transmits sound with no resistance. No echoes are returned.

That is why fluid is anechoic and appears

dark. The sound is transmitted freely beyond fluid, posterior enhancement.

Pus is complex fluid and will produce low level echoes due to high protein content and tissue debris.

Sound does not travel well through air and that is the reason US examination is not optimal in abdominal
examination. It is suitable for pelvic structure evaluation, where bowel can be displaced by filling bladder
with urine. This is achieved by asking the patient to drink a large amount of water before the procedure.
US is directed through fluid filled bladder to evaluate pelvic structures. Transvaginal US is also a method
that allows visualization of pelvic structures without bowel interference and no need for filling bladder.

Bone does not transmit sound waves. Thus, US it is not suitable for evaluation of adult head. It is useful in
children before the fontanelles are closed.

Calcified tissues do not transmit sound waves and are highly echogenic and appear white. Since they do
not transmit sound there will be shadows posterior to the lesion (acoustic shadows).

Fat and hair are echogenic and appear white but are not associated with acoustic shadows.

Value Of US In Renal Failure Cases

Image Atlas With Examples For Each Type Of Renal Failure

US is a non-invasive procedure useful in distinguishing the etiology for renal failure. It is critical for ruling
out obstruction. When procedures requiring contrast like IVP and CT cannot be done, US of kidneys is
very helpful.

Blood flow to kidneys can also be evaluated with doppler US. Flowing blood appears an echoic and dark.
Vessels can be recognized in that fashion. With doppler, sound waves become audible based on the
velocity of blood flow.

Right kidney can be evaluated through the liver. Left kidney is imaged in decubitus position. If
unsuccessful, it is examined from back. If the spleen is enlarged it can be used as a window. These
options avoid interference from bowel gas.
 Normal Kidney

Normal kidney measures between 10.5

to 12.5 cms.
Cortex is about 2.5 cms and has the
same kind of echoes as liver.
Central echoes are from fat surrounding
renal pelvis and are white.
Medulla is hypoechoic and appears
dark. You can distinguish it from fluid
filled calyces, as there will be no
increased transmission of sound
beyond.
Renal pelvis is filled with urine and is
echo free with posterior enhancement
behind renal pelvis (next normal kidney).

Normal Kidney

Kidneys appear normal in acute renal failure

(hypovolemia or acute tubular necrosis).
 Chronic Renal Failure (Medical Kidney)

Kidneys are smaller than normal.

Surface may be irregular.
Cortex is thinned and is hyperechoic
than liver due to scar tissue.
Medulla is hypoechoic and appears
dark. You can distinguish them from fluid
filled calyces as there will be no
increased transmission of sound as in
fluid.
Renal pelvis is filled with urine and is
echo free. Note the posterior
enhancement behind renal pelvis.

Kidneys are small, irregular and hyperechoic

in chronic renal failure due to medical renal
disease.

Hydronephrosis

Dilated anechoic calyces with increased

posterior transmission of sound.
Hyperechoic fat delineating dilated
calyces.
Cortex is normal with similar echo
pattern of liver.

Kidneys in obstructive renal disease show

hydronephrosis.
 Simple Renal Cyst

Simple renal cysts are common. We call them

simple when they are in the cortex, thin walled,
the inner lining is smooth. The fluid is anechoic
with no internal echoes and has good sound
transmission with posterior enhancement. These
cysts do not require further work-up.

Complex Renal Cyst

Cysts where the inner lining is irregular, with

septations and fluid has echoes are considered
complex cysts. Complex cysts require additional
further work-up to rule out cavitating cancer or
renal abscess.

Anechoic mass. Some irregularities are

seen along the inner lining (arrow
heads).
Posterior enhancement indicates that it
is clear fluid.
 ic Principles Of Ultrasound Examination

High frequency ultrasonic sound waves are sent through a transducer to the organs from a site
where the transducer is placed on skin. The sRENAL ULTRASOUND

Basic Principles Of Ultrasound Examination

High frequency ultrasonic sound waves are sent through a transducer to the organs from a site where the
transducer is placed on skin. The sound waves bounce off tissues like echoes and return to the
transducer. The transducer coverts them into an electronic picture.

