Ultrasound examination (ultrasound) of the kidneys and ureters

The urinary system includes the following organs structuring it – kidneys, ureters, urethra, bladder. Most often, the kidneys and ureters are involved in the pathological process, which are most often subject to serious pathological processes. For a detailed study of emerging problems of the kidneys or ureters, an ultrasound diagnostic method is successfully used.

General indications and preparatory procedures for ultrasound

Ultrasound examination of the urinary organs is performed in cases where there is a suspicion of inflammatory diseases, nephrosclerosis, various diseases of the body, pathologies leading to urodynamic disorders, urolithiasis, congenital anomalies, cyst formations and oncological diseases, as well as for preventive purposes to assess health status.

The preparatory stage for an ultrasound examination of the kidneys and ureters means the creation of such conditions under which the diagnosis will bring the most accurate results of the state of the internal organs. Despite the high quality of modern ultrasound devices, many tissues and organs are characterized by weak echogenicity, and in order to increase it, the patient must prepare for the procedure in a certain way. At the same time, specialists take into account the principles of ultrasound diagnostics, which indicate that sound waves can be scattered in an environment with air and reflected in an environment with a large amount of liquid.

That is why a few days before the study, it is recommended to review your diet and exclude foods that promote gas formation. A few days before the procedure, it is undesirable to eat raw fruits and vegetables, carbonated drinks, alcohol, rye bread, legumes. In some cases, in the presence of concomitant diseases of the gastrointestinal tract, it is recommended to conduct a cleansing enema 2-3 days before the diagnosis.

Ultrasound examination of the kidneys and ureters is performed regardless of the state of fullness of the stomach, so the patient does not need to control food intake. An hour before the planned procedure, it is recommended to drink 4 glasses of pure non-carbonated water, which will increase the echo signal and improve the accuracy of the procedure. With very strong urge to go to the toilet on the eve of the diagnosis, you should empty your bladder and drink water again.

During the ultrasound examination of the kidneys and ureters, various injection procedures can be performed that will require different preparation.

Preparation for ultrasound with nephrostomy

In some clinical conditions, there is a need for an invasive procedure called a nephrostomy. At the same time, a catheter is inserted through the abdominal wall, under the control of ultrasound, into the kidney cavity, with the help of which urine is drained.

Nephrostomy is necessary for patients with a violation of the natural outflow of urine from the kidneys through the ureters, in the presence of oncological processes, stones or strictures. If you do not provide timely outflow of urine, then hydronephrosis is formed (filling the cavity of the kidney with urine, followed by the formation of atrophy of its tissues). In addition, a violation of the outflow of urine leads to the development of pyelonephritis. Sometimes a nephrostomy is performed to access the ureters to crush the formed stones, as well as to conduct chemotherapy for cancer.

To perform a nephrostomy, some preparation of the patient is required. It includes the mandatory delivery of a set of tests that are usually necessary before any surgical intervention:

• blood tests;
• urine tests;
• urography;
• coagulogram;
• biochemistry.

Sometimes, with this diagnostic method, computed tomography is also performed for a more complete picture of the disease.

Preparation for ultrasound during laparoscopy of ignipuncture cysts

Ignipuncture is a decompression surgical procedure aimed at opening the resulting cysts and introducing a sclerosing agent into them. This procedure allows you to reduce the pressure inside the kidneys, which minimizes pain in the patient. Sometimes, if there are no special difficulties with the treatment of a cyst, surgical ignipuncture is replaced by a laparoscopic puncture under ultrasound control. This method is an invasive percutaneous puncture of the cyst without open surgical access to it, under ultrasound guidance.

Special preparation for such a small operation is not required, except that it is performed on an empty stomach.

Preparing for an Ultrasound for a Kidney Biopsy

A biopsy is a collection of tissue from a specific organ for further diagnosis. There are open and closed biopsies, when tissues for morphological analysis are obtained by puncture, or during surgical access to the organ under study. Biopsy tissues are examined for:

• clarification of the diagnosis;
• clarification of the dynamics of the ongoing therapy;
• monitoring changes in the condition of the kidneys after transplants.

As preparation for ultrasound of the kidneys for closed percutaneous biopsy, the patient is recommended to take blood tests, urine tests, radiography and urography of the kidneys, and a coagulogram. With severe hypertension, the patient is carefully reduced and set to a normal level of pressure before and after the biopsy. An additional ultrasound is performed before the biopsy. Doctors recommend that you stop taking medications, in particular coagulants and anti-inflammatory drugs. You also need to start following a diet that helps reduce flatulence 3 days before the procedure. Before starting the study, you need to fill the bladder by drinking about half a liter of clean water.

Thus, it will not be difficult to prepare for an ultrasound examination of the kidneys and ureters, however, in each case, individual recommendations of specialists are possible, which must be followed.

Kidney ultrasound

In the event of pain in the lumbar region, a change in the color of urine, pain during urination and abnormalities in urine tests and blood biochemistry, ultrasound of the kidneys is indicated for diagnostic purposes. Including indications for this diagnosis are various edema, diagnosed pyelonephritis, injuries of the urinary organs, cystitis, indications for examination of the arteries of the kidneys in cases of hypertension, urolithiasis, gout, diabetes mellitus, cysts and focal renal diseases.

Ultrasound of the kidneys is performed in the supine position on the side, back or abdomen, and with nephroptosis – standing. Under normal conditions, the kidney is about 12 centimeters long, its width and thickness is 5 centimeters, its parenchyma is homogeneous, and echogenicity is normal. Normally, the expansion of the pyelocaliceal system is also unacceptable, the anteroposterior size of which is usually 1,5-2 centimeters. During an ultrasound examination, both the kidney and the tissue around it are examined. However, for many categories of citizens, these parameters may differ from the above. These categories include pregnant women, the elderly, children. If during the ultrasound diagnosis of the kidneys, neoplasms are detected, then the measurement of blood flow by the Doppler method is mandatory.

Ultrasound examination of the ureters

In a normal physiological state of a person, the ureters cannot be determined. Their visualization is available only with strong dilations resulting from pathologies of a different nature, for example, the formation of stones, cicatricial narrowing of the ureters or other obstructive causes. Therefore, for the purpose of a detailed diagnosis of the condition of the ureters, ureteroscopy is most often resorted to. The essence of the method is the introduction of a microscopic sensor up through the lower urinary tract. This study is the only effective method for examining the ureters from the inside.

The ureters are anechoic tubular echo structures, which should normally be about 30 centimeters long and about 5 millimeters in diameter. The ureters extend from the renal pelvis to the bladder. With their diseases, symptoms such as the appearance of traces of blood in the urine, painful urination, pain in the iliac and lumbar regions are found.

When urolithiasis occurs, the ureters expand due to the accumulation of urine due to obstruction of their lumen by the formed stones. With the help of an ultrasound examination of the ureters, it is easy to determine the localization and size of the calculi, since they have a different echogenicity from the normal cavity of the ureter. With the development of tumors, the contour of the ureters changes.

Ultrasound of the ureters is often performed in parallel with ultrasound of the kidneys, and if necessary, it can be done individually for certain indications. The ureters are examined by external ultrasound, transrectal or transvaginal access.

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