Radiology and renal anatomy

Plain radiography

• The renal edge may be visible, outlined by the surrounding perirenal fat (see Fig. 12.4). Intrarenal anatomy is never visible. Similarly the bladder may be outlined by the perivesical fat but the non-opacified ureters are also never seen.

• The kidneys are about 3.5 vertebral bodies (11–15 cm) in length (renal size is magnified by 15% on radiographs); however, ptotic kidneys may appear foreshortened, as they flop posteriorly.

Intravenous urography (IVU)

After opacification by intravenous contrast, the renal parenchyma and outline can be assessed in the early or nephrographic phase, and the collecting system and ureteric anatomy in the urographic phase (see Figs. 12.3a– c, e , g, h, 12.6, 12.7 and 12.9a).

Cross-sectional anatomy

Ultrasound

Ultrasound allows multiplanar evaluation of renal anatomy: assessment of size, parenchyma, the pelvicalyceal system, masses and calculi can be readily performed. The liver is used as an acoustic window to assess the right kidney as it lies posteroinferior to the liver. h e let kidney requires a more posterior approach as it lies inferomedial to the spleen (see Fig. 12.12).