X-ray signs of kidney disease

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

Renal colic

The patient's condition is serious. He notes an attack of cramping pain in the kidney area, often radiating to the lower abdominal part of the abdominal and the pelvic area. Pain syndrome is often accompanied by nausea or vomiting, paresis of the intestine. Sometimes rapid urination is observed. The patient is shown thermal procedures, painkillers. The attending physician - a urologist or surgeon determines the indications for radiation research and the time of its conduct.

The renal colic is due to stretching of the pelvis due to impaired urinary outflow, which can be caused by blockage or compression of the upper urinary tract. In the vast majority of cases, the cause of blockage is a stone, but it can be caused by a clot of blood or mucus. The compression of the ureter can determine the tumor. The study tactics used in such cases are given in the diagram.

An examination of a patient with renal colic should begin with sonography. Colic is characterized by the expansion of the pelvis on the side of the pain attack. A stone is usually detected in a suck or ureter. It is easier to detect a stone in a pelvis. Creditas of more than 0.5 cm are visualized as echopositive formations with clear outlines. Behind the stone there is an acoustic shadow. Stones of less than 0.5 cm in size do not give such a shadow, and it is difficult to distinguish them from the accumulations of mucus or purulent masses. In such a situation, re-conducting 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 strain results, a viewing radiograph of the kidneys and urinary tract is performed. Most of the renal stones consists of inorganic salts - oxalates or phosphates, which intensively absorb X-ray radiation and give a distinguishable shadow in the pictures. Analyzing the radiograph, determine the number of stones, their localization, shape, size, structure. In 2-3 % of cases, renal stones consist mainly of protein substances - fibrin, amyloid, cystine, xanthine, bacteria. They poorly absorb radiation and are not visible on x-rays.

The size of urinary stones can be different. A large stone sometimes repeats the shape of cups and pelvis and resembles coral (“coral” stone). Small stones have a rounded, polygonal, floodplain or irregular shape. In the bladder, the stone gradually takes a spherical shape. It is important not to confuse urinary calculi with stones and petrifies of a different nature - with gallstones, calcified small cysts, lymph nodes in the abdominal cavity, etc. Often there are doubts when detecting military stones (phlebolites) in the basin. It should be borne in mind that they have the correct spherical shape, small size, a transparent center and a clear concentric structure, are located mainly in the lower pelvic parts.

The next stage of examination of a patient with renal colic is urography. With its help, they confirm the presence of stone in the urinary tract and clarify its whereabouts. At the same time, urography makes it possible to evaluate the anatomical state of the kidneys, the type of pelvis, the degree of expansion of the cups, pelvis, ureter.

With x-ray stones on urograms, a defect of the urinary tract with clear contours is detected. Sometimes, with a sharply disturbed outflow of urine, an enlarged kidney with an enhanced nephrographic effect is found on urograms without contrasting the cup-lobe system - the so-called large white kidney. A similar urogram shows that the kidney function is preserved. If the function is lost, then the reinforcement 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 the assessment of their reserve capabilities. On the side of the affected kidney, the renographic curve has a constantly ascending character - an obstructive type of curve. The steeper the rise of the curve, the more the kidney function is preserved. In order to distinguish obstructive uraopathy from functional (dilatation), during renography, a test described above with the introduction of a diuretic is used.

When planning the operation - surgical elimination of occlusion - it is advisable to produce renal angiography. This method allows you to study the vascular architectonics, which is important when resection of the kidney, nephrotomy. If the renal artery is narrowed by more than 50 % of its normal diameter, then the loss of kidney function is usually irreversible.

Radiation studies are widely used to control the effectiveness of various kidney interventions. In recent years, a method of crushing stones in the body has been developing - extorporepal shock wave lithotripsy.

Snograms and radiographs help to evaluate the results of the intervention and identify possible complications, in particular, intra-fire hematomas. During the surgical removal of stones, an ultrasonic location directly on the operating table is brought certain benefits.

Clogging or compression of the upper urinary tract leads to the expansion of the cup-lobe system. Initially, an increase in the pelvis - pyelectasia, then the expansion of the cups - hydrocalicosis joins it, but it is also possible isolated expansion of one or more cups. If the cause of impaired urinary outflow is not eliminated, then there is a persistent and increasing expansion of the entire cup-lobe system, which ultimately leads to the atrophy of the kidney parenchyma. This condition is called hydronephrotic transformation, or hydronephrosis.

