Urogenital ImagingGlomerulonephritis
a
pathological process of the kidney, which is characterized by bilateral inflammatory changes in the glomeruli which are not the result of infection. There are many causes of glomerulonephritis, with post-streptococcal immune reaction as a well-established cause. Diagnosis is primarily made through
pathological examination. In the acute stages, the kidneys usually appear unremarkable on imaging.
Affected patients present with peripheral oedema associated with proteinuria. Approximately 50% of patients eventually develop the nephrotic syndrome. Secondary hypertension is seen, along with eventual renal failure. Urinalysis reveals the presence of protein, red blood cells, white blood cells, renal epithelial cells, and hyaline and granular casts.
In the chronic stages, the kidneys are small and have smooth contours. The loss of renal parenchyma reflects changes of both nephritis and secondary hypertension. An excess of peripelvic fat is detected.
On excretory urography, the calyces and papillae appear normal. The severity of disease is reflected in the density of the nephrogram and collecting system. Renal cortical calcification is occasionally seen. On ultrasound (Fig.1) the renal echogenicity is increased, along with the echogenicity of the renal sinus. On CT, the affected kidney may appear small, and striations may be present within the CT nephrogram. A small kidney may also be seen on MRI, along with the nonspecific loss of cortical medullary differentation on T1-weighted imaging. Angiographic findings are similar to those of arteriosclerosis and nephrosclerosis.
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Longitudinal ultrasound image of the right kidney, showing increased echogenicity of the renal parenchyma, due to medical renal disease in a patient with glomerulonephritis.
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Glomerulonephritis, Fig.1 | |