Kidneys

PGI Tricia Mae J. Batohanon

Anatomy
Congenital Renal
Anomalies
Renal Agenesis
Absence
• the complete congenital of the right
kidney
absence of renal tissue.

• associated with uterine

anomalies in females and
ipsilateral seminal vesicle
cysts in males.
Absence of the

• compensatory hypertrophy
right kidney,
with
compensatory
and congenital anomalies hypertrophy of
of the remaining kidney the left kidney.

are often evident.

Horseshoe
Kidney
• most common renal fusion anomaly

• the lower poles of the kidneys are joined across the

midline by a fibrous or parenchymal band.

• As a result of fusion, the kidneys are malrotated, with

the renal pelvises directed more anteriorly and the
lower pole calyces directed medially.

• The fused kidney is low in position in the abdomen

because normal ascent is prevented by renal tissue
encountering the inferior mesenteric artery in the midline.
 R L

Plain CT
Horseshoe Kidney
 Crossed-fused
Renal Ectopia
• defined as a kidney located on the opposite side of the
midline from its ureter.

• the two kidneys are fused (upper pole of the ectopic

kidney to lower pole of the opposite kidney) on the
one side of the abdomen.

• anomaly is thought to result because of an abnormally

situated umbilical artery that prevents normal
cephalic migration from occuring; in such cases, the
developing kidney takes the path of least resistance
and crosses to the opposite side, where cephalic
migration resumes.

• Confirmatory: Demonstration that one kidney is absent

from its normal location and that the ureters insert in
their normal locations in the bladder trigone.
The left kidney lies in the right abdomen and is fused to the right kidney.
Cystic Renal Masses
Simple Renal
Cyst

• The most common renal mass.

• Common in the older population (>55 years old)
Complicated
Cyst
Bosniak I

(a) cysts with delicate thin septations no more than 1 to 2 mm thick

(b) cysts with delicate thin calcification in the wall or septum
Bosniak II (c) “high-density” cysts that are hyperdense (60 to 100 H) on CT
because of high concentration of protein or blood breakdown
products and are of size of less than 3 cm.

- very likely benign but require additional follow-up imaging to

confirm benignancy.
Bosniak IIF - These lesions may have many thin septa or minimal smooth
thickening of the walls or septa but without measurable
contrast enhancement.

- indeterminate lesions that may be benign or malignant. Most should

be treated surgically
Bosniak III
- thick irregular calcification, irregular margins, thick or enhancing
septa, areas of nodularity, thick walls, and multilocular mass

- clearly malignant necrotic cystic neoplasms or tumors that

Bosniak IV
arise in the wall of a cyst.
 usually from pyelonephritis
Renal Abscess complicated by liquefactive necrosis
of the renal parenchyma.

Renal Abscess. The right renal abscess (A) has characteristic thick walls and septations and internal fluid density. Edema
reduces the CT density of the renal parenchyma adjacent to the mass (thin arrow) and infiltrates the perirenal space
(thick arrow). This patient also has multiple small renal cysts associated with autosomal dominant polycystic disease.
 Renal Cell
Carcinoma
• may appear as a
predominantly cystic or
multiloculated cystic
mass

• Malignant tumor cells

line the walls and
septa.

• Thick walls, thick

septations, and
contrast enhancement
are usually evident.
 Multilocular Cystic Nephroma
aka
Adult Cystic Nephroma
Mixed Epithelial and Stromal Tumor
(“MEST”)

• uncommon benign neoplasm consisting of a cluster of

noncommunicating cysts of varying size separated by
connective tissue septations of varying thickness.

• the tumor has a thick capsule with thin septations.

• most commonly in middle-aged women (40 to 60 years).

• The CT appearance is usually characteristic
• The masses are large, averaging approximately 10 cm in diameter.
• They are sharply delineated from the normal renal parenchyma.
• hypovascular, but the septations enhance after intravenous contrast administration
• A characteristic feature: herniation of the mass into the renal pelvis.