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1. Obstructing ureteral blood clot

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Figure 46-1

Obstructing ureteral blood clot.

A. An unenhanced axial CT image of a 12-year-old bone marrow transplant patient with acute onset of hematuria and left flank pain shows a noncalcified object in the left ureter (arrow). This measured 55 Hounsfield units. B. A delayed image shows manifestations of acute ureteral obstruction, with a persistent intense nephrogram and lack of contrast excretion into the pelvicaliceal system.

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2. Hemolytic uremic syndrome

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Figure 46-2

Hemolytic uremic syndrome.

This 4-year-old boy presented with bloody stools, hypertension, oliguria, thrombocytopenia, and a creatinine level of 1.6. A. The night of admission, the patient became tachypneic. Chest radiography shows pulmonary edema, a left pleural effusion, and mild cardiomegaly, due to renal failure and hypoalbuminemia. B. Sonographic evaluation 10 days after clinical onset shows the right kidney to have diffusely prominent echogenicity.

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3. Hemolytic uremic syndrome

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Figure 46-3

Hemolytic uremic syndrome.

A longitudinal sonographic image demonstrates cortical hyperechogenicity (arrows) and relatively hypoechoic pyramids.

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4. Acute glomerulonephritis

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Figure 46-4

Acute glomerulonephritis.

A, B. There is cardiomegaly. Central interstitial markings are prominent, but there is no signifi-cant pleural fluid. C. Sonography shows diffuse parenchymal hyperechogenicity.

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5. Sickle cell disease

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Figure 46-5

Sickle cell disease.

A longitudinal sonographic image of an 8-year-old child with homozygous hemoglobin S disease demonstrates generalized renal parenchymal hyperechogenicity. There is a small hypoechoic focus in the lower pole (arrow) due to an acute infarct.

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6. Sickle cell disease

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Figure 46-6

Sickle cell disease.

A delayed IV urography image of a 16-year-old boy shows distortion of the collecting system. There is calyceal blunting throughout the kidney. A calyx in the midportion of the kidney has a prominent papillary impression (arrow).

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7. Lupus nephritis

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Figure 46-7

Lupus nephritis.

This 8-year-old girl presented with lower extremity swelling, hematuria, and hypertension. A. Sonography shows parenchymal hyperechogenicity and nephromegaly (the renal length was 12.4 cm). B. The resistive index of an interlobar artery in the right kidney was 0.72. Renal biopsy indicated class 4 lupus ...

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