OS 214 [B]: Digestion and Excretion
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Lec 12: Imaging of the KUB
December 5, 2013
Dr. Rosanna Fragante
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TOPIC OUTLINE
I. Introduction to KUB Imaging
A. KUB X-ray film
B. Intravenous Pyelography
C. Ultrasound
D. CT Scan
II. Renal Anatomical Abnormalities
A. Ptotic kidney
B. Horseshoe Kidney, Pelvic Kidney
C. Vesico-ureteral Reflux
III. Infections
A. Acute Pyelonephritis
B. Chronic Pyelonephritis
C. Renal Abscess
D. Renal Tuberculosis
IV. Calculi and Obstructive Uropathy
A. Stones and Calculi
B. Hydronephrosis
C. Ureteral Stricture
V. Renal Parenchymal Diseases
A. Acute Renal Parenchymal
Disease
B. Masses/Tumors and Cysts
VI. Urinary Bladder
A. Cystolithiasis
B. Prostatic Enlargement
withChronic Bladder
Obstruction/Cystitis
C. Emphysematous Cystitis
D. Chronic Cystitis
E. Contracted Bladder
F. Post-traumatic Bladder
Extrophy
G. UB Malignancy
VII. Adrenal Glands
A. Adrenal Gland Hyperplasia
B. Pheochromocytoma
VIII. Renal Vascular Lesions
Renal Artery Stenosis
Advise the patient to have empty bowel (e.g. take Dulcolax first) to
visualize the outlines of the kidneys and the psoas
Legends:
From the Powerpoint presentation
From the lecturer and other sources (textbook, Internet, etc.)
Note: Dra Fragante said that she will use the same pics in the exam.
I. INTRODUCTION TO KUB IMAGING
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Before using imaging modalities, make sure to perform a good
history and physical examination (PE) first, as these will give you
a working impression and guide you in choosing the appropriate
modalities.
The different modalities used for visualizing the KUB are:
o X-ray film
o Intravenous pyelography (IVP)
o Ultrasound (UTZ)
o Computerized Tomography (CT) Scan
o Magnetic Resonance Imaging (MRI)
History Taking
o Working Impression
o Renal Function: Serum BUN and Creatinine results (to make
sure that the kidney can fully excrete the iodinated contrast
medium)
o History of Allergies (in case patient is allergic to contrast like
iodine; may lead to anaphylactic shock)
o Take note also of comorbidities, e.g. diabetes mellitus,
hypertension
Review on the anatomy of the kidney
o The rectum, uterus, and vagina all had the same origin, with one
opening, the cloaca
o The superior pole of the kidney is oriented medially, while the
lower pole is oriented outward/laterally
o The kidney is a retroperitoneal organ located in the
paravertebral area
o The bladder, however, is extraperitoneally located. That is why if
ever there is a leakage of urine, it does not mix with the
intraabdominal space and organs “(sometimes may go unnoticed
by patients)
o Flow of urine: tubulescalycesureter
o The renal artery enters beside the medullary pyramids and form
the arcuate vessels
Figure 1. Review of the Anatomy of the Kidney. The upper pole is
medially oriented while the lower pole is laterally oriented. The glomeruli
are found in the cortex, while the collecting tubules are found in the
medulla.
A. KUB (KIDNEY, URETER, BLADDER) X-RAY FILM
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KUB X-ray is a plain film evaluation of the abdominal area
Lorvin, Roms, Deni
Figure 2. Normal KUB Film showing the psoas lines and the outlines of
the kidneys. Psoas lines are fat planes that outline the psoas muscles.
Fat is black, bone is white. Note that the right kidney (RK) is normally
lower than the left because of the liver.
