White pyramid sign (kidney)
Citation, DOI, disclosures and article data
Citation:
Khader.O.Thabet M, Bell D, Fahrenhorst-Jones T, et al. White pyramid sign (kidney). Reference article, Radiopaedia.org (Accessed on 17 Mar 2025) https://doi.org/10.53347/rID-28362
rID:
28362
Article created:
23 Mar 2014,
Mohammed Al Khader.O.Thabet
Disclosures:
At the time the article was created Mohammed Al Khader.O.Thabet had no recorded disclosures.
View Mohammed Al Khader.O.Thabet's current disclosures
Last revised:
Disclosures:
At the time the article was last revised Daniel J Bell had no financial relationships to ineligible companies to disclose.
View Daniel J Bell's current disclosures
Revisions:
14 times, by
11 contributors -
see full revision history and disclosures
Systems:
Sections:
Synonyms:
- Renal white pyramid sign
- Dense renal medulla sign (DRM)
- Hyperdense renal pyramids sign
The white pyramid sign, also known as dense renal medulla sign (DRM) or hyperdense renal pyramids sign, refers to the CT appearance of the medullary pyramids of the kidney which can be seen normally on unenhanced CT scans as high-attenuation triangular structures.
Pathology
Etiology
incidental normal finding
increased urine osmolality: dehydration, hypernatremia, high-protein diet, glycosuria, adrenal insufficiency, and syndrome of inappropriate antidiuretic hormone secretion (SIADH)
acute ureteric obstruction: the unilateral absence of white pyramids is a subtle secondary sign suggestive of ipsilateral urinary tract obstruction
high-dose antibiotic therapy: due to antibiotic precipitation in the collecting tubules
high caffeine intake
References
- 1. Webb WR, Brant W, Major N. Fundamentals of Body Ct. Saunders. (2006) ISBN:1416000305. Read it at Google Books - Find it at Amazon
- 2. Dogra VS, MacLennan GT. Genitourinary Radiology: Kidney, Bladder and Urethra. Springer. (2012) ISBN:1848002459. Read it at Google Books - Find it at Amazon
- 3. Step by Step in Emergency Radiology. Jaypee Brothers Medical Publishers. ISBN:818061803X. Read it at Google Books - Find it at Amazon
- 4. Roychowdhury A, Makris J, Colby JM, et al. Unilateral absence of the “white pyramid” sign on non-contrast CT: a sign of tubular hydronephrosis?. Presented at the 98th Meeting of the American Roentgen Ray Society, Scientific Session 33, San Francisco, Calif, April 26–May 1, 1998
- 5. Dalrymple NC, Casford B, Raiken DP, Elsass KD, Pagan RA. Pearls and pitfalls in the diagnosis of ureterolithiasis with unenhanced helical CT. (2000) Radiographics : a review publication of the Radiological Society of North America, Inc. 20 (2): 439-47; quiz 527-8, 532. doi:10.1148/radiographics.20.2.g00mc13439 - Pubmed
- 6. Sureka B, Bansal K, Arora A. Dense renal medulla sign. (2016) Indian journal of nephrology. 26 (3): 223-4. doi:10.4103/0971-4065.159554 - Pubmed
- 7. Kumar R, Wang Z, Fu Y, Forsythe C, Webb E, Yeh B. Visualization of Renal Medullary Hyperattenuation at Unenhanced CT: What Is the Effect of Furosemide Administration? Radiology. 2010;255(2):495-500. doi:10.1148/radiol.10091769 - Pubmed
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