The hydronephrotic transformation of the kidneys is determined using radiation methods - sonography, urography, scintigraphy. Signs of hydronephrosis are an increase in the kidney, the expansion of the cup-lobe complex until it turns into a large cavity with a flat or wavy inner surface, atrophy of the renal parenchyma, a sharp decrease or loss of kidney function.

The cause of hydronephrosis is usually a stone clogging the ureter. If the stone is not detected, then angiophafia is prescribed to exclude other causes, first of all, the additional renal artery, compressing the ureter.

Kidney and bladder injury and macrohematuria

Kidney damage is often combined with an injury to neighboring organs and bones, therefore it is advisable to start examining the victim with sightseeing radioscopy and radiography, in which the condition of the lungs, diaphragm, spine, ribs, organs of the abdominal cavity are clarified. The kidney isolated injuries include its bruise with the formation of a sucapsular hematoma, a violation of the integrity of the cup-lobe system, the rupture of the renal capsule with the formation of a retroperitoneal hematoma, the crushing or separation of the kidney.

On a sightseeing radiograph, the sucapsular hematoma of the kidney is manifested by an increase in the shadow of the organ. The sonogram allows you to detect hematoma and judge its location and size. With a relatively small injury to the primary examination, in addition to overview shots, intravenous urography is. First of all, it makes it possible to establish the degree of impaired function of the damaged kidney. In urograms, you can detect a volumetric formation (hematoma), the presence of urinary stones indicating the rupture of the cup-lobe system.

However, the most informative method of examining patients with kidney injuries is still computed tomography. It makes it possible to evaluate the condition of all organs of the abdominal cavity and identify the pericipal hematoma, rupture of the kidney capsule, violation of the integrity of fascia, blood accumulation in the abdominal cavity. The rupture of the kidney with pouring blood and urine into the perchaic tissue leads to the disappearance of the shadow of the kidney on the sightseeing radiograph and the contour of the large lumbar muscle on the side of the lesion. With radiography, metal foreign bodies are clearly determined.

If, on the basis of the results of sonography and tomography, it is impossible to determine the condition of the cups and pelvis, then resort to urography. With the integrity of cups and pelvis, their contours are even. In the case of the wall of the wall of a pelvis or cup, accumulations of contrasting substance outside of them, in the thickness of the renal fabric, as well as deformation of the cup-lobe complex are observed. In addition, a weak and later isolation of a contrast medium is noted. In case of suspicion of damage to a logo-flowing compound, a combination of CT and urography is especially valuable. They make it possible to distinguish a complete separation of the uretich from its anguish, in which it is possible to conduct stenting of the ureter and thereby limit yourself to conservative therapy.

In macrohematuria and dubious results of urography and CT, angiography is shown, in which direct signs of damage to blood vessels and extravasation of contrast agent during their breakdown are revealed. The nephrogram can be clarified by the area of damage.

In case of injury to the bladder, a leading role is played by an X-ray examination. Viewing pelvic pictures are especially important for extra-bubble bubbles, since they are usually associated with fractures of the pelvic bones. However, the main importance of the artificial contrast of the bladder is cystography. A contrast medium is introduced into the bladder through a catheter in an amount of 350-400 ml. With the intra-Brush rupture of the OIO, it flows into the side channels of the abdominal cavity and changes its position when the patient’s body is changed. For an extra-blessed gap, the transition of a contrast medium to the near-pussy tissue is characteristic, where it creates shapeless clusters anteriorly and on the sides of the bubble. A pelvic injury and perineum may be accompanied by a rupture of the urethra.

Directly to quickly and reliably recognize this damage and set the gap site is urethrography. The contrast agent introduced through the external hole of the urethra reaches the gap, and then forms the staging in parauretral tissues.

Inflammatory kidney diseases

Pyelonephritis is a non-specific inflammatory process with a predominant damage to the interstitial tissue of the kidney and its cup-lobe system. On radiographs and sonograms, a small increase in the affected kidney is noted.

On computer tomograms, it is possible to determine the thickening of the renal fascia and the accumulation of exudate in the perirenal space. With dynamic scintigraphy, a decrease in the rate of RAP withdrawing is almost constantly revealed, i.e. Reducing the steepness of the decline of the third segment of the renogram curve. Later, the flattening of the renographic peak, the stretch of the first and second segments are found.

