SPHP

Kidneys: evaluate size (symmetry), hydronephrosis, calculi, mass

Aorta:  Record Pulse Doppler of aorta just distal to SMA. Record peak systolic and end diastolic velocities.   

Renal arteries:  Pulse Doppler proximal, mid, distal.  Record peak systolic and end diastolic velocities.  Record acceleration time, resistive indices, and end-diastolic ratio. 

Segmental arteries:  Pulse Dopple evaluation at upper and lower pole.  Record peak systolic and end diastolic velocities.  Record acceleration time, resistive indices, and end-diastolic ratio.

Look for accessory renal arteries.  

Scanning sequence:  

1. Three sagittal right kidney images (medial, mid, lateral).  Measure length mid.   Include spleen-kidney interface.
2. Three transverse images right kidney (upper, mid, lower)
3. Repeat steps #1 and #2 for left kidney
4. Gray scale and color sagittal aorta
5. Pulse Doppler sagittal aorta just below SMA origin
6. Gray scale and color right renal artery
7. Pulse Doppler right renal artery (prox, mid, dist)
8. Pulse Doppler right segmenal arteries (upper, lower poles) - record RI, EDR
9. Repeat steps #7-#9 for left side
10. Show any accessory renal arteries (gray scale, color, Pulse Doppler)

• Peak systolic velocity >180 cm/sec predictive of 50% or greater diameter reduction
• Renal-aortic ratio (RAR) >/=3.5 predictive of 50% or greater diameter reduction
• End-diastolic ratio (EDV/PSV) <0.2 abnormal
• Resistive index (PSV-EDV) / PSV >0.7 abnormal