Different types of tissue affect the speed at which sound waves travel. Resistance to sound transmission
varies with the nature of tissue. Fluid transmits sound with no resistance. No echoes are returned. That is
why fluid is anechoic and appears dark. The sound is transmitted freely beyond fluid, posterior
enhancement.

Pus is complex fluid and will produce low level echoes due to high protein content and tissue debris.

Sound does not travel well through air and that is the reason US examination is not optimal in abdominal
examination. It is suitable for pelvic structure evaluation, where bowel can be displaced by filling bladder
with urine. This is achieved by asking the patient to drink a large amount of water before the procedure.
US is directed through fluid filled bladder to evaluate pelvic structures. Transvaginal US is also a method
that allows visualization of pelvic structures without bowel interference and no need for filling bladder.

Bone does not transmit sound waves. Thus, US it is not suitable for evaluation of adult head. It is useful in
children before the fontanelles are closed.

Calcified tissues do not transmit sound waves and are highly echogenic and appear white. Since they do
not transmit sound there will be shadows posterior to the lesion (acoustic shadows).

Fat and hair are echogenic and appear white but are not associated with acoustic shadows.

Value Of US In Renal Failure Cases

Image Atlas With Examples For Each Type Of Renal Failure

US is a non-invasive procedure useful in distinguishing the etiology for renal failure. It is critical for ruling
out obstruction. When procedures requiring contrast like IVP and CT cannot be done, US of kidneys is
very helpful.

Blood flow to kidneys can also be evaluated with doppler US. Flowing blood appears an echoic and dark.
Vessels can be recognized in that fashion. With doppler, sound waves become audible based on the
velocity of blood flow.

Right kidney can be evaluated through the liver. Left kidney is imaged in decubitus position. If
unsuccessful, it is examined from back. If the spleen is enlarged it can be used as a window. These
options avoid interference from bowel gas.
 Normal Kidney

Normal kidney measures between 10.5

to 12.5 cms.
Cortex is about 2.5 cms and has the
same kind of echoes as liver.
Central echoes are from fat surrounding
renal pelvis and are white.
Medulla is hypoechoic and appears
dark. You can distinguish it from fluid
filled calyces, as there will be no
increased transmission of sound
beyond.
Renal pelvis is filled with urine and is
echo free with posterior enhancement
behind renal pelvis (next normal kidney).

Normal Kidney

Kidneys appear normal in acute renal failure

(hypovolemia or acute tubular necrosis).
 Chronic Renal Failure (Medical Kidney)

Kidneys are smaller than normal.

Surface may be irregular.
Cortex is thinned and is hyperechoic
than liver due to scar tissue.
Medulla is hypoechoic and appears
dark. You can distinguish them from fluid
filled calyces as there will be no
increased transmission of sound as in
fluid.
Renal pelvis is filled with urine and is
echo free. Note the posterior
enhancement behind renal pelvis.

Kidneys are small, irregular and hyperechoic

in chronic renal failure due to medical renal
disease.

Hydronephrosis

Dilated anechoic calyces with increased

posterior transmission of sound.
Hyperechoic fat delineating dilated
calyces.
Cortex is normal with similar echo
pattern of liver.

Kidneys in obstructive renal disease show

hydronephrosis.
 Simple Renal Cyst

Simple renal cysts are common. We call them

simple when they are in the cortex, thin walled,
the inner lining is smooth. The fluid is anechoic
with no internal echoes and has good sound
transmission with posterior enhancement. These
cysts do not require further work-up.

Complex Renal Cyst

Cysts where the inner lining is irregular, with

septations and fluid has echoes are considered
complex cysts. Complex cysts require additional
further work-up to rule out cavitating cancer or
renal abscess.

Anechoic mass. Some irregularities are

seen along the inner lining (arrow
heads).
Posterior enhancement indicates that it
is clear fluid.
ound waves bounce off tissues like echoes and return to the transducer. The transducer coverts them into
an electronic picture.

Different types of tissue affect the speed at which sound waves travel. Resistance to sound transmission
varies with the nature of tissue. Fluid transmits sound with no resistance. No echoes are returned. That is
why fluid is anechoic and appears dark. The sound is transmitted freely beyond fluid, posterior
enhancement.

