Published Online:https://doi.org/10.1148/rg.305095222

Normal appearances of the renal pyramids in neonates, infants, and older children are reviewed, and examples of various patterns of altered echogenicity that may occur are presented, with pathologic correlation provided when available.

In neonates and children, sonographic examinations of the renal pyramids may depict a spectrum of unique changes in echogenicity due to the effects of physiologic processes or a wide variety of pathologic processes that may affect the collecting ducts or interstitium of the pyramids. Focused sonographic evaluation of the pyramids with high-frequency transducers produces the most detailed images of the pyramids, revealing some appearances not previously reported, to the authors’ knowledge. The authors highlight the clinical settings in which they have documented detailed changes in the echogenicity of the pyramids. The patterns of altered echogenicity alone may reflect a specific cause but in many instances are nonspecific, with clinical and biochemical correlation required to establish a more precise diagnosis. However, there is a lack of histologic data to completely explain the mechanism of many of these changes in echogenicity in all of the processes. As the authors have expanded their use of the focused sonographic technique, they have been able to depict altered echogenicity in the pyramids in greater numbers of children in whom an explanation for the changes is not always immediately apparent; for now, the cause must be considered idiopathic. More work is required to expand the use of this focused technique together with clinical, biochemical, and histologic correlation in an attempt to offer more complete explanations for the changes in echogenicity of the pyramids.

