Renal disorders are common, but can be difficult to diagnose clinically due to their non-specific presentations and imaging is often used to identify causes of urinary origin. Although the majority of complications that affect the kidneys are not immediately life threatening, there are multiple etiologies that constitute renal emergencies and require rapid diagnosis and communication to minimize patient morbidity and mortality.
Educational Goals / Teaching Points
1. Imaging is not indicated in uncomplicated renal infection, but patients with a history of uncontrolled diabetes, immunocompromise, urolithiasis, or a structural urological abnormality should have imaging to guide treatment and to avoid sepsis.
2. Renal transplant vascular complications are associated with a high incidence of graft loss and mortality. Tumors are the most common cause of non-traumatic retroperitoneal hemorrhage of renal origin, which can be life threatening.
3. The non-specific clinical presentation of renal ischemia often leads to delayed or missed diagnosis; a rapid imaging aided diagnosis with early treatment can restore vascular flow and reduce ischemic time.
4. Imaging is necessary for the assessment of suspected renal injuries after blunt or penetrating trauma as radiologic classification of traumatic injuries is integrated with clinical information to determine a treatment plan.
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Key pathophysiologic issues include morbidity from diminished renal function and/or sepsis. Diagnostic delays must be minimized and rapid renal imaging is usually necessary when a renal emergency is suspected. Contrast enhanced CT is often the imaging modality of choice for suspected acute renal disorders as it is readily available and can quickly and accurately depict most renal injuries.
This exhibit reviews infectious, hemorrhagic, vascular, and traumatic renal emergencies with a focus on the pertinent clinical and imaging findings necessary to make the diagnosis and guide management.