Pus is complex fluid and will produce low level echoes due to high protein content and tissue debris.

Sound does not travel well through air and that is the reason US examination is not optimal in abdominal
examination. It is suitable for pelvic structure evaluation, where bowel can be displaced by filling bladder
with urine. This is achieved by asking the patient to drink a large amount of water before the procedure.
US is directed through fluid filled bladder to evaluate pelvic structures. Transvaginal US is also a method
that allows visualization of pelvic structures without bowel interference and no need for filling bladder.

Bone does not transmit sound waves. Thus, US it is not suitable for evaluation of adult head. It is useful in
children before the fontanelles are closed.

Calcified tissues do not transmit sound waves and are highly echogenic and appear white. Since they do
not transmit sound there will be shadows posterior to the lesion (acoustic shadows).

Fat and hair are echogenic and appear white but are not associated with acoustic shadows.

Value Of US In Renal Failure Cases

Image Atlas With Examples For Each Type Of Renal Failure

US is a non-invasive procedure useful in distinguishing the etiology for renal failure. It is critical for ruling
out obstruction. When procedures requiring contrast like IVP and CT cannot be done, US of kidneys is
very helpful.

Blood flow to kidneys can also be evaluated with doppler US. Flowing blood appears an echoic and dark.
Vessels can be recognized in that fashion. With doppler, sound waves become audible based on the
velocity of blood flow.

Right kidney can be evaluated through the liver. Left kidney is imaged in decubitus position. If
unsuccessful, it is examined from back. If the spleen is enlarged it can be used as a window. These
options avoid interference from bowel gas.
 Normal Kidney

Normal kidney measures between 10.5

to 12.5 cms.
Cortex is about 2.5 cms and has the
same kind of echoes as liver.
Central echoes are from fat surrounding
renal pelvis and are white.
Medulla is hypoechoic and appears
dark. You can distinguish it from fluid
filled calyces, as there will be no
increased transmission of sound
beyond.
Renal pelvis is filled with urine and is
echo free with posterior enhancement
behind renal pelvis (next normal kidney).

Normal Kidney

Kidneys appear normal in acute renal failure

(hypovolemia or acute tubular necrosis).
 Chronic Renal Failure (Medical Kidney)

Kidneys are smaller than normal.

Surface may be irregular.
Cortex is thinned and is hyperechoic
than liver due to scar tissue.
Medulla is hypoechoic and appears
dark. You can distinguish them from fluid
filled calyces as there will be no
increased transmission of sound as in
fluid.
Renal pelvis is filled with urine and is
echo free. Note the posterior
enhancement behind renal pelvis.

Kidneys are small, irregular and hyperechoic

in chronic renal failure due to medical renal
disease.

Hydronephrosis

Dilated anechoic calyces with increased

posterior transmission of sound.
Hyperechoic fat delineating dilated
calyces.
Cortex is normal with similar echo
pattern of liver.

Kidneys in obstructive renal disease show

hydronephrosis.
 Simple Renal Cyst

Simple renal cysts are common. We call them

simple when they are in the cortex, thin walled,
the inner lining is smooth. The fluid is anechoic
with no internal echoes and has good sound
transmission with posterior enhancement. These
cysts do not require further work-up.

Complex Renal Cyst

Cysts where the inner lining is irregular, with

septations and fluid has echoes are considered
complex cysts. Complex cysts require additional
further work-up to rule out cavitating cancer or
renal abscess.

Anechoic mass. Some irregularities are

seen along the inner lining (arrow
heads).
Posterior enhancement indicates that it
is clear fluid.
 sic Principles Of Ultrasound Examination

High frequency ultrasonic sound waves are sent through a transducer to the organs from a site where the
transducer is placed on skin. The sound waves bounce off tissues like echoes and return to the
transducer. The transducer coverts them into an electronic picture.

Different types of tissue affect the speed at which sound waves travel. Resistance to sound
transmission varies with the nature of tissue. Fluid transmits sound with no resistance. No echoes
are returned. That is why fluid is anechoic and appears dark. The sound is transmitted freely
beyond fluid, posterior enhancement. RENAL ULTRASOUND

Basic Principles Of Ultrasound Examination

High frequency ultrasonic sound waves are sent through a transducer to the organs from a site where the
transducer is placed on skin. The sound waves bounce off tissues like echoes and return to the
transducer. The transducer coverts them into an electronic picture.