B. INTRAVENOUS PYELOGRAPHY
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Series of films with contrast material to better visualize the urinary
system
To see if there is retention of urine
REQUIREMENTS FOR IVP
 Evaluate renal function
o Get the serum BUN and creatinine to be assured that the
contrast material will be excreted
 History Taking:
o Diabetes, HPN
o Inquire about the allergy history of the patient to foresee allergic
reactions to the contrast material that will be used
o To know what to look for in IVP
CONTRASTS
 Ionic- hyperallergenic and hyperosmolar (may cause pain); gives a
burning feeling when given intravenously; more affordable (Php 300
in PGH)
 Non-ionic- hypoallergenic with low osmolarity; more expensive (Php
1500)
IVP PROCEDURE
 Scout film→inject contrast→film 3 minutes after contrast→film again
after 10 minutes→during full bladder→post-void
 Can be used to assess kidney function
Figure 3. IV Pyelogram
Longer, more complete IVP Procedure:
 1. Plain film/Scout film
o Calcific densities→stones
o Used as reference figure
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Lec 12: Imaging of the KUB
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2. Inject contrast material
3. Film at 3 minutes
o Kidney and upper collecting systems visualized
o The contrast in the cortex and the medulla is seen
4. Film at 5 minutes
o Visualize pelvis (collecting system and ireters are opacifying)
5. Contrast at 10 minutes
o Contrast has reached the pelvocalyceal system, ureters
o This is the time to look for stones ion these areas
o If you drink water, you expect to feel full at 10 minutes
6. Film at 15 minutes
o Whole abdomen profile
o Kidneys are still evaluated
o Bladder is starting to fill
7. Full bladder film at 20 minutes
o Full bladder has very smooth borders
o “dapat bilog na”
8. Post-void film
o To check urinary retention
o <50 cc
o You can still see some degree of contrast in the various areas of
the GU system
C. ULTRASOUND
Trivia: The ultrasound originated from sonar waves in the ocean
emitted by submarines
The image is produced through sonar waves that bounce back
Generally available, non-invasive, inexpensive
Used to see the kidney morphology (oval configuration)
You place the probe on top or at the back of the patient
OS 214
Figure 5. Ptotic right kidney- notice that it is almost completely at the
level of the pelvis.
B. HORSESHOE KIDNEY, PELVIC KIDNEY
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Congenital malrotation/ Ectopia
Horseshoe kidney- lower poles of the kidneys are medially
connected with an isthmus→malrotation of kidneys
The central portions are fused and medially rotated, leading to poor
drainage
o Patients with this are prone to infections, stones, and
malignancies so take care of patient’s risk factors
o Horseshoe kidney is medially located
Pelvic kidney- at the level of the pelvis. Left kidney failed to go up,
and right kidney is displaced upward (not only upon standing);prone
to UTI because the path is shorter
Pregnancy (an enlarging uterus) may be problematic: prone to
hydronephrosis and can make labor very difficult
o In pregnancy, there is extrinsic compression of the ureter,
making the female more prone to infection
o Other symptoms are bedwetting and recurrent UTI
Figure 4. Sagittal (left) and transverse (right) views of the kidney
through ultrasonography. The outer hypoechoic area denotes the renal
parenchyma, while the inner hyperechoic area denotes the renal pelvis
(collecting system) – white fatty area.
D. CT SCAN
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A CT Scan emits high energy beams of X-ray that image the whole
abdomen
Has more detail than the other modalities, but more expensive
Patient is scanned in the supine or decubitus position. Occasionally,
a prone position may prove useful
The best images are obtained with the patient’s respiration
suspended; frequently, the end of partial or full inspiration brings the
kidney to better view
Allows us to see cortex, medulla, and renal drainage also the
vascular structures
Able to see axial or coronal sections
Better visualization of kidney and adjacent structures
II. ANATOMICAL ABNORMALITIES
A. PTOTIC KIDNEYS
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Kidney is descended by at least two vertebral levels during standing
position; “drooping lily sign”
The calyceal system is downwardly displaced
Prone to having obstruction and infection
Clinical presentation: when the patient goes from a supine position
to an upright position, there is intermittent pain (because the kidneys
descend)
“Kapag nakahiga po ako, ok lang po. Kapag tumatayo po ako,
sumasakit po likod ko.” Because the ptotic kidney falls
down=intermittent pain
Mostly asymptomatic. If symptomatic, surgery is needed to attach it
upward
It can also lead to stenosis or bleeding at the level of the ureteropelvic junction
Lorvin, Roms, Deni
Figure 6. Horseshoe Kidney (left) and Pelvic/Ectopic Kidney (right)
C. VESICO-URETERAL REFLUX
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Urine goes back to the kidneys (renal pelvis); patients are prone to
pyelonephritis (if there are bacteria in the bladder)
One of the most common causes of infections in the kidneys
Early detection is the key- prevent chronic pyelonephritis (from
infected urine)
Reflux increases risk for infection, recurrent infection leads to
scarring
Results in dilatation of the collecting system when hydronephrosis is
severe
Common in children, causing UTI
In a voiding cystourethrogram (VCUG), you put the contrast in the
bladder and ask the baby to void
Premature babies are prone to reflux due to the immaturity of the
GU system. When the babay voids, there is upward displacement of
the urine, making him/her prone to nephritis
If the urine continues to go up and down, and up and down,
hydronephrosis eventually occurs and this could lead to renal failure
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Lec 12: Imaging of the KUB
OS 214
White arrow-enlarged kidney. Enlargement of the kidney is due to
edema of inflammation. Areas of avascularity are due to toxic secretions
from bacteria (most common is E.coli) which cause vasoconstriction.