© RSNA, 2010

References

  • 1 Slovis TL, Bernstein J, Gruskin A. Hyperechoic kidneys in the newborn and young infant. Pediatr Nephrol 1993;7(3):294–302. Crossref, MedlineGoogle Scholar
  • 2 Siegel MJ. Urinary tract. In: Siegel MJ, ed. Pediatric sonography. 3rd ed. Philadelphia, Pa: Lippincott Williams & Wilkins, 2002; 385–473. Google Scholar
  • 3 Jain M, LeQuesne GW, Bourne AJ, Henning P. High-resolution ultrasonography in the differential diagnosis of cystic diseases of the kidney in infancy and childhood: preliminary experience. J Ultrasound Med 1997;16(4):235–240. Crossref, MedlineGoogle Scholar
  • 4 Riebel TW, Abraham K, Wartner R, Müller R. Transient renal medullary hyperechogenicity in ultrasound studies of neonates: is it a normal phenomenon and what are the causes? J Clin Ultrasound 1993;21(1):25–31. Crossref, MedlineGoogle Scholar
  • 5 Howlett DC, Greenwood KL, Jarosz JM, MacDonald LM, Saunders AJ. The incidence of transient renal medullary hyperechogenicity in neonatal ultrasound examination. Br J Radiol 1997;70:140–143. Crossref, MedlineGoogle Scholar
  • 6 Khoory BJ, Andreis IA, Vino L, Fanos V. Transient hyperechogenicity of the renal medullary pyramids: incidence in the healthy term newborn. Am J Perinatol 1999;16(9):463–468. Crossref, MedlineGoogle Scholar
  • 7 Makhoul IR, Soudack M, Smolkin T, et al.. Neonatal transient renal failure with renal medullary hyperechogenicity: clinical and laboratory features. Pediatr Nephrol 2005;20(7):904–909. Crossref, MedlineGoogle Scholar
  • 8 Nakamura M, Yokota K, Chen C, et al.. Hyperechoic renal papillae as a physiological finding in neonates. Clin Radiol 1999;54(4):233–236. Crossref, MedlineGoogle Scholar
  • 9 Avni EF, Spehl-Roberecht M, Lebrun D, Gomes H, Garel L. Transient acute tubular disease in the newborn: characteristic ultrasound pattern. Ann Radiol (Paris) 1983;26(2–3):175–182. MedlineGoogle Scholar
  • 10 Ali US, Sengupta K, Andankar P, Saraf S, Chawla A, Deshpande S. Reversible renal medullary hyperechogenicity in neonatal hypernatremic dehydration. Pediatr Nephrol 2004;19(9):1050–1052. Crossref, MedlineGoogle Scholar
  • 11 Hijazi Z, Keller MS, Gaudio KM, Siegel NJ. Transient renal dysfunction of the neonate. Pediatrics 1988;82(6):929–930. MedlineGoogle Scholar
  • 12 Salisz JA, Kass EJ, Cacciarelli AA. Transient acute renal failure in the neonate. Urology 1993;41(2):137–140. Crossref, MedlineGoogle Scholar
  • 13 Starinsky R, Vardi O, Batasch D, Goldberg M. Increased renal medullary echogenicity in neonates. Pediatr Radiol 1995;25(suppl 1):S43–S45. Crossref, MedlineGoogle Scholar
  • 14 Tálosi G, Streitman K, Surányi A, Pintér S, Horváth I, Mulugeta Z. The possible role of uric acid in renal hyper-echogenicity in neonatal hypoxic acute shock. J Perinat Med 1996;24(6):693–697. Crossref, MedlineGoogle Scholar
  • 15 Mercado-Deane MG, Beeson JE, John SD. US of renal insufficiency in neonates. RadioGraphics 2002;22(6):1429–1438. LinkGoogle Scholar
  • 16 Chavhan G, Daneman A, Moineddin R, Lim R, Langlois V, Traubici J. Renal pyramid echogenicity in ureteropelvic junction obstruction: correlation between altered echogenicity and differential renal function. Pediatr Radiol 2008;38(10):1068–1073. Crossref, MedlineGoogle Scholar
  • 17 Dunbar JS, Nogrady MB. The calyceal crescent: a roentgenographic sign of obstructive hydronephrosis. Am J Roentgenol Radium Ther Nucl Med 1970;110(3):520–528. Crossref, MedlineGoogle Scholar
  • 18 Cremin BJ, Davey H, Oleszczuk-Raszke K. Neonatal renal venous thrombosis: sequential ultrasonic appearances. Clin Radiol 1991;44(1):52–55. Crossref, MedlineGoogle Scholar
  • 19 Wright NB, Blanch G, Walkinshaw S, Pilling DW. Antenatal and neonatal renal vein thrombosis: new ultrasonic features with high frequency transducers. Pediatr Radiol 1996;26(9):686–689. Crossref, MedlineGoogle Scholar
  • 20 Hibbert J, Howlett DC, Greenwood KL, MacDonald LM, Saunders AJS. The ultrasound appearances of neonatal renal vein thrombosis. Br J Radiol 1997;70(839):1191–1194. Crossref, MedlineGoogle Scholar
  • 21 Sty JR, Wells RG, Hardie RC. AIDS: sonography of hyperechoic renal pyramids in renal candidiasis. Wis Med J 1994;93(12):621–622. MedlineGoogle Scholar