Different types of tissue affect the speed at which sound waves travel. Resistance to sound transmission
varies with the nature of tissue. Fluid transmits sound with no resistance. No echoes are returned. That is
why fluid is anechoic and appears dark. The sound is transmitted freely beyond fluid, posterior
enhancement.

Pus is complex fluid and will produce low level echoes due to high protein content and tissue debris.

Sound does not travel well through air and that is the reason US examination is not optimal in abdominal
examination. It is suitable for pelvic structure evaluation, where bowel can be displaced by filling bladder
with urine. This is achieved by asking the patient to drink a large amount of water before the procedure.
US is directed through fluid filled bladder to evaluate pelvic structures. Transvaginal US is also a method
that allows visualization of pelvic structures without bowel interference and no need for filling bladder.

Bone does not transmit sound waves. Thus, US it is not suitable for evaluation of adult head. It is useful in
children before the fontanelles are closed.

Calcified tissues do not transmit sound waves and are highly echogenic and appear white. Since they do
not transmit sound there will be shadows posterior to the lesion (acoustic shadows).

Fat and hair are echogenic and appear white but are not associated with acoustic shadows.

Value Of US In Renal Failure Cases

Image Atlas With Examples For Each Type Of Renal Failure

US is a non-invasive procedure useful in distinguishing the etiology for renal failure. It is critical for ruling
out obstruction. When procedures requiring contrast like IVP and CT cannot be done, US of kidneys is
very helpful.

Blood flow to kidneys can also be evaluated with doppler US. Flowing blood appears an echoic and dark.
Vessels can be recognized in that fashion. With doppler, sound waves become audible based on the
velocity of blood flow.
Right kidney can be evaluated through the liver. Left kidney is imaged in decubitus position. If
unsuccessful, it is examined from back. If the spleen is enlarged it can be used as a window. These
options avoid interference from bowel gas.

Normal Kidney

Normal kidney measures between 10.5

to 12.5 cms.
Cortex is about 2.5 cms and has the
same kind of echoes as liver.
Central echoes are from fat surrounding
renal pelvis and are white.
Medulla is hypoechoic and appears
dark. You can distinguish it from fluid
filled calyces, as there will be no
increased transmission of sound
beyond.
Renal pelvis is filled with urine and is
echo free with posterior enhancement
behind renal pelvis (next normal kidney).

Normal Kidney

Kidneys appear normal in acute renal failure

(hypovolemia or acute tubular necrosis).
 Chronic Renal Failure (Medical Kidney)

Kidneys are smaller than normal.

Surface may be irregular.
Cortex is thinned and is hyperechoic
than liver due to scar tissue.
Medulla is hypoechoic and appears
dark. You can distinguish them from fluid
filled calyces as there will be no
increased transmission of sound as in
fluid.
Renal pelvis is filled with urine and is
echo free. Note the posterior
enhancement behind renal pelvis.

Kidneys are small, irregular and hyperechoic

in chronic renal failure due to medical renal
disease.

Hydronephrosis

Dilated anechoic calyces with increased

posterior transmission of sound.
Hyperechoic fat delineating dilated
calyces.
Cortex is normal with similar echo
pattern of liver.

Kidneys in obstructive renal disease show

hydronephrosis.
 Simple Renal Cyst

Simple renal cysts are common. We call them

simple when they are in the cortex, thin walled,
the inner lining is smooth. The fluid is anechoic
with no internal echoes and has good sound
transmission with posterior enhancement. These
cysts do not require further work-up.

Complex Renal Cyst

Cysts where the inner lining is irregular, with

septations and fluid has echoes are considered
complex cysts. Complex cysts require additional
further work-up to rule out cavitating cancer or
renal abscess.

Anechoic mass. Some irregularities are

seen along the inner lining (arrow
heads).
Posterior enhancement indicates that it
is clear fluid.
Pus is complex fluid and will produce low level echoes due to high protein content and tissue debris.