Vasoconstriction could cause hypoperfusion in the kidney which makes
it prone to infection and abscess formation. And liquefaction necrosis,
and eventually, kidney dies.
B. CHRONIC PYELONEPHRITIS
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May have cortical irregularities or scarring
Atrophied kidney and cortical abnormalities. If not treated, renal
abscess forms
Figure 7. Vesico-ureteral Reflux. Black arrows point to the reflux (right)
Note: Female GU Tract
 Wiping from back to front after a bowel movement may force germs
into urethra
 Always do it from front to back
III. INFECTIONS
Females are more prone to infection due to close proximity of vagina,
uterus, and urinary bladder to each other,
A. ACUTE PYELONEPHRITIS
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Inflammation of the kidney
Normal findings in almost all various imaging modalities (IVP), so
this is difficult to diagnose using imaging modalities
Can have enlargement of one kidney, hypodense on CT Scan
Nuclear scan provides earlier detection
“mahapding balakang”
Presentation: flank pain, fever, dysuria
Extra-painful if kidney-punched; Pain can be elicited even with
kidney tap “jerking movement”
Risk factors- e.g. stones
Extrusion of contrast may not be as much because bacteria produce
enzymes that may vasoconstrict (lower RBF→ lower GFR)
Seen as hypodensities (poor excretion of contrast due to not much
contrast reaching that area)
Red cup project- spot check of urinalysis of children from grades 1-6
showed that 25% of them have undiagnosed UTI
Figure 10. Cortical scarring which can be a sign of chronic
pyelonephritis. Distance at poles should not differ by greater than 2mm.
on the left kidney, there is thinning of the cortex. The kidneys get smaller
and smaller as they are continually scarred.
C. RENAL ABSCESS
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The only way to treat is to aspirate the renal abscess
Abscess is hypodense/hypoechoic
Predispoding factors: immunocompromised state, chronic steroid
intake, diabetes
Figure 11. Ultrasound (left ) and CT Scan (right) showing renal
abscess. White arrows show fluid densities (due to pus). In UTZ, the
abscess is hyperechoic. In CT Scan, it is dark. It happens when you
do not treat your chronic pyelonephritis.
D. RENAL TUBERCULOSIS
Figure 8. KUB Film showing acute pyelonephritis. Left kidney is
shown to be edematous and larger than the right.
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TB in the Philippines is still a problem
Usually from hematogenous spread from liver and spleen leading to
bacilli deposition in the kidney
Potty kidney- areas of necrosis and calcifications
Presents with “sterile pyuria”- pus on urinalysis, but organism can’t
be isolated
Patients already come when they are in the late stage of TB
If you get UTI unresponsive to most antibiotics, rule out TB
With renal tuberculosis, the kidney becomes one bif putty mass of
pus, which eventually calcifies. There is multiple involvement of the
liver and both kidneys, as seen in the photo on the CT Scan photos
Figure 9. Ultrasound (left) and CT Scan (right) showing Acute
Pyelonephritis (pointed by their respective arrows). Black arrow-stone.
Lorvin, Roms, Deni
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Lec 12: Imaging of the KUB
Figure 12. KUB Film (left) and CT Scan (right) with foci of renal
tuberculosis, shown by white arrows. Multiple calcific densities are
seen. In the ureter, there are stones. CT scan (upper right) shows
presence of multiple granuloma in the liver (possible source of
genitourinary TB).
OS 214
Figure 14. Staghorn calculi in both plain (left) and contrast (right)
films. They can occupy a whole collecting system. They conform to the
configuration of the pelvocalyceal system.
