2007-01-02-13 Hyperechoic kidney © Cuillier www.thefetus.net/
Diagnostic Medical Sonographer, Translator, Editor, Novato, California;
Department of Gynecology, Félix Guyon Hospital, 97400 Saint-Denis, Ile de la Réunion, France. Tel: 0262 90 55 22. Fax: 0262 90 77 30;
Department of Neonatology, Félix Guyon Hospital, 97400 Saint-Denis, France;
Department of Neonatal Surgery, Félix Guyon Hospital, 97400 Saint-Denis, France.
We report a case of a 35-year-old patient with noncontributive family history, G2P1. On 12-week sonography, nuchal translucency was normal. The triple marker screen was normal at 17 weeks GA. At 24 weeks GA, the sonographer discovered left pelvicalyceal dilatation and bilateral hyperechoic kidneys, an appearance perhaps consistent with a microcystic entity. Amniocentesis was performed at 31 weeks GA (46 XX, CMV-negative). The kidney anomalies were again seen at 27, 29, 34, and 37 weeks GA. The patient delivered at 38 WG. Amniotic fluid was normal. On day one, the creatinine level was abnormally high, but by day three it had resolved to normal.
Pediatric renal sonography was performed on day three with the following findings:
The right kidney measured 3.7 cm with no pelvicalyceal dilatation, but overall hyperechogenicity and loss of corticomedullary differentiation; its small size and appearance were suggestive of hypertrophy.
The left kidney measured 5.4 mm with pelvicalyceal dilatation of 12 mm, with overall hyperechogenicity and loss of corticomedullary differentiation.
There was no ureteral dilatation.
The baby underwent cystography; neither vesical reflux nor urethral valves were seen. At this time, the baby is in good health with a stable creatinine level. Here are some images we obtained.
Images 1, 2. Sagittal images at 24 weeks showing left renal pelvicalyceal dilatation (left image) and hyperechogenicity of both kidneys without corticomedullary differentiation.
Images 3, 4. (3) Axial renal images, 24 weeks GA showing pelvicalyceal dilatation on the left. (4) Coronal section at 27 weeks GA with right renal measurement (bottom of image) and left dilated renal pelvis measurement.
Images 5. 6. (5) Parasagittal images at 27 weeks with measurements (left kidney is on the left image). (6) Parasagittal images at 29 weeks GA; left kidney is on the left image.
Images 7, 8. (7) Axial section at 29 weeks GA measuring left pelvicaliceal dilatation. (8) Axial section at 29 weeks GA with measurement of right kidney (at top left of image) and left pelvicalyceal dilatation.
Images 9, 10. (9) Axial section at 29 weeks GA with anteroposterior measurement of renal cortical thinning due to pelvicalyceal dilatation. (10) Parasagittal images at 34 weeks GA.
Images 11, 12. (11) Parasagittal views of the kidneys at 34 weeks GA. (12) At 37 weeks GA, parasagittal images of both kidneys. Left kidney on left image.