diagnotic imaging of nephrocalcinosis
TRANSCRIPT
![Page 1: Diagnotic Imaging of Nephrocalcinosis](https://reader034.vdocuments.mx/reader034/viewer/2022042605/587171611a28ab58758b791f/html5/thumbnails/1.jpg)
Genito-Urinary System
Nephrocalcinosis
![Page 2: Diagnotic Imaging of Nephrocalcinosis](https://reader034.vdocuments.mx/reader034/viewer/2022042605/587171611a28ab58758b791f/html5/thumbnails/2.jpg)
Mohamed Zaitoun
Assistant Lecturer-Diagnostic Radiology Department , Zagazig University Hospitals
EgyptFINR (Fellowship of Interventional
Neuroradiology)[email protected]
![Page 3: Diagnotic Imaging of Nephrocalcinosis](https://reader034.vdocuments.mx/reader034/viewer/2022042605/587171611a28ab58758b791f/html5/thumbnails/3.jpg)
![Page 4: Diagnotic Imaging of Nephrocalcinosis](https://reader034.vdocuments.mx/reader034/viewer/2022042605/587171611a28ab58758b791f/html5/thumbnails/4.jpg)
![Page 5: Diagnotic Imaging of Nephrocalcinosis](https://reader034.vdocuments.mx/reader034/viewer/2022042605/587171611a28ab58758b791f/html5/thumbnails/5.jpg)
Knowing as much as possible about your enemy precedes successful battle
and learning about the disease process precedes successful management
![Page 6: Diagnotic Imaging of Nephrocalcinosis](https://reader034.vdocuments.mx/reader034/viewer/2022042605/587171611a28ab58758b791f/html5/thumbnails/6.jpg)
Nephrocalcinosisa) Calculib) Nephrocalcinosis
![Page 7: Diagnotic Imaging of Nephrocalcinosis](https://reader034.vdocuments.mx/reader034/viewer/2022042605/587171611a28ab58758b791f/html5/thumbnails/7.jpg)
a) Calculi :1-Incidence2-Radographic Features
![Page 8: Diagnotic Imaging of Nephrocalcinosis](https://reader034.vdocuments.mx/reader034/viewer/2022042605/587171611a28ab58758b791f/html5/thumbnails/8.jpg)
1-Incidence :-5% of population-If a stone passes into the ureter , there are
three areas of ureteric narrowing where the stone may lodge :
a) Just past the UPJb) Where the ureter crosses the iliac vesselsc) At the UVJ (most common)
![Page 9: Diagnotic Imaging of Nephrocalcinosis](https://reader034.vdocuments.mx/reader034/viewer/2022042605/587171611a28ab58758b791f/html5/thumbnails/9.jpg)
![Page 10: Diagnotic Imaging of Nephrocalcinosis](https://reader034.vdocuments.mx/reader034/viewer/2022042605/587171611a28ab58758b791f/html5/thumbnails/10.jpg)
2-Radographic Features :a) Plain Radiographyb) U/S c) IVPd) CT
![Page 11: Diagnotic Imaging of Nephrocalcinosis](https://reader034.vdocuments.mx/reader034/viewer/2022042605/587171611a28ab58758b791f/html5/thumbnails/11.jpg)
a) Plain Radiography :-Radiopaque calculus , 90%-Radiolucent calculi are best detected by IVP
b) U/S :-Hyperechoic focus (calculus) , posterior
shadowing , calculi 3 mm or less may not be detected
![Page 12: Diagnotic Imaging of Nephrocalcinosis](https://reader034.vdocuments.mx/reader034/viewer/2022042605/587171611a28ab58758b791f/html5/thumbnails/12.jpg)
![Page 13: Diagnotic Imaging of Nephrocalcinosis](https://reader034.vdocuments.mx/reader034/viewer/2022042605/587171611a28ab58758b791f/html5/thumbnails/13.jpg)
![Page 14: Diagnotic Imaging of Nephrocalcinosis](https://reader034.vdocuments.mx/reader034/viewer/2022042605/587171611a28ab58758b791f/html5/thumbnails/14.jpg)
c) IVP :-Delayed and persistent nephrogram due to