IV. CALCULI AND OBSTRUCTIVE UROPATHY
A. STONES AND CALCULI
 Stones are spiculated and cause extreme pain (stones with high
calcium content are more radio-dense)
 Analogy of pain from stones in ureter: glass rubbed on palate
 Uric acid stones
o intake of beans, beer, meat, oats (eating oatmeal 3x a day, since it
is high in uric acid)
o usually not radioopaque or radiolucent on xray (along with cystine
stones) because of low calcium content
 Calcium stones
o from salty foods ( ie. junk food), calcium tablets, mineral water with
lots of minerals
o very radioopaque (appears very white on xray film because it is
calcified)
o hard stones
o hard to treat – need surgery
 Stones form in the calyx may be transported to the renal pelvis and
then to the ureter; obstruction may lead to hydronephrosis
 Staghorn calculi
o Stones can occupy an entire collecting system, conforming to the
pelvocalyceal system; thus, the “reindeer configuration”.
o Clinical presentation: “nangangalay ang balakang”
o Can be detected by ultrasound and CT scan regardless of
composition (calcium, uric acid etc)
o Avoid calcium supplements when not menopausal yet, as it can be
a predisposing factor. Drink milk instead.
Figure 15. Renal Calculi as shown in UTZ. The stones are
hyperechoic, with shadowing behind (below) them. Does not depend
on the stone composition, whatever it is, you’ll see it on UTZ. . Black
arrow on the left photo shows a stone in the proximal ureter
Figure 16. CT-stonogram showing the stones. Black arrows point to
stones found in the renal pelvis. This is requested when X-ray is not
enough; better image quality than UTZ.
Composition of the stone can also be identified using CT-stonogram.
If >500 HFU (high frequency ultrasound) – Calcium stones, <500 HFU
– Uric acid or cystine stone
You can assign a CT number based in the appearance of the stone
which can determine the type of management for the patient (cystine
and uric acid stones can be melted by alkalinizing the urine while
calcium stones need shockwave or surgery)
Figure 13. Renal calculi, as shown by arrows (white calcified structures
hence calcium stones) – hyper dense laminated calcifications
Lorvin, Roms, Deni
 UTZ and CT – good modalities for stone detection because they
are not dependent on the composition of the stone, can be easily
visualized.
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Lec 12: Imaging of the KUB
OS 214
C. URETERAL STRICTURE
 An area of narrowing in the ureter
 Stones and inflammation are more common causes  can lead to
fibrosis and scarring, leading to stricture
 “Parang zesto straw yung normal caliber ng ureter.” But it is much
less in stricture
Figure 17. Ureteral stones as seen in plain and contrast films
using retrograde pyelography (RPG). Notice the discontinuation of
the contrast because of obstruction by the stones. If patient has flank
pain – in the clinics, diagnostics: stenograph.
B. HYDRONEPHROSIS
 “Hydro meaning water and nephrosis meaning collecting system of
the kidney”; accumulation of water in the kidney
 Obstruction in the collecting system --> urine cannot drain down to the
bladder dilatation of the collecting system
 Too much ballooning/dilatatonparenchyma compression thinning
of (cortex) parenchyma with loss of function
 May be uni- or bilateral
 KUB/IVP: Reduced excretion of contrast, enlargement of kidneys
 in chronic obstruction prone to infection consequent pus
formation --> Hydronephrosis
Figure 18. Hydronephrosis. Left film shows an enlarged right kidney.
Right film shows a right kidney with diminished cortex and dilated
collecting system.
Ureter
PCS
pus/debris
Figure 19. UTZ showing hydronephrosis. Note the much-dilated
pelvis, and the thinned out parenchyma. PCS – pelvocalyceal system;
Ur – ureter. *black areas are fluid in the collecting system; pus and
debris in ureter; becomes septicaspirate for kidneys to recover.
Lorvin, Roms, Deni
Figure 20. Ureteral stricture. Left ureteral stone in retrograde
pyelogram; stricture at the proximal segment (narrowing), dilated pelvis
(stricture or scar remains even if stone has been removed)
V. RENAL PARENCHYMAL DISEASE
A. ACUTE RENAL PARENCHYMAL DISEASE
 Patients are edematous, ascitic (with pleural effusion) because the
glomeruli are unable to filter; fluid can’t be excreted.
 “Akala ng magulang, malusog yung anak, yun pala ascites na.”
 Enlarged (edematous) kidneys on UTZ
 Hyperechogenic ball-like kidney
 Most common: glomerulonephritis
Figure 21. UTZ showing acute renal parenchymal disease. The
areas are hyperechoic (lighter/brighter than normal) because of
inflammation.
