Is a complete urological evaluation necessary in all newborns with asymptomatic renal ectopia?

Abstract

Aim:To evaluate if a complete urological screening is justified by potential urological anomalies in newborns or infants with asymptomatic renal ectopia (RE). Methods: The database records of 60 consecutive neonatal cases of RE diagnosed at the authors' hospital from 1990 to 2004 were retrospectively reviewed. Results: At diagnosis, mean patient age was 1.6 months. In 58 of 60 patients, the suspected diagnosis of RE was made during prenatal or postnatal screening ultrasonography, including two newborns with anorectal malformation. There were 24 patients with crossed RE (C-RE) and 36 patients with simple RE (S-RE). A solitary RE was present in two patients. The most frequent associated urological abnormality was vesicoureteral reflux (37.5% of C-RE and 16.6% of S-RE). Hydronephrosis was detected in seven RE and five contralateral kidneys. An obstructive megaureter was present in one patient with C-RE. In 40% of S-RE and 92.9% of C-RE, the 99m Tc DMSA documented reduction of function of RE. The longitudinal diameter of the ectopic kidney was significantly smaller than the contralateral one. Other non-renal diseases were present in 15% of patients, of which the most frequent was cryptorchidism (6.6%). Conclusions: A complete urological evaluation is necessary in newborns with C-RE for the high incidence of associated urological anomalies, of which VUR is the most frequent. A complete urological evaluation is also reasonable in patients with S-RE who have a pelvic dilatation. No diagnosis or treatment of the associated urological diseases, in consideration of congenital decreased function of the ectopic kidney, might predispose these children to improvement of renal function impairment.

Acute management of neonatal respiratory failure due to crossed ectopic obstructed megaureter in a duplicated pelvic kidney

“…In a review of 32,221 newborn screening ultrasounds, renal ectopia was identified in 60 (0.2%), 40% of which were crossed [3]. Of note, 40% of the patients with renal ectopia had additional urological abnormalities including vesicoureteral reflux (25%), and ureteropelvic and ureterovesical junction obstruction.…”

Are children with congenital solitary kidney at risk for lifelong complications? A lack of prediction demands caution

“…Associated urological anomalies have been observed in *40% of patients with CSFK [15]. In particular, VUR was more frequently associated with CSFK [16] (15% of cases), followed by pyeloureteral junction obstruction (PUJO) (12%), ureterovesical junction obstruction (2%), and other urological anomalies in 9% of children with CSFK [5,7,16,17].…”

Crossed Fused Renal Ectopia

“…99m Tc-DMSA scan and contrast-enhanced multidetector CT were recommended to evaluate renal ectopia. 1 Left-to-right ectopia is more common than right-to-left. 2,3 In addition, approximately 90% of crossed ectopic kidney are fused to the ipsilateral kidney.…”

“…In some cases, it may be associated with recurrent urinary tract infections, nephrolithiasis, vesicoureteral reflux, ureteropelvic junction obstruction, hydronephrosis, and multicystic renal dysplasia. 1,5 Although ultrasound is the first imaging study to start the diagnostic approach, a single kidney usually identifies in renal fossa with increased size and dilated renal pelvis, which suggest unilateral renal agenesis, and further imaging studies are required. 6,7 99m Tc-DMSA scan can reveal the location of functioning renal tissue with a high degree of sensitivity, 3,8 and additional SPECT imaging may be helpful to find any morphologic anomalies and cortical defects.…”