Report of One Interesting Case - unilateral Kidney Agenesis Associated with Ipsilateral Kidney Malrotation, Anal Atresia and Pulmonary Artery Failure

Abstract

Renal agenesis is a fairly common congenital anomaly with an unknown definite etiology. Unilateral renal agenesis is much more common than bilateral renal agenesis, but it usually does not carry any major health consequence, as long as the other kidney is healthy. In some cases, renal agenesis may by associated with other congenital anomalies. We report a neonatal female patient born with unilateral renal agenesis associated with malrotation of ipsilateral kidney, anal atresia and pulmonary artery failure. One month old female child was referred to Nuclear Medicine Department for dynamic renal scintigraphy which performed after intravenously injection of 0.5 mCi(99m) TcDTPA. Scintigraphy was carried out on a Dual Head-Siemens gamma camera using a high resolution collimator. During the dynamic scintigraphy patient was positioned in a supine position. Furosemide, as diuretic stimulator was administered intravenously at 18th minute of the study. The female patient, eight months old, with cough, short breath (dispnea), fatigue, nausea, vomiting and diarrhea was referred to DTPA renal scintigraphy. Symptoms were manifested ten days before patient had undergone the renal scintigraphy. During this time the patient was under pediatrics' control. A patient has undergone the biochemistry, ultrasound and radiologic examinations. Samples were isolated from the urine culture Pseudomonas aureginosa. The patient received antibiotics (Amikacin) for seven days, whereas last five days she received salbutamole and bisolvon. During physical examination we noticed a left abdominal stoma without palpation sensibility associated with an imperforate anus. From DTPA renal scintigraphy we found the absence of a right kidney, malrotation of a left kidney associated with seriously problems during the elimination of urine. Unilateral renal agenesis usually is without any major health consequences, but in cases where it is associated with other congenital malformations, such as malrotation of existing kidney, anal atresia and cardiopulmonary anomalies can be very serious problem for life. Dynamic renal scintigraphy is very highly sensitive and helpful method for detection of renal congenital malformations and function abnormalities.