  • 22 Karlowicz MG. Candidal renal and urinary tract infection in neonates. Semin Perinatol 2003;27(5):393–400. Crossref, MedlineGoogle Scholar
  • 23 Berman LH, Stringer DA, St Onge O, Daneman A, Whyte H. An assessment of sonography in the diagnosis and management of neonatal renal candidiasis. Clin Radiol 1989;40(6):577–581. Crossref, MedlineGoogle Scholar
  • 24 Hurley R, Winner HI. Experimental renal moniliasis in the mouse. J Pathol Bacteriol 1963;86:75–82. Crossref, MedlineGoogle Scholar
  • 25 Traubici J, Daneman A. High-resolution renal sonography in children with autosomal recessive polycystic kidney disease. AJR Am J Roentgenol 2005;184(5):1630–1633. Crossref, MedlineGoogle Scholar
  • 26 Lucaya J, Enríquez G, Nieto J, Callis L, Garcia Peña P, Domínguez C. Renal calcifications in patients with autosomal recessive polycystic kidney disease: prevalence and cause. AJR Am J Roentgenol 1993;160(2):359–362. Crossref, MedlineGoogle Scholar
  • 27 Avni FE, Guissard G, Hall M, Janssen F, DeMaertelaer V, Rypens F. Hereditary polycystic kidney diseases in children: changing sonographic patterns through childhood. Pediatr Radiol 2002;32(3):169–174. Crossref, MedlineGoogle Scholar
  • 28 Choyke PL, Siegel MJ, Oz O, Sotelo-Avila C, DeBaun MR. Nonmalignant renal disease in pediatric patients with Beckwith-Wiedemann syndrome. AJR Am J Roentgenol 1998;171(3):733–737. Crossref, MedlineGoogle Scholar
  • 29 Goldman M, Shuman C, Weksberg R, Rosenblum ND. Hypercalciuria in Beckwith-Wiedemann syndrome. J Pediatr 2003;142(2):206–208. Crossref, MedlineGoogle Scholar
  • 30 Jequier S, Kaplan BS. Echogenic renal pyramids in children. J Clin Ultrasound 1991;19(2):85–92. Crossref, MedlineGoogle Scholar
  • 31 Shultz PK, Strife JL, Strife CF, McDaniel JD. Hyperechoic renal medullary pyramids in infants and children. Radiology 1991;181(1):163–167. LinkGoogle Scholar
  • 32 Nayir A, Kadioğlu A, Ş;irin A, Emre S, Tonguç E, Bilge I. Causes of increased renal medullary echogenicity in Turkish children. Pediatr Nephrol 1995;9(6):729–733. Crossref, MedlineGoogle Scholar
  • 33 Cremin B, Wiggelinkhuizen J, Bonnici F. Nephrocalcinosis in children. Br J Radiol 1982;55(654):413–418. Crossref, MedlineGoogle Scholar
  • 34 Adams ND, Rowe JC. Nephrocalcinosis. Clin Perinatol 1992;19(1):179–195. Crossref, MedlineGoogle Scholar
  • 35 Alon US. Nephrocalcinosis. Curr Opin Pediatr 1997;9(2):160–165. Crossref, MedlineGoogle Scholar
  • 36 Rönnefarth G, Misselwitz J. Nephrocalcinosis in children: a retrospective survey. Members of the Arbeitsgemeinschaft für pädiatrische Nephrologie. Pediatr Nephrol 2000;14(10–11):1016–1021. Crossref, MedlineGoogle Scholar
  • 37 Mantan M, Bagga A, Virdi VS, Menon S, Hari P. Etiology of nephrocalcinosis in northern Indian children. Pediatr Nephrol 2007;22(6):829–833. Crossref, MedlineGoogle Scholar
  • 38 Bruwer A. Primary renal calculi: Anderson-Carr-Randall progression? AJR Am J Roentgenol 1979;132(5):751–758. Crossref, MedlineGoogle Scholar
  • 39 Patriquin H, Robitaille P. Renal calcium deposition in children: sonographic demonstration of the Anderson-Carr progression. AJR Am J Roentgenol 1986;146(6):1253–1256. Crossref, MedlineGoogle Scholar
  • 40 Katz ME, Karlowicz MG, Adelman RD, Werner AL, Solhaug MJ. Nephrocalcinosis in very low birth weight neonates: sonographic patterns, histologic characteristics, and clinical risk factors. J Ultrasound Med 1994;13(10):777–782. Crossref, MedlineGoogle Scholar
  • 41 Kooh SW, Binet A, Daneman A. Nephrocalcinosis in X-linked hypophosphataemic rickets: its relationship to treatment, kidney function, and growth. Clin Invest Med 1994;17(2):123–130. MedlineGoogle Scholar
  • 42 Cramer B, Husa L, Pushpanathan C. Pattern and permanence of phosphate-induced nephrocalcinosis in rabbits. Pediatr Radiol 1998;28(1):14–19. Crossref, MedlineGoogle Scholar
  • 43 Cote G, Jequier S, Kaplan P. Increased renal medullary echogenicity in patients with Williams syndrome. Pediatr Radiol 1989;19(6–7):481–483. Crossref, MedlineGoogle Scholar
  • 44 Cramer B, Husa L, Pushpanathan C. Nephrocalcinosis in rabbits: correlation of ultrasound, computed tomography, pathology and renal function. Pediatr Radiol 1998;28(1):9–13. Crossref, MedlineGoogle Scholar
