Hosting 728 files, 2951 images, and 4 contributors.

Random Case

Joseph Junewick, MD FACR
over 11 years ago
Enter A Workflow
Standard2   Academic2

Please choose a workflow. A standard workflow allows you to browse the repository with full case detail; the academic workflow allows you to browse the repository with limited case detail revealed. Double click on the images to launch image viewer.

ARSt Case Repository

Diffuse Renal Ischemia

Case Detail

Anatomy: Genitourinary
Joseph Junewick, MD FACR
Diagnostic Category: Vascular
Created: over 9 years ago
Updated: over 9 years ago
Tags: PEDS
Modality/Study Types: US
Adobe32 PDF Imagej32 ImageJA


Unstable premature infant with anuria.

Case Images


Diffuse Renal Ischemia


US – Enlarged kidney with increased cortical and medullary echogenicity.


Renal insufficiency and failure can result from a variety of congenital, developmental, and acquired conditions in the newborn infant. Renal blood flow is proportionately lower in neonates than in older children and adults. This normal physiologic characteristic puts the neonate at risk for renal insufficiency and failure when blood flow is decreased by perinatal and postnatal events. such as hypoxemia, anoxia, hypovolemia, cardiac failure, and patent ductus arteriosus.

The causes of renal injury in neonates are predominantly prerenal in nature. Common pathogeneses include hypoperfusion caused by perinatal asphyxia; systemic diseases such as sepsis, surfactant deficiency, and severe congenital heart disease; and patent ductus arteriosus. Renal perfusion may also be diminished by the presence of umbilical catheters, the use of positive pressure ventilation and certain medications (e.g., tolazoline hydrochloride, captopril, and indomethacin).

Impaired renal perfusion may lead to acute tubular necrosis, medullary or cortical necrosis, and renal vein thrombosis and involve the pyramids, cortex, or renal vasculature. The affected kidney usually becomes enlarged and heterogeneous in echogenicity during the acute phase. Corticomedullary differentiation may be completely lost, or in some cases the pyramids may become profoundly hypoechoic or hyperechoic.


Daneman A, Navarro OM, Somers GR et al. Renal Pyramids: Focused Sonography of Normal and Pathologic Processes. Radiographics 2010; 30(5):1287-1307.

Mercado-Deane MG, Beeson JE, John SD. US of Renal Insufficiency in Neonates. RadioGraphics 2002; 22: 1429-1438.


Linda Woolpert, RT RDMS

Corporate Office: 616.363.7272, 3264 North Evergreen Drive, Grand Rapids, MI 49525

Spectrum Health Helen Devos Childrens Hospital GE HealthCare