Sound does not travel well through air and that is the reason US examination is not optimal in abdominal
examination. It is suitable for pelvic structure evaluation, where bowel can be displaced by filling bladder
with urine. This is achieved by asking the patient to drink a large amount of water before the procedure.
US is directed through fluid filled bladder to evaluate pelvic structures. Transvaginal US is also a method
that allows visualization of pelvic structures without bowel interference and no need for filling bladder.

Bone does not transmit sound waves. Thus, US it is not suitable for evaluation of adult head. It is useful in
children before the fontanelles are closed.

Calcified tissues do not transmit sound waves and are highly echogenic and appear white. Since they do
not transmit sound there will be shadows posterior to the lesion (acoustic shadows).

Fat and hair are echogenic and appear white but are not associated with acoustic shadows.

Value Of US In Renal Failure Cases

Image Atlas With Examples For Each Type Of Renal Failure

US is a non-invasive procedure useful in distinguishing the etiology for renal failure. It is critical for ruling
out obstruction. When procedures requiring contrast like IVP and CT cannot be done, US of kidneys is
very helpful.

Blood flow to kidneys can also be evaluated with doppler US. Flowing blood appears an echoic and dark.
Vessels can be recognized in that fashion. With doppler, sound waves become audible based on the
velocity of blood flow.

Right kidney can be evaluated through the liver. Left kidney is imaged in decubitus position. If
unsuccessful, it is examined from back. If the spleen is enlarged it can be used as a window. These
options avoid interference from bowel gas.
 Normal Kidney

Normal kidney measures between 10.5

to 12.5 cms.
Cortex is about 2.5 cms and has the
same kind of echoes as liver.
Central echoes are from fat surrounding
renal pelvis and are white.
Medulla is hypoechoic and appears
dark. You can distinguish it from fluid
filled calyces, as there will be no
increased transmission of sound
beyond.
Renal pelvis is filled with urine and is
echo free with posterior enhancement
behind renal pelvis (next normal kidney).

Normal Kidney

Kidneys appear normal in acute renal failure

(hypovolemia or acute tubular necrosis).
 Chronic Renal Failure (Medical Kidney)

Kidneys are smaller than normal.

Surface may be irregular.
Cortex is thinned and is hyperechoic
than liver due to scar tissue.
Medulla is hypoechoic and appears
dark. You can distinguish them from fluid
filled calyces as there will be no
increased transmission of sound as in
fluid.
Renal pelvis is filled with urine and is
echo free. Note the posterior
enhancement behind renal pelvis.

Kidneys are small, irregular and hyperechoic

in chronic renal failure due to medical renal
disease.

Hydronephrosis

Dilated anechoic calyces with increased

posterior transmission of sound.
Hyperechoic fat delineating dilated
calyces.
Cortex is normal with similar echo
pattern of liver.

Kidneys in obstructive renal disease show

hydronephrosis.
 Simple Renal Cyst

Simple renal cysts are common. We call them

simple when they are in the cortex, thin walled,
the inner lining is smooth. The fluid is anechoic
with no internal echoes and has good sound
transmission with posterior enhancement. These
cysts do not require further work-up.

Complex Renal Cyst

Cysts where the inner lining is irregular, with

septations and fluid has echoes are considered
complex cysts. Complex cysts require additional
further work-up to rule out cavitating cancer or
renal abscess.

Anechoic mass. Some irregularities are

seen along the inner lining (arrow
heads).
Posterior enhancement indicates that it
is clear fluid.
 Pas de contre-indication absolue, lexception de mentions lgales interdisant les spcialits
contenant de l alcool benzylique
duodnal), permettant de prlever des biopsies au niveau antro-
fundique. Le diagnostic positif de 39 de ani i a absolvit Universitatea de Medicin i
Farmacie "Carol Davila" Bucureti n 1998, cu media general de promovare a anilor de
studii 9,63 i media la examenul de licen 10. Este medic specialist chirurgie general
din octombrie 2006 i lucreaz la Institutul Clinic Fundeni, n Laboratorul de Cercetare
Chirurgie. El a participat la zeci, poate chiar sute de transplanturi alturi de prof. dr.
Irinel Popescu, eful Centrului de Chirurgie General i Transplant Hepatic Fundeni.