  • 45 Igarashi T, Shibuya K, Kamoshita S, et al.. Renal cyst formation as a complication of primary distal renal tubular acidosis. Nephron 1991;59(1):75–79. Crossref, MedlineGoogle Scholar
  • 46 Moudgil A, Rodich G, Jordan SC, Kamil ES. Nephrocalcinosis and renal cysts associated with apparent mineralocorticoid excess syndrome. Pediatr Nephrol 2000;15(1–2):60–62. Crossref, MedlineGoogle Scholar
  • 47 Watanabe T, Tajima T. Renal cysts and nephrocalcinosis in a patient with Bartter syndrome type III. Pediatr Nephrol 2005;20(5):676–678. Crossref, MedlineGoogle Scholar
  • 48 Herman TE, McAlister WH. Gastrointestinal and renal abnormalities in cardio-facio-cutaneous syndrome. Pediatr Radiol 2005;35(2):202–205. Crossref, MedlineGoogle Scholar
  • 49 Navarro O, Daneman A, Kooh SW. Asymmetric medullary nephrocalcinosis in two children. Pediatr Radiol 1998;28(9):687–690. Crossref, MedlineGoogle Scholar
  • 50 Navarro OM, Daneman A, Matzinger MA. Unilateral hyperechoic renal pyramids in a child with renal artery stenosis. J Ultrasound Med 2006;25(1):127–130; quiz 131–132. Crossref, MedlineGoogle Scholar
  • 51 Pearse DM, Kaude JV, Williams JL, Bush D, Wright PG. Sonographic diagnosis of furosemide-induced nephrocalcinosis in newborn infants. J Ultrasound Med 1984;3(12):553–556. Crossref, MedlineGoogle Scholar
  • 52 Hein G, Richter D, Manz F, Weitzel D, Kalhoff H. Development of nephrocalcinosis in very low birth weight infants. Pediatr Nephrol 2004;19(6):616–620. Crossref, MedlineGoogle Scholar
  • 53 Pope JC, Trusler LA, Klein AM, Walsh WF, Yared A, Brock JW. The natural history of nephrocalcinosis in premature infants treated with loop diuretics. J Urol 1996;156(2 pt 2):709–712. Crossref, MedlineGoogle Scholar
  • 54 Hoppe B, Duran I, Martin A, et al.. Nephrocalcinosis in preterm infants: a single center experience. Pediatr Nephrol 2002;17(4):264–268. Crossref, MedlineGoogle Scholar
  • 55 Porter E, McKie A, Beattie TJ, et al.. Neonatal nephrocalcinosis: long term follow up. Arch Dis Child Fetal Neonatal Ed 2006;91(5):F333–F336. Crossref, MedlineGoogle Scholar
  • 56 Schell-Feith EA, Kist-van Holthe JE, Conneman N, et al.. Etiology of nephrocalcinosis in preterm neonates: association of nutritional intake and urinary parameters. Kidney Int 2000;58(5):2102–2110. Crossref, MedlineGoogle Scholar
  • 57 Stevens SK, Parker BR. Renal oxypurine deposition in Lesch-Nyhan syndrome: sonographic evaluation. Pediatr Radiol 1989;19(6–7):479–480. Crossref, MedlineGoogle Scholar
  • 58 Toyoda K, Miyamoto Y, Ida M, Tada S, Utsunomiya M. Hyperechoic medulla of the kidneys. Radiology 1989;173(2):431–434. LinkGoogle Scholar
  • 59 Chen YT. Type I glycogen storage disease: kidney involvement, pathogenesis and its treatment. Pediatr Nephrol 1991;5(1):71–76. Crossref, MedlineGoogle Scholar
  • 60 Lin CC, Tsai JD, Lin SP, Lee HC. Renal sonographic findings of type I glycogen storage disease in infancy and early childhood. Pediatr Radiol 2005;35(8):786–791. Crossref, MedlineGoogle Scholar
  • 61 Fick JJ, Beek FJ. Echogenic kidneys and medullary calcium deposition in a young child with glycogen storage disease type 1a. Pediatr Radiol 1992;22(1):72–73. Crossref, MedlineGoogle Scholar
  • 62 Walker TM, Serjeant GR. Increased renal reflectivity in sickle cell disease: prevalence and characteristics. Clin Radiol 1995;50(8):566–569. Crossref, MedlineGoogle Scholar
  • 63 Zinn D, Haller JO, Cohen HL. Focal and diffuse increased echogenicity in the renal parenchyma in patients with sickle hemoglobinopathies: an observation. J Ultrasound Med 1993;12(4):211–214. Crossref, MedlineGoogle Scholar
  • 64 Papadaki MG, Kattamis AC, Papadaki IG, et al.. Abdominal ultrasonographic findings in patients with sickle-cell anaemia and thalassaemia intermedia. Pediatr Radiol 2003;33(8):515–521. Crossref, MedlineGoogle Scholar
  • 65 Balci A, Karazincir S, Sangün Ö, et al.. Prevalence of abdominal ultrasonographic abnormalities in patients with sickle cell disease. Diagn Interv Radiol 2008;14(3):133–137. MedlineGoogle Scholar
  • 66 Davidson AJ. Increased renal reflectivity in sickle cell disease. Clin Radiol 1996;51(3):231. Crossref, MedlineGoogle Scholar

Article History

Received: Dec 17 2009
Revision requested: Mar 1 2010
Revision received: Mar 17 2010
Accepted: Mar 25 2010
Published online: Aug 31 2010
Published in print: Sept 2010