Patients of pyelonephritis are performed by urography. The contrast agent is excreted by the affected by the kidney, as a rule, weakly and slowly. Initially, a barely noticeable deformation of the cups can be noted. Then their expansion (hydrocalicosis) is observed. There is also a dilatation of a pelvis. Its dimensions of more than 2-3 cm indicate pyelectasia, but unlike pyelectasia and hydrocalicosis when blocking the ureter or pelvis with a stone, the outlines of cups and pelvis become uneven. The process can go to the phase of pionophrosis. At first glance, his urographic picture resembles such with hydronephrotic deformation of the kidney, but here the distinctive feature is the eating of the contours of the resulting cavities.

Pyelonephritis can be complicated by the development of the abscess, carbuncle, paranephritis. Sonography and angiography allow you to directly identify the cavity of the abscess or carbuncle. The contours of the cavity are initially uneven, in the lumen there are scraps of necrotic tissues, and around the zone of compacted fabric. With paranephritis, there is an infiltrate in the near-covered space. It should be noted that the upper posterior paranephritis actually represents a subjugoal abscess, therefore, with radioscopy and radiography of the lungs, the deformation and limitation of the mobility of the diaphragm on the lesion side, the blur of its outlines, the appearance of small atelectases and foci of infiltration in the base of the lung and fluid in the pleurisy cavity can be seen. On the sightseeing radiograph of the abdominal organs, the contour of the large lumbar muscle disappears.

Among the nephrological diseases, glomerulonephritis is of greatest importance, other diffuse lesions of the renal parenchyma are less common: cortical necrosis, nodal periarteritis, systemic red lupus, etc. The primary method of studying this kind is sonography. With it, it is possible to detect a change in the size of the kidneys (increase or decrease), expansion and compaction of the cortical layer. As a rule, the defeat is bilateral, relatively symmetrical, while there are no signs of hydronephrosis, which are so characteristic of pyelonephritis. Other methods of radiation research for kidney lesions of this group are limited. The exception is renography. At the same time, it is necessary to pay attention to the following: since the glomerulus are primarily affected by glomerulonephritis, the study must be performed with ^99MTc-dtpa, which is released with glomeruli, while with pyelonephritis they give preference to the hypopurant and they give preference and ^99MTC-Mag-3, which are distinguished mainly by the channel epithelium. In patients with glomerulonephritis, the renogram curve is gradually flattened as the degree of severity of the lesion of the kidney increases.

Chronically leaking pyelonephritis, glomerulonephritis, long-term arterial hypertension and atherosclerosis of the renal artery lead to nephrosclerosis - the replacement of the kidney parenchyma with connective tissue. The kidney decreases, wrinkles, its surface becomes uneven, its function decreases sharply. Reducing of the kidney is recorded on radiographs, urograms, and sonograms. CT shows that the reduction goes mainly due to the parenchyma. In a radionuclide examination, there is a decrease in renal plasmotok. A flattened, almost horizontal line can be observed on the renogram. Angiography demonstrates a picture of impoverished renal blood flow with reduction of small arterial renal vessels (the picture of the “charred tree”).

Thus, the tactics of radiation examination with diffuse lesions of the kidneys are reduced to a combination of a radionuclide study of renal function with sonography or CT. Urography and angiography are performed as additional studies to clarify the condition of the cup-lobe complex and kidney vessels.

Specific inflammatory lesions include kidney tuberculosis. During the period of freshly parting the kidney with tuberculosis granulomas, radiation methods do not bring real benefits, only impaired renal function during renography can be determined. In the future, fibrous changes and cavities in the parenchyma of the kidneys occur. On the slogging of the Cavern resembles a kidney cyst, but its contents are heterogeneous, and the surrounding tissue is compacted. In the transition of inflammation to the cup-lobe system, the uneven circuits of the cups occur. Later, cicatricial deformation of cups and pelvis occurs. If during the urography changes are inseparable, then retrograde pyelography should be performed. The contrast matter from the cups penetrates into the caverns located in the tissue of the kidneys. The defeat of the ureters leads to the bumps of their outlines and shortening. If the process has switched to the bladder, then its image also changes: its asymmetry, reduction, flow of contrast matter back into the ureter (bubble-memorial reflux) are observed.

The volume and localization of tuberculosis lesions in the kidney can best be determined in CT. When planning surgical intervention, arteriography is of great benefit. In the arterial phase, the deformation of the small arteries, their cliffs, the uneven contours are found. On the nephrogram, areas that do not function are clearly drawn. To obtain an idea of the nature of the kidney vascularization, instead of angiography, the energy doppler mapping is increasingly applying more widely, however, the doctor receives similar data when conducting a CT with strengthening.

