KIDNEY (RENAL) ULTRASOUND The kidney sonogram is a noninvasive test used to visualize kidney parenchyma and associated structures,

including renal blood vessels. This procedure is often performed after an intravenous pyelogram (IVP)to define and characterize mass lesions or the cause of nonvisualized kidney. Because no contrast medium is administered, renal ultrasound is valuable for visualizing the kidneys of the patients with iodine hypersensitivities. This procedure is also helpful in monitoring the status of a transplanted kidney, guiding stent and biopsy needle placement, and evaluating the progression of chronic conditions. Renal sonography is a preferred method for evaluating possible hydronephrosis in spinal cord injury patients. Procedure: Preparation Explain the purpose and procedure of the test. Assure the patient that there is no pain involved and that the only discomfort is that caused by lying quietly for a long period. Explain that a liberal coating of coupling agent must be applied to the skin so that there is no air between the skin and transducer and to allow for easy movement of the transducer over the skin. A sensation of warmth and wetness may be felt. Although the acoustic couplant does not stain, advise the patient not to wear good clothing for the examination. Explain that the patient will be instructed to control breathing patterns while the images are being made. Check with ultrasound department for guidelines about fasting. It usually is not necessary but maybe required in certain laboratories. Implementation Have the patient lie quietly on an examining table. Scans are often performed with the patient in the decubitus position. Apply warm oil or gel to the patients skin. Ask the patient to inspire as deeply as possible for visualization of the upper parts of the kidney. Tell the patient that the total study time varies from 15-30 minutes. Normal Values: Normal pattern image indicating normal size and position of kidneys, appropriate flow in renal vessels. Clinical Implications: Abnormal pattern readings reveal: Cysts Solid masses

Hydronephrosis Obstruction of ureters Results provide information on the size, site, and internal structure of a nonfunctioning kidney. Results differentiate between bilateral hydronephrosis, polycystic kidneys, and the small, end-stage kidneys of glomerulonephritis or pyelonephritis. Results may be used to monitor kidney development in children with congenital hydronephrosis. This approach is safer than repeated IVP studies. Perineal fluid collections such as those associated with complications of transplantation may be detected. These collections include abscesses, hematomas, urinomas, and lymphoceles. Solid lesions may be differentiated from cystic lesions. The spread of cancerous conditions from the kidney into the renal vein or inferior vena cava can be detected. If ultrasound is combined with Doppler evaluations, the patency and flow characteristics of the renal vessels may be scrutinized.

Interfering factors: Retained barium from radiology studies causes poor results. Obesity adversely affects tissue visualization.