DMSA Scintigraphy in Renal Duplex System

Cm, Kullendorff; Wallin, Lena

doi:10.1055/s-2008-1063517

Cited by 13 publications

(6 citation statements)

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“…A study by Kullendorff and Wallin, where dimercaptosuccinic acid scintigraphy was used to characterise renal function in identified cases of duplex kidneys found 44% of cases had severely deteriorated function. 18 Our study supports current literature where duplex kidney are found to be up to two times more common in female patients and bilateral in less than 20%. 1,3,8,19 There is the suggestion that inheritance of duplex kidneys may be of a dominant nature with variable penetrance 8,20 ; however, the well-described female predomience is not explained by this.…”

Section: Discussionsupporting

confidence: 92%

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Duplex kidney: Not just a drooping lily

2015

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Introduction: Duplex kidneys are common, mostly asymptomatic and of no clinical significance. However, they can be associated with significant pathology, often with long-term morbidity. There is minimal literature on the review of the duplex kidney, its associated anomalies and complications. The purpose of this paper is to review our experience of imaging the spectrum of abnormalities associated with duplex kidneys in the paediatric population and correlate this with contemporary literature. Method: A retrospective review of the radiology database in a tertiary paediatric centre was performed. A word search of the Radiology Information System for 'duplex' of patients under the age of 16 was undertaken and limited to studies performed between 2006 and 2013. Results: Two hundred seventy-four patients were identified (age range 0-16, median 3 years, gender 59.9% female) who had 836 studies: ultrasound 598/836 (71.6%), nuclear medicine 180/836 (21.5%), micturating cystourethrogram 52/836 (6.2%), MRI 5/836 (<1%) and CT scan 1/836 (<1%). Patients were categorised as duplex and no complication (151/ 274 = 55.1%), upper moiety obstruction, lower moiety reflux/scarring, multicystic dysplastic kidney, abnormal ureteric insertion and other pathology. Conclusion: Duplex kidneys are common and often not clinically significant. However, this study demonstrates almost 50% of paediatric patients investigated for duplex kidneys had complications requiring treatment. The most common complications were upper moiety obstruction associated with a ureterocele and lower moiety vesicoureteric reflux. Ultrasound was the most common modality for early detection of these complications.

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Section: Discussionsupporting

confidence: 92%

“…This high incidence of complication is similar to the literature. A study by Kullendorff and Wallin, where dimercaptosuccinic acid scintigraphy was used to characterise renal function in identified cases of duplex kidneys found 44% of cases had severely deteriorated function …”

Section: Discussionmentioning

confidence: 99%

Duplex kidney: Not just a drooping lily

2015

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“…In a study by Kullendorff and Wallin, where dimercaptosuccinic acid scintigraphy was used to characterise renal function, 44% cases with duplex kidneys had severely deteriorated renal function. 21 Elhadi et al presented a case report of left side duplex kidney with lower moiety renal calculus. 22 Several other studies has also mentioned calculus in urinary tract associated with duplex kidney.…”

Section: Discussionmentioning

confidence: 99%

Duplex kidney anomalies and associated pathology: a single centre retrospective review

et al. 2019

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Background: Duplex kidneys are common developmental renal anomaly with an incidence of 1% in healthy adult population. Adult individuals may present as non-functional moiety, calculus disease or an incidental finding. Duplex kidney is defined as a renal unit comprised of two pelvicalyceal systems. Based on the degree of fusion, it can present as bifid renal pelvis, partial ureteric duplication (Y-shaped ureter), incomplete ureteric duplication with ureters joining near or in bladder wall (V-shaped ureter) and complete ureteric duplication with separate ureteric orifices. The purpose of this study is to retrospectively review the various duplex kidney anomalies and associated pathology. Methods: This is a retrospective study, performed at Department of Urology, Gauhati Medical College Hospital, a tertiary centre, from September, 2018 to August, 2019. Preoperative imaging, plain intravenous urography or computed tomography intravenous urography was done. Results: 29 patients were diagnosed with variants of duplex kidney anomaly. It includes right side, left side and bilateral anomalies. Among all the patients 4 had incidental findings. 16 patients had associated renal or ureteral calculus. 5 patients had associated ureteropelvic junction obstruction while 1 patient had ureterovesical junction stricture. We found single patient in each group of duplex kidney anomaly associated with non-functional moiety with renal cell carcinoma, ureterocele with urothelial malignancy and horseshoe kidney with ureteropelvic junction obstruction respectively. Conclusions: Duplex kidney anomaly in most individuals is of no clinical significance. High index of suspicion along with good quality imaging can accurately detect specific anomaly and associated condition.Cite this article as: Sarma D, Pratihar SK, Rajeev TP, Barua SK, Bagchi PK, Phukan M. Duplex kidney anomalies and associated pathology: a single centre retrospective review. Int Surg J 2020;7:76-82.

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“…These findings are in keeping with those reported previously. In a study of 52 duplicated kidneys, 23 of which showed severely deteriorated function (15 upper‐moiety and nine lower‐pole) Kullendorf and Wallin [ 8] noted the differential function of the affected moiety to be ≤14% (mean 5.7%). They therefore recommended ablative surgery when the affected kidney moiety comprised <14% of the total renal function.…”

Section: Discussionmentioning

confidence: 99%

Lower moiety heminephroureterectomy in the duplex refluxing kidney: the accuracy of isotopic scintigraphy in functional assessment

Carter¹,

Malone²,

Lewington³

1998

British Journal of Urology

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Objective To determine the accuracy of dimercaptosuccinic acid (DMSA) scintigraphy in assessing the differential function between upper and lower moieties of a refluxing duplex system. Patients and methods Between 1990 and 1996, 20 patients underwent lower moiety heminephroureterectomy. All patients had their differential renal function assessed by DMSA scintigraphy before and after surgery, the results being assessed by comparing the predicted and actual loss of renal function. Results The mean (SD, range) function attributed to the scarred lower moiety (predicted loss of function) was 4.3 (4.9, 0–14)%, which compared with an actual mean loss of function of 6.8 (5.1, +4 to −16)%. Thus the mean (SD, range) difference between the predicted and actual loss of renal function was −2.1 (3.2, +4 to −8)%. Conclusion DMSA scintigraphy provides an accurate assessment of the differential renal function between upper and lower moieties in a duplex system. The decision to proceed to lower moiety heminephroureterectomy can be logically based on the information gained from DMSA scintigraphy.

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DMSA Scintigraphy in Renal Duplex System

Cited by 13 publications

References 1 publication

Duplex kidney: Not just a drooping lily

Duplex kidney: Not just a drooping lily

Duplex kidney anomalies and associated pathology: a single centre retrospective review

Lower moiety heminephroureterectomy in the duplex refluxing kidney: the accuracy of isotopic scintigraphy in functional assessment

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