ureteral obstruction-Column of opacified urine extends in ureter
from renal pelvis to lodged calculus (diminished or absent peristalsis)
d) CT :-CT detects most calculi regardless of calcium
content
![Page 15: Diagnotic Imaging of Nephrocalcinosis](https://reader034.vdocuments.mx/reader034/viewer/2022042605/587171611a28ab58758b791f/html5/thumbnails/15.jpg)
(a) IVP shows a normal flow from the kidneys, through the ureters, to the bladder (white arrows), (b) shows a kidney stone blocking the normal flow of urine in the ureter on the right
![Page 16: Diagnotic Imaging of Nephrocalcinosis](https://reader034.vdocuments.mx/reader034/viewer/2022042605/587171611a28ab58758b791f/html5/thumbnails/16.jpg)
IVP (30-minute delay image) of the right kidney shows a moderately hydronephrotic collecting system to the level of a proximal ureteral stone (arrow)
![Page 17: Diagnotic Imaging of Nephrocalcinosis](https://reader034.vdocuments.mx/reader034/viewer/2022042605/587171611a28ab58758b791f/html5/thumbnails/17.jpg)
On a scout image obtained before excretory urography, a calculus fills nearly the entirety of a bifid right renal collecting system, giving it a branched appearance that resembles the antlers of a stag
![Page 18: Diagnotic Imaging of Nephrocalcinosis](https://reader034.vdocuments.mx/reader034/viewer/2022042605/587171611a28ab58758b791f/html5/thumbnails/18.jpg)
![Page 19: Diagnotic Imaging of Nephrocalcinosis](https://reader034.vdocuments.mx/reader034/viewer/2022042605/587171611a28ab58758b791f/html5/thumbnails/19.jpg)
![Page 20: Diagnotic Imaging of Nephrocalcinosis](https://reader034.vdocuments.mx/reader034/viewer/2022042605/587171611a28ab58758b791f/html5/thumbnails/20.jpg)
b) Nephrocalcinosis :-Refers to renal parenchymal calcification-The calcification may be dystrophic or metastatic
>>>1-Dystrophic calcification :-There is deposition of calcium in devitalized tissue
, usually resulting from ischemia or necrosis-This type occurs in infection, tumors , abscesses
and hematomas
![Page 21: Diagnotic Imaging of Nephrocalcinosis](https://reader034.vdocuments.mx/reader034/viewer/2022042605/587171611a28ab58758b791f/html5/thumbnails/21.jpg)
T.B. autonephrectomy
![Page 22: Diagnotic Imaging of Nephrocalcinosis](https://reader034.vdocuments.mx/reader034/viewer/2022042605/587171611a28ab58758b791f/html5/thumbnails/22.jpg)
T.B. autonephrectomy
![Page 23: Diagnotic Imaging of Nephrocalcinosis](https://reader034.vdocuments.mx/reader034/viewer/2022042605/587171611a28ab58758b791f/html5/thumbnails/23.jpg)
![Page 24: Diagnotic Imaging of Nephrocalcinosis](https://reader034.vdocuments.mx/reader034/viewer/2022042605/587171611a28ab58758b791f/html5/thumbnails/24.jpg)
2-Metastatic nephrocalcinosis :-Occurs most commonly with hypercalcemic
states caused by hyperparathyroidism , renal tubular acidosis and renal failure
-Classified according to calcium deposition into cortical or medullary nephrocalcinosis
![Page 25: Diagnotic Imaging of Nephrocalcinosis](https://reader034.vdocuments.mx/reader034/viewer/2022042605/587171611a28ab58758b791f/html5/thumbnails/25.jpg)
a) Cortical Nephrocalcinosis :-Etiology :1-Acute cortical necrosis2-Chronic glomerulonephritis3-Chronic hypercalcemic states4-Ethylene glycol poisoning5-Sickle cell disease6-Rejected renal transplants-U/S :Cortical nephrocalcinosis is seen as increased cortical