Nefrogenia arterial hypertension

A bright and easily detected manifestation of this syndrome is high blood pressure. It differs in resistance and is not amenable to therapeutic influences until the cause of hypertension is eliminated. And there may be two reasons. The first is to violate the flow of arterial blood to the organ. It can be caused by a narrowing of the renal artery due to fibromuscular dysplasia, atherosclerosis, thrombosis, bending with nephroptosis, aneurysm. This form of nephrogenic hypertension is called vasorenal, or renovascular. The second reason is a violation of intracranial blood flow with glomerulonephritis or chronic pyelonephritis. This form of the disease is called parenchymal.

The basis for the radial 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 are presented in the scheme below.

Duplex sonography allows you to establish the position and size of the kidneys, study the pulsation of their arteries and veins, detect the lesions (cysts, tumors, scars, etc.). Renography provides a study of blood flow in the kidneys and a comparative assessment of the function of glomerulus and tubules of the right and left kidneys. It should also be remembered about the possibility of a renin-sectioning tumor (Feochromocytoma). It is found using sonography, AGG and L and MRI.

The arteriography of the kidneys most clearly reflects the lesions of the renal artery - its narrowing, an excess, aneurysm. Arteriography is required 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), it is DSA.

In recent years, an ultrasound examination of renal blood flow by the method of energy Doppler mapping has been developing rapidly and successfully when examining patients with vasornal hypertension, which in some cases avoids such an invasive study, which is x-ray angiography. MR-angiography, performed in several projections, especially with the use of paramagnetics and three-dimensional reconstruction of the image, allows you to accurately determine the narrowing of the renal artery for the first 3 cm from its mouth and evaluate the degree of occlusion of the vessel. However, it is difficult to judge the condition of more distal areas of arteries based on the results of the grade.

Tumors and cysts of kidneys, bladder, prostate gland

Volumetric formation in the kidney, bladder or prostate gland is one of the most frequently detected syndromes of the lesion of these organs. Cysts and tumors for a long time can develop hiddenly, without causing pronounced clinical symptoms. Laboratory tests of blood and urine have a very relative value due to their nonspicuousness and heterogeneity of the results. It is not surprising that a decisive role in identifying and establishing the nature of the volumetric process is assigned to radiation methods.

The main methods of radiation diagnostics used in patients who are suspected of volumetric education are sonography and CT. The first of them is simpler, cheap and affordable, the second is more accurate. Additional data can be obtained using MRI, Doppler mapping and scintigraphy. When planning surgical interventions on the kidney, angiography may be useful. It is also used as the first stage of intravascular research in embolization of the renal artery before nephrectomy.

On the sonograms, a solitarian cyst is loosened as a rounded echonegative formation, devoid of internal echostructures. This education is sharply outlined, has even contours. Only occasionally, with hemorrhage into the cyst cavity, gentle structural formations can be detected. A large cyst or cyst located near the kidney sinus can cause deformation of cups or pelvis. The near-headed cyst sometimes resembles an expanded pelvis, but in the latter, a rupture of the contour at the place of transition of the pelvis to the ureter is visible. The retention cyst and echinococcus are indistinguishable in some cases. In favor of a parasitic cyst, internal echostructures and deposits of lime in a fibrous capsule indicate. The cyst stands out as a homogeneous and relatively low density rounded formation with even sharp contours. You can install the localization of a cyst in a parenchyma, under a capsule, near a pelvis. The parapelvical cyst is located in the kidney gate and usually grows outward. Parasitic cysts are visible a capsule. CT, like ultrasound, is used for puncture of cysts and kidney tumors.

In urograms, mainly indirect symptoms of cysts are found: pushing, compression, deformation of cups and pelvis, sometimes amputation of the cup. The cyst can cause a semicircular impression on the wall of the pelvis, lead to lengthening the cups, which, as it were, envelop the neoplasm. In the nephrographic phase on linear tomograms, you can get a display of cysts in the form of a rounded defect in contrast of the parenchyma. The possibilities of radionuclide research in the diagnosis of a cystic disease are limited. On the scintigrams of the kidneys, only large large cysts are visualized, more than 2-3 cm in size.