Potrivit gandul.info, dr. Zamfir a avut chiar ocazia s coordoneze operaii extrem de
rare, cum ar fi cazul unei femei care avea

se gsesc extrem de rar. De obicei, cei care au grupe sanguine mai rare ateapt mai
mult pe lista de ateptare, deci motivul bucuriei este mai mare", declara Radu Zamfir,
n urm cu 9 luni, atunci cnd a efectuat transplantul de ficat la Fundeni.

, titrul acestora nu se va repeta dect dup 6 luni de la efectuarea

tratamentului, urmrindu-se scderea acestuia cu cel puin jumtate
din valoarea iniial ca rspuns la tratament.

Tratament medicamentos
Pe lng regimul igieno-dietetic obligatoriu n tratamentul gastritelor i
ulcerului peptic de la culture est la ralisation dun antibiogramme permettant la recherche de
rsistance plusieurs familles dantibiotiques. Lexamen bactriologique inclut la mise en vidence
de HP par PCR et/ou culture. La PCR seffectue directement partir de la biopsie. Elle permet de
dtecter simultanment la prsence de HP et sa rsistance la clarithromycine en recherchant les
principales mutations responsables.
(3) En labsence de culture bactrienne, quatre associations thrapeutiques peuvent tre proposes en
traitement probabiliste, en insistant sur la ncessit absolue dune bonne observance (risque
importants de rsistance secondaire) (doses : tableau 1) :
Traitement squentiel, prfr en premire intention (IPp + amoxicilline pendant 5 j, puis IPp +
clarithromycine + imidazol pendant 5 j ;
IPp + amoxicilline + clarithromycine ;
IPp + amoxicilline + imidazol ;
Sels de bismuth + amoxicilline + imidazol (dans les pays ou les sels de bismuth sont autoriss et
disponibles, ce qui nest pas le cas de la France).

Tableau I. Doses des mdicaments utiliss pour l'radiction de l'HP

 Amoxicilline 50-60 mg/kg en deux prises

Clarithromycine 20-30 mg/kg en deux prises

Omprazole 2 mg/kg en deux prises jeun

Mtronidazole 20-30 mg/kg en deux prises

La dure thorique du traitement triple (hors traitement squentiel) est de 7 jours. Cependant
plusieurs auteurs prconisent une dure de 10-14 j.
Lorsque lantibiogramme est disponible (ou les rsultats de la PCR) :
(4) si la souche est rsistante la clarithromycine, lassociation IPp + amoxicilline + imidazol sera
prfre pour une dure de 10-14 jours ;
(5) si la souche de HP est sensible la clarithromycine, lassociation IPp + amoxicilline +
clarithromycine sera prescrite pour une dure de 7 jours.
(6) LUBT et la dtection de lantigne HP dans les selles selon la mthode ELISA sont considrs
comme des tests non invasifs fiables pour contrler lradication de HP. Ces tests doivent tre
raliss au moins 6-8 semaines aprs la fin du traitement et au moins 4 semaines aprs larrt des
IPP.
(7) Si le test respiratoire ou la dtection dantignes dans les selles sont ngatifs linfection HP est
considre comme radique. La persistance dpigastralgies malgr lradication bactrienne, est
due la persistance de la gastrite histologique ncessitant un traitement par un IPP pendant 4-8
semaines supplmentaires, il en est de mme en cas de lsion ulcre.
(8) En cas dchec dradication, UBT et/ou le HpSA sont positifs, en particulier aprs un traitement
incluant de la clarithromycine, la rsistance de HP cet antibiotique doit tre recherche :
En effectuant une nouvelle endoscopie avec prlvement de biopsies. Le nouveau traitement sera
adapt en fonction des rsultats ;
Il faut bien valuer la compliance thrapeutique ;
Une enqute familiale la recherche dune infection HP peut tre utile en cas de persistance de
linfection malgr un traitement bien adapt lantibiogramme et une bonne compliance
thrapeutique. Certaines habitudes culturelles, comme le fait de manger avec les doigts dans un plat
commun sont dconseiller.
Liens dintrts
N. Kalach : Lauteur a dclar navoir aucun conflit dintrts pour cet article.
J. Raymond : Lauteur na pas communiqu ses conflits dintrts.