic kidney disease. This is a peculiar condition, in which in both kidneys there are multiple cysts of different sizes, not associated with cups and pelvis. Already on the survey radiographs you can see large shadows of the kidneys with slightly wavy contours, but a particularly bright picture is observed in sonography and CT. When analyzing sonograms and tomograms, you can not only detect an increase in the kidneys, but also get a complete picture of the number, size and location of the cysts. When sonography, they stand out as rounded echo-negative formations, lying in the parenchyma and pushing the calyx and pelvis. On the tomograms, the cysts are seen no less clearly as clearly delineated low-density formations, sometimes with septa and lime deposits. On scintigrams with poly-cystosis, large kidneys with multiple defects ("cold" foci) are visible.

The urographic picture is by no means poor. The calyx and pelvis seem to be elongated, the cervical calyxes are elongated, their foramen section is broadened in a bulbous manner. On the walls of cups and pelvis there may be flat and semicircular impressions. The radiological signs of polycystosis on angiograms are even more obvious: there are avascular rounded zones

A large number of abnormalities of kidney vessels is due to the complexity of embryonic development of the kidneys. Two equivalent arterial vessels or several arteries can approach the kidney. Practical value has an additional artery, which exerts pressure on the prilochnochnuyu part of the ureter, which leads to difficulty in the outflow of urine and the secondary expansion of the pelvis and calyces until the formation of hydronephrosis. On urograms there is an inflection and narrowing of the ureter in the place where it crosses with an additional vessel, but incontrovertible evidence is obtained with renal angiography.

Radiotherapy is widely used in the selection of a donor kidney and assessment of the condition of the transplanted kidney.