The tactics of examining patients with kidney tumors at first do not differ from such with cysts. At the first stage, it is advisable to perform sonography. Its resolution is quite high: a tumor node is detected by a size of 2 cm. It stands out against the general background as a rounded or oval formation of an irregular shape, not quite homogeneous in echogenic density. The outlines of the node, depending on the type of growth, can be quite clear or uneven and blurry. Hemorrheations and necrosis determine the hypo- and anechogenic areas inside the tumor. This is especially characteristic of the tumor of Wilms (a tumor of embryonic nature in children), which is characterized by cystic transformation.

The further course of the examination depends on the results of sonography. If with it data confirming the presence of a tumor is not obtained, then CT is justified. The fact is that some small tumors in echogenicity differ little from the surrounding parenchyma. On a computer tomogram, a small tumor is visible as a node with a size of 1.5 cm or more. In terms of density, such a knot is close to the renal parenchyma, so it is necessary to carefully analyze the image of the kidney at a number of sections, revealing the heterogeneity of its shadow in any area. Such heterogeneity is due to the presence in the tumor of denser areas, foci of necrosis, sometimes lime deposits. The presence of a tumor is also indicated by such signs as deformation of the contour of the kidney, imprisonment on a cup or sucker. In unclear cases, they resort to the gain, since the tumor node is determined more clearly.

Large neoplasms are clearly visible for CT, especially performed according to an enhanced methodology. At the same time, the criteria for the malignancy of the tumor are the heterogeneity of the pathological formation, the unevenness of its contours, the presence of foci of calcification, as well as the phenomenon of increasing the shadow of the tumor after intravenous administration of a contrast agent. The kidney sinus is deformed or not determined: you can register the spread of tumor infiltration along the vascular leg. With MRI with tumors and kidney cysts, similar paintings are obtained, but its resolution is slightly higher, especially when using a contrast agent. On magnetic resonance tomograms, the transition of the tumor to vascular structures, in particular to the lower half of the vein, is more clearly outlined.

If the tumor is not installed with computed and magnetic resonance imaging, but there is a slight deformation of the pelvis and the patient has a hematuria, then there is reason to use retrograde pyelography to exclude a small tumor of the renal pelvis.

With tumors of medium and large sizes after sonography, it makes sense to produce urography. Already on a viewing radiograph, an increase in the kidneys and deformation of its contour, and sometimes small deposits of lime in the tumors, can be detected. At the urogramkh, the tumor determines a number of symptoms: deformation and pushing of cups and pelvis, and sometimes amputation of cups, uneven contours of a pelvis or a defect of filling in it, deviation of the ureter. On the nephrotomogram, the tumor mass gives an intensive shadow with uneven outlines. This shadow can be heterogeneous due to individual clusters of a contrast medium.

Even with the mentioned 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 differentiate benign and malignant neoplasms, detect small tumors in the cortical layer, evaluate the condition of the renal and lower hollow veins (in particular, is there no tumor thrombus in them), identify the germination of the tumor in neighboring tissues and metastases in the opposite kidney, liver, lymphic nodes. All these data are extremely important for the choice of medical measures.

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

The tumors of the bladder - papillomas and cancer - are recognized with cystoscopy with biopsy, but two circumstances determine the need and value of radiation research. The malignant transformation of papilloma occurs primarily in the depths of the neoplasm, and it is far from always possible to establish it in the study of biopsytas. In addition, with cystoscopy, it is impossible to identify the germination of the tumor into neighboring tissues and metastases in regional lymph nodes.

It is advisable to start a radial study with a bladder tumor with sonography or CT. On the sonogram, the tumor is clearly visible in the filled bubble. Judge about its nature, i.e. On benignity or malignancy, it is possible only if the tumor’s invasion into the wall of the bubble and periwest fiber are found. The early stages of tumor growth are convincingly detected with endovence sonography.

No less clearly the tumor is released on computer and magnetic resonance tomograms, and the latter are especially valuable when identifying the bottom tumor and the roof of the bubble. The advantage of MRI is the opportunity not only to see the lymph nodes affected by metastases, but also to distinguish them from the blood vessels of the pelvis, which is not always possible with CT. On cystograms, the tumor is visible with double contrasting of the bladder. It is easy to determine the position, size, shape and condition of the surface of the tumor. With infiltrating growth, deformation of the bubble wall in the tumor area is set.

The main method of radiation studies 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 clarifying methods that allow us to judge the degree of spread of the tumor process.

