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Age: Newborn (term delivery)

Sex: Male

Indication: Imperforate anus

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Case #34


Findings

  • Normal size and appearance of the kidneys without hydronephrosis
  • Hyperechoic material in the medullary pyramids, compatible with residual Tamm-Horsfall protein
  • Urinary bladder is partially decompressed without wall thickening


Diagnosis

  • Normal renal ultrasound
  • Tamm-Horsfall protein deposition

Sample Report

Normal renal ultrasound. Hyperechoic material in the medullary pyramids is compatible with residual Tamm-Horsfall protein, which is normal for patient age.


Discussion

  • The renal medulla is typically hypoechoic relative to the cortex in neonates, but there is a known transient phenomenon where precipitation of Tamm-Horsfall protein leads to increased medullary echogenicity within the first few days of life, typically resolving in 1-2 weeks
  • This finding is almost always incidental with no corresponding renal impairment or need for followup imaging, though cases of transient mild renal impairment associated with these imaging findings have been reported
  • If there is corresponding renal impairment, then more serious diagnoses need to be considered including medication side effects and nephrocalcinosis. Followup imaging at 1-2 weeks can help differentiate these conditions from Tamm-Horsfall protein deposition (which should clear by that time)



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