B. MASSES/TUMORS AND CYSTS
RENAL CYSTS
 Most common in adults; increase in incidence with age
o Fluid-filled and can cause obstruction if large enough
o Seen as “fraying of the collecting system”  tubules are so dilated
then they pinch off
o May cause obstruction
o Hard to palpate due to retroperitoneal location unless the mass is
enlarged
o Usually benign
o A 50 year old has a 50% chance of having a renal cyst
o Renal tumors may metastasize to nearby organs such as the liver
and spleen; first symptom is hematuria (painless).
o Do not be alarmed when you already see a cyst on UTZ. Confirm
first if benign or malignant. Not alarming if less than three, small
and does not cause obstruction; advise to have regular check ups
WILMS TUMOR
o most common in the pediatric population – akala mataba, sa isang
side lang pala at may tumor na
o may occupy the whole kidney;
o diffused, multiple masses
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Lec 12: Imaging of the KUB
OS 214
o Can be palpated in the abdomen of the child so don’t forget when
you rotate in the wards (but not readily palpable until its very large)
RENAL CELL CARCINOMA
o More common in adults
o Diffuse malignancies – because of cancers like lymphomas
(multiple masses)
o Detected late because kidneys are retroperitoneal When
palpable, it is already large!
o Age >50 y/o- regular checkup is recommended
Figure 25. UTZ (left) and CT scan (right) showing renal involvement in
diffuse malignancies (eg. lymphomas).
VI. URINARY BLADDER
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Normal filled UB: very smooth borders, like a balloon
Normal post-void UB: not more than 50cc of urine left; if more
than 50cc, then UB is more prone to infection
If the urine is expelled in drops, then suspect obstruction
Full bladder can accommodate 200 cc of fluid (as much as 800 cc)
Bladder content of 200cc: start of urge to urinate
Age >50 years old urinate more often due to lessened capacity of
the bladder
Problem with males with enlarged prostate glands
Figure 22. Cysts, as shown in IVP (left), UTZ (upper right, has fluid
beside cyst) and CT scan (lower right). Cysts in IVP are white.
Figure 26. Normal filled UB (left and middle) and normal post-void UB
(right).
A. CYSTOLITHIASIS
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Figure 23. Wilms tumor or nephroblastoma in UTZ (left) and CT scan
(right). Most common in the pediatric population; chance of
metastasis is high, common in the lungs
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LM
Common in the Philippines because we are near the sea (high salt
diet)
Stones of the Urinary Bladder; calcific, rounded/ovoid opacity that
have the same density as bone and may look like eggs
Usually lamellated; lamellae represent times of deposition, just like
in “tree rings”
progression: small stones in the UB accumulates more sediment -> lamellated large stones
High salt diet, like living near the sea, can be a risk factor
Capacity of UB is decreased; there may also be reflux
Patient becomes more prone to cystitis
Moves with changes in position
Usually smooth borders but can be mulitlobulated
Plain
Contrast
SM
Figure 24. CT scan images showing renal cell carcinoma (left, with
arrows) and organ metastases (LM – liver metastasis, SM – splenic
metastasis).
Lorvin, Roms, Deni
Figure 27. Plain and contrast films showing cystolithiasis. Right
image is very prone to having chronic cystitis.
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Lec 12: Imaging of the KUB
OS 214
D. CHRONIC CYSTITIS
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UB may become fibrotic
Prone to vesico-ureteral reflux
VU Reflux: Infected urine goes back to the kidneys (due to
increased pressure in the bladder) which can lead to chronic
pyelonephritis
Can lead to chronic renal parenchymal disease
Inflammation  thicker bladder wall lumen size decreases
(contracted bladder) less capacity of bladder  voids often
VUR
Figure 28. UB calculi with blood clots, as shown in UTZ. Presents
most commonly with hematuria (gross/tea colored/mildly red) and
dysuria
B. PROSTATIC ENLARGEMENT WITH CHRONIC BLADDER
OBSTRUCTION/CYSTITIS
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Patients have poor stream due to retention (dribbling- with
obstruction, frequent urination)
If large enough, can present as abdominal mass.
Rectal UTZ is used to evaluate prostate (male greater than 50 years
old)
Figure 31. Chronic cystitis: with vesico-ureteral reflux (VUR), as
shown in contrast film (left), and with thickened bladder wall (white lining
of the UB located in the center), as shown in CT scan (right).
Enlarged prostate
Figure 29. Enlargement of the prostate, leading to UB obstruction and
cystitis. Bladder is elevated by prostate (left). Sometimes appears like a
Christmas tree and may lead to formation of UB diverticulum due to high
pressure, prone to infection and malignancy; Note the irregular bladder
wall borders
Figure 32. Normal findings in UTZ (top images), compared to findings of
cystitis in UTZ (bottom images). The normal UB has smooth walls, while
the cystitic UB has rough edges.
