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CKD
Renal failure

Renal failure ultrasound case study

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CKD/Renal Failure ultrasound case study

CASE–1

Clinical History

An 85-year-old patient with a known history of chronic kidney disease (CKD)/renal failure on maintenance hemodialysis (6 dialysis sessions) presented for follow-up ultrasound evaluation. The patient has a history of left ureteric Double-J (DJ) stent placement for urinary tract obstruction. Ultrasound was performed to assess the left kidney and stent position.

Ultrasound Findings

Ultrasound examination demonstrates a small left kidney with increased cortical echogenicity and poor corticomedullary differentiation, consistent with chronic medical renal disease. A linear hyperechoic tubular structure is visualized within the left renal pelvis extending into the calyceal system, consistent with an indwelling Double-J (DJ) ureteric stent. No definite renal calculus is identified. Mild fullness of the pelvicalyceal system may be present. No perinephric collection is seen.

Ultrasound of the left kidney. The linear hyperechoic structure within the left renal pelvis/calyceal system represents an indwelling Double-J (DJ) ureteric stent. Sonographic features are consistent with a ureteric stent in situ in a patient with chronic kidney disease.

Report Line

The left kidney appears small with diffusely increased cortical echogenicity and loss of corticomedullary differentiation, consistent with chronic medical renal disease. A linear hyperechoic tubular structure is visualized within the left renal pelvis/calyceal system, consistent with an indwelling Double-J ureteric stent. No definite renal calculus or perinephric collection is identified. Sonographic findings are consistent with CKD with left DJ ureteric stent in situ.

Impression

Features are consistent with chronic kidney disease (CKD) involving the left kidney with an indwelling left Double-J (DJ) ureteric stent in situ.

Recommendation

Clinical correlation with renal function tests and dialysis status is recommended. Urology follow-up is advised to assess stent patency and determine the need for timely stent exchange or removal. Correlation with previous imaging and clinical findings is recommended. Non-contrast CT KUB may be considered if stent encrustation, migration, or recurrent obstruction is suspected.

Key Learning Points

Chronic kidney disease typically demonstrates small kidneys with increased cortical echogenicity and poor corticomedullary differentiation.
A Double-J ureteric stent appears as a linear hyperechoic tubular structure within the renal collecting system and ureter on ultrasound.
Ultrasound confirms the presence and approximate position of the stent but has limited ability to assess stent patency.
Long-term indwelling stents require periodic exchange to prevent encrustation, obstruction, and infection.
Patients on maintenance hemodialysis require regular nephrology and urology follow-up.
CT KUB is more sensitive for detecting stent encrustation, migration, or associated urinary calculi.
Clinical symptoms such as flank pain, fever, or recurrent urinary tract infection should raise suspicion for stent-related complications.