Logo

Log In Sign Up |  An official publication of: American College of Emergency Physicians
Navigation
  • Home
  • Multimedia
    • Podcasts
    • Videos
  • Clinical
    • Airway Managment
    • Case Reports
    • Critical Care
    • Guidelines
    • Imaging & Ultrasound
    • Pain & Palliative Care
    • Pediatrics
    • Resuscitation
    • Trauma & Injury
  • Resource Centers
    • mTBI Resource Center
  • Career
    • Practice Management
      • Benchmarking
      • Reimbursement & Coding
      • Care Team
      • Legal
      • Operations
      • Quality & Safety
    • Awards
    • Certification
    • Compensation
    • Early Career
    • Education
    • Leadership
    • Profiles
    • Retirement
    • Work-Life Balance
  • Columns
    • ACEP4U
    • Airway
    • Benchmarking
    • Brief19
    • By the Numbers
    • Coding Wizard
    • EM Cases
    • End of the Rainbow
    • Equity Equation
    • FACEPs in the Crowd
    • Forensic Facts
    • From the College
    • Images in EM
    • Kids Korner
    • Medicolegal Mind
    • Opinion
      • Break Room
      • New Spin
      • Pro-Con
    • Pearls From EM Literature
    • Policy Rx
    • Practice Changers
    • Problem Solvers
    • Residency Spotlight
    • Resident Voice
    • Skeptics’ Guide to Emergency Medicine
    • Sound Advice
    • Special OPs
    • Toxicology Q&A
    • WorldTravelERs
  • Resources
    • ACEP.org
    • ACEP Knowledge Quiz
    • Issue Archives
    • CME Now
    • Annual Scientific Assembly
      • ACEP14
      • ACEP15
      • ACEP16
      • ACEP17
      • ACEP18
      • ACEP19
    • Annals of Emergency Medicine
    • JACEP Open
    • Emergency Medicine Foundation
  • About
    • Our Mission
    • Medical Editor in Chief
    • Editorial Advisory Board
    • Awards
    • Authors
    • Article Submission
    • Contact Us
    • Advertise
    • Subscribe
    • Privacy Policy
    • Copyright Information

Focused Renal Sonography

By ACEP Now | on August 1, 2012 | 0 Comment
CME CME Now
  • Tweet
  • Click to email a link to a friend (Opens in new window) Email
Print-Friendly Version

Learning Objectives

After reading this article, the physician should be able to:

You Might Also Like
  • EFAST—Extended Focused Assessment With Sonography for Trauma
  • European Association of Urology Guidelines for Evaluating, Managing Blunt Renal Trauma
  • A Cost-effective Way to Evaluate Patients with Recurrent Renal Colic
Explore This Issue
ACEP News: Vol 31 – No 08 – August 2012
  • Describe the technique for renal ultrasound acquisition.
  • Identify and classify hydronephrosis.
  • Describe the technique and indications for performing bedside ultrasound of the bladder.
  • Describe the technique for obtaining bedside ultrasound bladder volumes.

Renal ultrasonography has replaced more invasive radiographic assessments such as IVP (intravenous pyelogram) in the diagnosis of the more common kidney complaints. In the emergency department, bedside renal ultrasound has allowed the physician to quickly and accurately assess the kidneys and the bladder for obstruction. Gorelik et al. found that in the diagnosis of renal calculus, the sensitivity of renal ultrasound alone was 93% and specificity 83%.1 When combined with KUB, the specificity increased to 100%.

Chief complaints that can lead to the diagnosis of renal pathology include flank pain, abdominal pain, back pain, urinary retention, dysuria, and/or hematuria. The emergency physician can easily bring the ultrasound machine to the bedside for quick assessment of the kidneys and the bladder to evaluate for renal pathology.

Probe Selection and Technique

Use a low-frequency 3- to 5-mHZ curvilinear probe with color Doppler. It is necessary to view both kidneys in the transverse and longitudinal planes, fanning through the superior and inferior poles to allow for full visualization of the entire kidney. The transducer mark should face toward the patient’s head for a longitudinal view, then be turned 90 degrees to view the transverse plane of the kidney (Fig. 1A, 1B). The physician must keep in mind that the liver on the right side will cause the right kidney to be positioned more caudal than the left. Therefore, when scanning the left kidney, the transducer should be placed cephalad and posterior, as compared to the right side.

Anatomy

The renal medulla points inward toward the central pelvis, which collects into the ureter of each kidney (Fig. 2). The renal pelvis is hypoechoic, or white, compared with the cortex. In normal kidneys, the renal pelvis has an organized cotton ball appearance (Fig. 3-5).

There are two main questions that can easily be answered with bedside renal ultrasonography: Is there hydronephrosis? What is the bladder volume?2

Is There Hydronephrosis?

As hydronephrosis develops, one can imagine the cotton center of the pelvis is stretched (Fig. 6, 7). This creates a “thinned-out” appearance to the inner white layer. In severe hydronephrosis, the cotton center is stretched to its capacity, leaving only a thin white line as a remnant of the once-organized center. In its place, the renal pelvis takes on a “bear claw” appearance2 (Fig. 8, 9).

Pages: 1 2 3 4 | Single Page

Topics: Clinical GuidelineCMEDiagnosisEmergency MedicineEmergency PhysicianImaging and UltrasoundInternal MedicineProcedures and SkillsRenalUltrasound

Related

  • 10 Essentials for Your Emergency Department Fanny Pack

    June 17, 2025 - 0 Comment
  • Case Report: Rapid Diagnosis of Acute Aortic Dissection with POCUS

    June 11, 2025 - 0 Comment
  • EM Runs in the Family

    February 26, 2025 - 0 Comment

Current Issue

ACEP Now: July 2025

Download PDF

Read More

About the Author

ACEP Now

View this author's posts »

No Responses to “Focused Renal Sonography”

Leave a Reply Cancel Reply

Your email address will not be published. Required fields are marked *


*
*

Wiley
  • Home
  • About Us
  • Contact Us
  • Privacy
  • Terms of Use
  • Advertise
  • Cookie Preferences
Copyright © 2025 by John Wiley & Sons, Inc. All rights reserved, including rights for text and data mining and training of artificial technologies or similar technologies. ISSN 2333-2603