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Striated nephrogram

Last revised by Dr Mostafa El-Feky on 12 Jul 2022

Striated nephrogram is a descriptive term indicating an appearance of alternating linear bands of high and low attenuation in a radial pattern extending through the corticomedullary layers of the kidney on iodine-based intravenous contrast enhanced imaging.

It is important to know that a similar striated appearance on gadolinium-enhanced pediatric MR imaging may not be pathologic 6,7.

Striations result from stasis and concentration of contrast material in edematous or necrosed tubules. It demonstrates increasing attenuation over time 3.

The pattern is non-specific, and may be seen in a number of conditions:

The term "nephrogram" was originally used in the evaluation of plain film excretory urography 3. The use of intravenous contrast for imaging evaluation of the kidney was pioneered by American physician Moses Swick (1900-1985) in 1929 5. He worked with German urologist Alexander von Lichtenberg and chemist Arthur Binz to develop the first excretory contrast agent, known as Uroselectan.

In modern radiology, the nephrogram patterns are more commonly observed on CT urography and on plain film radiography following intravenous injection of an iodinated contrast agent.

  • spotted nephrogram
    • more segmental or subsegmental areas of corticomedullary hypoattenuation
    • secondary to multiple small-vessel infarctions
    • seen in intrarenal vasculitis (classic), embolic disease
    • see also: cortical rim sign
  • rim nephrogram
    • enhancing cortex, and absent medullary enhancement
    • seen days-to-weeks following global renal infarction, due to collateral circulation
      • main renal artery occlusion
      • main renal vein occlusion/thrombosis (more commonly associated with enlarged kidney)
    • see also: cortical rim sign
  • reverse rim nephrogram

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Cases and figures

  • Case 1: autosomal recessive polycystic kidney disease
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  • Case 2
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  • Case 3: acute tubular necrosis
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  • Case 4: acute pyelonephritis
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  • Case 5: acute tubular necrosis
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  • Case 6: hypotension
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  • Case 7: probable acyclovir induced nephropathy
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  • Case 8: from renal vein thrombosis
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  • Case 9: right acute pyelonephritis
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  • Case 10: bilateral in pyelonephritis
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