Delayed nephrogram

Dr Henry Knipe and Dr Zishan Sheikh et al.

Delayed nephrogram, commonly described on plain film urography, but also visible on CT urography, is when there is absence or reduction of normal renal parenchymal enhancement on nephrographic phase images.

A delayed nephrogram is characteristically unilateral and is usually distinguished from bilateral delayed nephrograms, which are termed persistent nephrograms, and are usually caused by systemic hypotension.

Pathology

Normal enhancement of the renal parenchyma involves contrast passing via the renal arterial bed to the glomeruli and nephrons before being finally concentrated into the collecting system. A temporal delay in this occurring can therefore result from any disruption of the pathways in this process.

Aetiology

Failure of the normal temporal progression of nephrographic contrast can result from a number of renal conditions:

Radiographic features

The abnormal kidney shows nephrographic enhancement in the delayed or urographic phase which persists for a prolonged period of time. This is evident on delayed images as the normal kidney shows contrast within the collecting system and ureters while the abnormal kidney does not.

These features are distinct from non-enhancement of the renal parenchyma which can occur in cases of renal infarction.

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Article Information

rID: 47656
System: Urogenital
Section: Signs
Synonyms or Alternate Spellings:
  • Delayed nephrograms

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Cases and Figures

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    Case 1: IVP
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    Case 2: obstructive uropathy
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    Case 3: renal artery stenosis
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    Case 4: bilateral delayed nephrogram from RAS
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