With transrectal sonography, congenital and acquired prostate cysts are clearly loomed. Nodular hyperplasia leads to an increase and deformation of the gland, the appearance of adenomatous nodes and cystic inclusions in it. In most cases, a cancerous tumor causes a diffuse increase and a change in the structure of the gland with the formation of hypo- and hyperechogenic areas in it, as well as changes in the size, shape and structure of the seminal vesicles. The detection of any form of decreased echogenicity of the prostate gland is considered an indication for diagnostic puncture under the control of ultrasound examination.

Malignant tumors of the kidneys and prostate gland are known for their tendency to metastasis in the skeleton bones of the skeleton in this case are characterized by osteolithic metastases while the prostate cancer - osteoplastic, primarily in the ribs, spine and bones of the pelvis. In this regard, with all malignant lesions of the urinary system and the prostate gland, a radionuclide study (scintigraphy) of the skeleton is indicated, in some cases augmented by radiography of the suspicious area of the bone.

Malformations of kidneys and urinary tract

Anomalies of kidney development are not always manifested by specific clinical symptoms, but they need to be remembered, since these anomalies are often observed and, moreover, are not so rarely complicated by infection or stone formation. Anomalies in which tumor-like formations are palpated in the stomach in the stomach. It is clear that the doctor can suspect the tumor in the case when it is actually not.

Radiation studies play the main role in identifying and establishing the nature of the abnormalities of the kidneys and urinary tract. We indicate the most common malformations and methods for their detection. The kidney aplasia is very rare, but the doctor’s responsibility for its identification is extremely high. In all radial studies, the image of the kidney in this case is absent, but direct evidence of the innate 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).

Anomalies of the magnitude - large and small kidneys are slightly more often detected. In the first case, there is a kidney with a doubling of a pelvis and two groups of cups. There are also two ureters, but they could merge at a distance of 3 - 5 cm from the kidney. Occasionally, two ureters, departing from one kidney, enter the bladder with separate mouths of one of the options for doubling the ureter - its splitting in the distal section. It is more difficult to recognize a small kidney. The fact of detecting a kidney of a small size is not yet evidence of an innate defect, i.e. Hypoplasia, since the kidney can decrease as a result of nephrosclerosis. However, these two states can be differentiated. With hypoplasia, the kidney retains the correct shape and even outlines, a cup-lobe complex of a conventional shape is loomed in it. The function of the hypoplazed kidney is reduced, but saved. The second kidney usually has large sizes and functions normally

Numerous options for kidney dystopia, i.e. anomalies of their position. The kidney can be at the level of lumbar vertebrae - lumbar dystopia, at the level of the sacrum and iliac - iliac dystopia, in the small pelvis - pelvic dystopia, on the opposite side - cross dystopia. With cross dystopia, different options for fusion of the kidneys are observed. Two of them - L- and S-S-S-Brown Poles - are shown in the same figure. The dystoped kidney has a short ureter, which differs from the lowered kidney. In addition, it is usually turned around the vertical axis, so its pelvis is laterally located, and the cups are medially. Distopted buds can be fraught with their upper ones or, more often observed, the lower poles. This is a horseshoe-shaped kidney.

The anomalies also include polycystic kidneys. This is a kind of state in which multiple cysts of different sizes that are not related to cups and a sucker occur in both kidneys. Already on sightseeing radiographs, you can notice large shadows of the kidneys with slightly wavy contours, but a particularly bright picture is observed during 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. During sonography, they stand out as rounded echonegament formations lying in the parenchyma and pushing cups and a pelvis. On tomograms, cysts are visible no less clearly as clearly delimited formations of low density, sometimes with partitions and lime deposits. On scintigrams with poly-acidosis, large buds with multiple defects (“cold” foci) are visible.

The urographic picture is by no means poor. The cups and pelvis, as it were, are elongated, the cups of the cups are elongated, their forensic section is convertingly expanded. On the walls of cups and pelvis can be flat and semicircular inhabitation. An even more clearly radiological signs of polycystosis in angiograms: Surgery rounded zones are noted

A large number of anomalies of renal vessels are explained by the complexity of the embryonic development of the kidneys. Two equivalent arterial vessels or several arteries can approach the kidney. The additional artery is of practical significance, which exerts pressure on the proloric part of the ureter, which leads to difficulty in the outflow of urine and the secondary expansion of the pelvis and cups up to the formation of hydronephrosis. In the urograms there is an overgrown and narrowing of the ureter in the place where it crosses with an additional vessel, but irrefutable evidence is obtained with renal angiography.

Radiation methods are widely used when choosing a donor kidney and assessing the condition of a transplanted kidney.