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Endoskopie heute 2015; 28(01): 50-64
DOI: 10.1055/s-0034-1399065
Review
© Georg Thieme Verlag KG Stuttgart · New York

Nierensonografie und Sonografie der ableitenden Harnwege

Renal and urogenital ultrasound
J. Tuma
1   Sonographie Institut, Uster, Schweiz
,
J. Selbach
2   Caritas-Krankenhaus, Medizinische Klinik
,
C. F. Dietrich
3   Caritas-Krankenhaus, Medizinische Klinik 2
› Author Affiliations
Further Information

Publication History

Publication Date:
23 March 2015 (online)

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Zusammenfassung

Bei jeder abdominalen Untersuchung sollten die Nieren und die ableitenden Harnwege mituntersucht werden. Dabei werden Zufallsbefunde ohne spezifische Indikation für die Nierensonografie entdeckt. Diese sollten richtig interpretiert und evtl. auch weiter abgeklärt werden. Dazu zählt vor allem das Nierenzellkarzinom, welches dank Sonografie und Computertomografie immer häufiger als Zufallsbefund entdeckt wird. Pseudotumore und weitere Normvarianten muss man von echten Tumoren unterscheiden. Die Nierensonografie wird auch bei Hämaturie, Proteinurie, bei einem nephrotischen und nephritischen Syndrom, akuter und chronischer Niereninsuffizienz, bei einem komplizierten Harnwegsinfekt, bei Nierenkolik oder im Rahmen familiärer Abklärung hereditärer Nierenerkrankungen untersucht. Die Kenntnisse der Klinik fließen in die Beurteilung der Sonografie ein. Die Nieren werden nach sonomorphologischen Kriterien beurteilt: die Lage der Nieren, die Form, die Kontur, die Größe, die Architektur des Nierenparenchyms und des Nierensinus. Mit FKDS und Spektralanalyse wird zusätzlich die Durchblutung der Nieren beurteilt. In vielen Fällen gelingt es dank Synthese der klinischen und sonografischen Daten eine definitive Diagnose zu stellen. In anderen Fällen, wo keine spezifische Diagnose möglich ist, wird die Richtung der weiteren Abklärung mitbestimmt. Die echokontrastverstärkte Sonografie (CEUS) hilft bei der Beurteilung der fokalen Veränderungen sowie beim Verdacht auf fokale Perfusionsausfälle der Nieren (Niereninfarkte). Für die Beurteilung der zystischen und komplex zystisch-soliden Veränderungen werden Bosniak-Kriterien angewandt.

Abstract

In every abdominal examination, the kidneys and urinary tract should also be investigated. In many cases, incidental findings are discovered without specific indication for renal ultrasound. These should be properly interpreted and possibly also further clarified. Thanks to sonography and computed tomography, it is primarily renal cell carcinoma that is detected more frequently as an incidental finding. Pseudo tumours and other normal variants must be distinguished from true tumours. Renal ultrasonography is also performed in hematuria, proteinuria, nephrotic and nephritic syndrome in acute and chronic renal failure in a complicated urinary tract infection, renal colic, or in the context of family clarification hereditary kidney disease. Clinical knowledge is incorporated when assessing sonography. The kidneys are evaluated according to sonographic criteria: the position of the kidneys, the shape, contour, size, the architecture of the renal parenchyma and the renal sinus. In addition, the blood flow to the kidneys is assessed with CCDS and spectral analysis. In many cases it is possible to make a definitive diagnosis through a combination of clinical and sonographic data. In other cases, where no specific diagnosis is possible, the direction of further evaluation is also determined. Echocontrast-enhanced ultrasonography (CEUS) helps in the assessment of focal changes as well as the suspicion of focal perfusion defects of the kidney (renal infarcts). For the evaluation of cystic and complex cystic-solid lesions, Bosniak criteria will be applied.

Schlüsselwörter

Zufallsbefunde - Nierenerkrankungen - Farbdopplersonografie - Kontrastmittelsonografie - Nierenkolik - Sonomorphologie

Key words

incidental findings - kidney disease - colour doppler imaging - contrast enhanced ultrasound - renal colic - sonomorphology
 

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