Khati Nadia J, Hill Michael C, Kimmel Paul L
Department of Radiology, The George Washington University Hospital, Washington, DC 20037, USA. e-mail:
Ultrasound Q. 2005 Dec;21(4):227-44. doi: 10.1097/01.wnq.0000186666.61037.f6.
Sonography is the best screening modality to evaluate patients presenting with renal insufficiency. Ultrasound findings can be normal in patients with renal disease, especially in prerenal azotemia and acute parenchymal renal disease. Echogenic kidneys indicate the presence of parenchymal renal disease; the kidneys may be of a normal size or enlarged. Small kidneys suggest advanced stage chronic kidney disease. Uncommonly, cystic disease of the kidney, especially adult type polycystic kidney disease may be the cause of the patient's renal insufficiency with bilaterally enlarged kidneys containing multiple cysts of various sizes. If hydronephrosis is present, the level and cause of the obstruction should be sought. When ultrasound cannot diagnose the level and cause of obstruction, other imaging modalities, including CT and MRI may be useful. When renovascular disease (arterial stenosis or venous thrombosis) is suspected, spectral and color Doppler can be useful in detecting abnormalities.
超声检查是评估肾功能不全患者的最佳筛查方式。肾病患者的超声检查结果可能正常，尤其是肾前性氮质血症和急性实质性肾病患者。肾实质回声增强提示存在实质性肾病；肾脏大小可能正常或增大。肾脏缩小提示慢性肾病晚期。罕见的是，肾囊性疾病，尤其是成人型多囊肾病可能是患者肾功能不全的原因，表现为双侧肾脏增大，含有多个大小不一的囊肿。如果存在肾积水，应寻找梗阻的部位和原因。当超声无法诊断梗阻的部位和原因时，其他成像方式，包括CT和MRI可能会有所帮助。当怀疑存在肾血管疾病（动脉狭窄或静脉血栓形成）时，频谱和彩色多普勒检查有助于检测异常情况。
