Urinary Protocol (Renal or Kidney)
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This protocol includes images of the kidneys and bladder
You must always evaluate the entire organ first before you store an image
You should understand completely why you stored the image and identify everything in the image
Multiple breathing techniques may be required
Organ/
Order
Scan Plane
Label
RT KID SAG LAT
RT KID SAG MID
Sagittal
plane of
the kidney
RT KID SAG MID
RT Kidney
RT KID SAG MED
RT KID TX SUP
Transverse
plane of
the kidney
RT KID TX MID
RT KID TX INF
LT KID SAG LAT
LT KID SAG MID
Sagittal
plane of
the kidney
LT KID SAG MID
LT Kidney
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Sagittal
BLADDER SAG
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Transverse
BLADDER TX
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LT KID SAG MED
LT KID TX SUP
Transverse
plane of
the kidney
LT KID TX MID
LT KID TX INF
Bladder
Key Landmarks Identified
AK\backup\Abdomen I\Protocols
Renal parenchyma and capsule
Renal parenchyma and capsule
Renal sinus
Renal parenchyma and capsule
Renal sinus
Measurement
o Length measurement from superior to inferior pole
Renal parenchyma and capsule
Renal sinus at hilum
Renal parenchyma and capsule
Renal sinus
Liver
Renal parenchyma and capsule
Renal sinus at hilum to include renal vessels
Renal parenchyma and capsule
Renal sinus
Renal parenchyma and capsule
Renal parenchyma and capsule
Renal Sinus
Renal parenchyma and capsule
Renal Sinus
Measurement
o Length measurement from superior to inferior pole
Renal parenchyma and capsule
Renal sinus at hilum
Renal parenchyma and capsule
Renal sinus
Renal parenchyma and capsule
Renal sinus at hilum to include renal vessels
Renal parenchyma and capsule
Renal sinus
Mid and bladder wall
Mid and bladder wall
Urinary Protocol
Anatomical/ Image Correlation
Lateral
Superior
Medial
Lateral
Mid
Mid
Medial
Sagittal Rt. Kidney with lateral,
mid and medial imaging planes
Sagittal sonographic
appearance. Mid
shows length
measurement location
Inferior
Transverse locations for
superior, mid and inferior
Transverse sonographic
images
appearance
Normal Measurement Ranges
Structure
Kidney
Area of Interest
Mid
Plane
Sagittal
Measurement
Length 10-12 cm
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Kidney
Mid
Sagittal
AP 2-3 cm
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Kidney
Mid
Transverse
Width 5-7.5 cm
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Bladder Wall
Area of
thickening
Transverse
3-6 mm
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Comments
Measure from superior pole to
inferior pole through the kidney
This is site specific – only taken if 3
measurements are required:
o Measure anterior to posterior
This is site specific – only taken if 3
measurements are required:
o Measure in a transverse plane
though the mid kidney
This is an AP measurement for a
distended bladder wall
o Only performed if abnormalities
are suspected
Common Laboratory Values to be Reviewed prior to Examination
Lab Value
Blood urea nitrogen
(BUN)
Creatinine
White blood cell count
(WBC)
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Organ
Kidneys
Level
Increased
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Indication or Association
Renal failure or renal disease
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Kidneys
Kidneys
Bladder
Increased
Increased
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Renal failure or renal disease
Indicates infection
AK\backup\Abdomen I\Protocols
Urinary Protocol
Tips
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Roll the patient up LLD and RLD, if necessary, to see kidneys better
o Use the liver on the right as a window
o Use the spleen on the left as a window
If urinary obstruction is a concern, use color Doppler to look for bladder jets to verify open ureter
If patient has a Foley catheter and the bladder is of concern, ask the patient’s nurse for permission to clamp the
bag shut at the beginning of the study so the bladder will fill while you scan - REMEMBER TO UNCLAMP WHEN
STUDY IS COMPLETE
Coronal Scanning
o Sometimes, especially on the left, the kidney can be seen best scanning coronally. Anterior and posterior
images can be obtained from the coronal scan plane.
 The medial and lateral images cannot be obtained from this plane.
 Therefore, anterior, mid, and posterior images in coronal should documented.
 The renal parenchyma, sinus, and capsule will be seen in each image
 Label Coronal - Anterior, Mid, or Posterior
Pathology Seen
o Gray scale sagittal and transverse images
o Gray scale sagittal and transverse images with 3 measurements (length, width, and height)
o Color Doppler image to document the presence of blood flow
o Spectral Doppler image to document type and velocity of blood flow
o For hydronephrosis, demonstrate connection of the dilated pyramids to the renal pelvis and include ureter
images if the ureter is dilated.
o For renal calculi, move the focal zone to the level of the calculus to aid in demonstrating posterior
shadowing
o If a pathology is seen in the bladder, roll the patient onto their side to determine if the pathology is mobile
or attached to the bladder wall.
AK\backup\Abdomen I\Protocols