echogenicity which may produce acoustic shadowing
![Page 26: Diagnotic Imaging of Nephrocalcinosis](https://reader034.vdocuments.mx/reader034/viewer/2022042605/587171611a28ab58758b791f/html5/thumbnails/26.jpg)
![Page 27: Diagnotic Imaging of Nephrocalcinosis](https://reader034.vdocuments.mx/reader034/viewer/2022042605/587171611a28ab58758b791f/html5/thumbnails/27.jpg)
![Page 28: Diagnotic Imaging of Nephrocalcinosis](https://reader034.vdocuments.mx/reader034/viewer/2022042605/587171611a28ab58758b791f/html5/thumbnails/28.jpg)
![Page 29: Diagnotic Imaging of Nephrocalcinosis](https://reader034.vdocuments.mx/reader034/viewer/2022042605/587171611a28ab58758b791f/html5/thumbnails/29.jpg)
![Page 30: Diagnotic Imaging of Nephrocalcinosis](https://reader034.vdocuments.mx/reader034/viewer/2022042605/587171611a28ab58758b791f/html5/thumbnails/30.jpg)
b) Medullary Nephrocalcinosis :-Etiology :1-Hyperparathyroidism (40 %)2-Renal tubular acidosis (20 %)3-Medullary sponge kidney4-Bone metastases5-Chronic pyelonephritis , renal papillary necrosis6-Cushing’s syndrome7-Hyperthyroidism8-Malignancy , sarcoidosis , sickle cell disease , vitamin D
excess and Wilson’s disease
![Page 31: Diagnotic Imaging of Nephrocalcinosis](https://reader034.vdocuments.mx/reader034/viewer/2022042605/587171611a28ab58758b791f/html5/thumbnails/31.jpg)
-U/S :Medullary nephrocalcinosis is apparent
when the medullary pyramids become more echogenic than the adjacent cortex , with time , further calcium deposition and stone formation occur with acoustic shadowing becoming apparent
![Page 32: Diagnotic Imaging of Nephrocalcinosis](https://reader034.vdocuments.mx/reader034/viewer/2022042605/587171611a28ab58758b791f/html5/thumbnails/32.jpg)
![Page 33: Diagnotic Imaging of Nephrocalcinosis](https://reader034.vdocuments.mx/reader034/viewer/2022042605/587171611a28ab58758b791f/html5/thumbnails/33.jpg)
![Page 34: Diagnotic Imaging of Nephrocalcinosis](https://reader034.vdocuments.mx/reader034/viewer/2022042605/587171611a28ab58758b791f/html5/thumbnails/34.jpg)
![Page 35: Diagnotic Imaging of Nephrocalcinosis](https://reader034.vdocuments.mx/reader034/viewer/2022042605/587171611a28ab58758b791f/html5/thumbnails/35.jpg)
![Page 36: Diagnotic Imaging of Nephrocalcinosis](https://reader034.vdocuments.mx/reader034/viewer/2022042605/587171611a28ab58758b791f/html5/thumbnails/36.jpg)
![Page 37: Diagnotic Imaging of Nephrocalcinosis](https://reader034.vdocuments.mx/reader034/viewer/2022042605/587171611a28ab58758b791f/html5/thumbnails/37.jpg)
![Page 38: Diagnotic Imaging of Nephrocalcinosis](https://reader034.vdocuments.mx/reader034/viewer/2022042605/587171611a28ab58758b791f/html5/thumbnails/38.jpg)
![Page 39: Diagnotic Imaging of Nephrocalcinosis](https://reader034.vdocuments.mx/reader034/viewer/2022042605/587171611a28ab58758b791f/html5/thumbnails/39.jpg)
![Page 40: Diagnotic Imaging of Nephrocalcinosis](https://reader034.vdocuments.mx/reader034/viewer/2022042605/587171611a28ab58758b791f/html5/thumbnails/40.jpg)
![Page 41: Diagnotic Imaging of Nephrocalcinosis](https://reader034.vdocuments.mx/reader034/viewer/2022042605/587171611a28ab58758b791f/html5/thumbnails/41.jpg)