C. EMPHYSEMATOUS CYSTITIS
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E. CONTRACTED URINARY BLADDER
Characterized by infection of urinary bladder (UB) and UB wall with
gas-forming organisms; thus, there is air outlining the wall of the
bladder. “Like inflating a balloon”
Formation of UB diverticulum prone to cystitis.
“Mickey Mouse” appearance because of diverticula (thinning of the
muscular wall leading to outpouching)
UB Div
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UB capacity approximately only 20cc
Inflammation  thicker bladder wall lumen size decreases
(contracted bladder) less capacity of bladder  voids often
Treated with bladder augmentation: Creating a “neobladder” or
ileal conduit from an ileal segment (ileal conduit) to have larger
capacity of bladder
UB Div
Figure 30 . Emphysematous cystitis. Note the outline of air in the UB
wall (shown by arrows) and the “Mickey Mouse” appearance (UB Div –
UB diverticula)
Lorvin, Roms, Deni
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Figure 33. Contracted bladder, consequence of TB (fibrosis and
scarring). Can have urine output of around 2 tbsp a day
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F. POST-TRAUMATIC BLADDER DYSTROPHY
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UB not only descends, but goes out
There is widening of the symphysis pubis even separated
sometimes; also, there is bilateral dilatation of the collecting systems
(including ureters)
Due mostly to straddle injuries (e.g. motorcycle accidents, pelvic
fractures, horseback riding)
May involve urethras in males
Figure 36. CT scans showing normal adrenal gland (left, appears like a
sliver of tissue) and hyperplastic adrenal gland (right).
B. PHEOCHROMOCYTOMA
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Tumors/mass of the adrenal medulla, resulting in increase in
catecholamine production – may result to increase in blood pressure
Hypertension is one manifestation (from catecholamine secretion)
Triad: Diaphoresis, palpitations, headache
Extreme case: fainting (due to hypertension) while urinating.
As opposed to adrenal gland hyperplasia, pheochromocytoma look
like round masses; in the former, the original shape is somewhat
retained
Figure 34. Bladder extrophy. The ureters are dilated, and the
symphysis pubis widened.
G. UB MALIGNANCY
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There is a change from “full moon” to “half/crescent moon”
UB wall may be eaten up by tumors
Risk factors: chronic infection, smoking and alcohol intake, also
those exposed to chemicals from working in factories, drug abuse,
those who handle chemotherapeutic agents
Most common history finding: gross hematuria ( urine is like iced
tea or orange juice), infection, working with chemicals, illegal
drug usage
Most common histopathologic type: transitional cell CA
(multicentric)
Figure 37. Pheochromocytoma, as seen in UTZ (left) and CT scans
(right)
VIII. RENAL VASCULAR LESIONS
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Renal angiography – used for visualizing the vascular tree of the
kidneys; aside from locating lesions, this is also used in screening
for organ transplants
In angiography, sometimes you can see many renal arteries (our
professor has seen 8 renal arteries!)
Philippines has one of the highest rates of kidney transplantations
(up to 4 or 5 transplants a day!)
Figure 35. UB malignancy as shown in CT scan (left) and contrast film
(right), where the “crescent moon” is very evident.
VII. ADRENAL GLANDS
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Normal Thickness 5-6mm to 10mm
Very important cause it produces catecholamines and
corticosteroids
Modalities of choice: CT or MRI because of the relative small size of
the adrenals
A. ADRENAL GLAND HYPERPLASIA
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Can produce excess ACTH, causing increased blood pressure.
The contralateral gland undergoes atrophy because of negative
feedback. (Inc glucocorticoid production from hyperplastic adrenals,
decreased ACTH, atrophy of contralateral gland due to loss of
function)
Lorvin, Roms, Deni
Figure 38. Normal renal angiogram
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Lec 12: Imaging of the KUB
OS 214
A. RENAL ARTERY STENOSIS


Renin-Angiotensin pathway is the cause of hypertension in patients
with Renal Artery Stenosis
The RAAS compensates for low renal blood flow thus retaining more
fluids and causes the hypertension
Before Stenting
After Stenting
Figure 39. The left angiogram shows renal artery stenosis, while the
right angiogram shows results after stenting
END OF TRANSCRIPTION
Greetings!
Lorvin: Merry Christmas and a Happy New Year!
Roms: Hi!!
Deni: AFTG!
Lorvin, Roms, Deni
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