Category: 3. Renal Ultrasound Protocol

• Maintaining the longitudinal view, center the kidney on your screen, and then rotate your probe 90 degrees counterclockwise.
• The indicator should be pointing Anteriorly.
• Tilt the probe superiorly and inferiorly to assess the entire left kidney.
• Visualize the same renal structures you did in the Right Kidney.

The technique for scanning the left kidney is very similar to that of the right kidney. Of note, the left kidney lies slightly superior and posterior compared to the right kidney due to the smaller size of the spleen.

• Point the probe indicator towards the patient’s head.
• Place your probe at the Left Posterior Axillary Line around the 8th to 10th intercostal space.
• To reach the posterior axillary line, your knuckles should touch the bed.
• Visualize the same renal structures you did in the Right Kidney (except instead of the liver you will see the spleen above the left kidney in this view).
• POCUS 101 Tip: Sometimes you may need to rely on the patient’s breathing pattern to bring the left kidney into view.

• Maintaining the longitudinal view of the right kidney, center the kidney on your screen, and then rotate your probe 90 degrees counterclockwise.
• The probe indicator should be pointing Posteriorly.

• Here is the ultrasound image transition that you should see as you go from the longitudinal kidney ultrasound view to the transverse view.

• In the transverse view, identify the Renal Cortex, Medullary Pyramid, and Renal Pelvis.
• Tilt the probe superiorly and inferiorly to assess the right kidney.

We will scan both the left and right kidneys using the long-axis and short-axis, also known as longitudinal and transverse views.

Step 1: RIGHT Kidney Ultrasound Longitudinal View

• Point the probe indicator towards the patient’s head.
• Place your probe at the Right Midaxillary Line around the 10th to 11th intercostal space.
• Tip: You may need to rotate the transducer 10-20 degrees counter-clockwise to get in between the rib spaces and optimize your view.

• Center the kidney on the ultrasound screen.
• Identify the: Liver, Renal Cortex, Medullary Pyramids, Renal Pelvis, Renal Sinus, Mainor Calyces, Minor Calyces.
• The normal size of an adult kidney is around 10-11cm in the longitudinal view.

• Slowly tilt/fan the probe anteriorly and posteriorly to assess the entire kidney.