Non-visualized Kidney Research Articles

Characterizing renal abnormalities in children with high anorectal malformation with renal scintigraphy: A single-centre experience

Objective: The purpose of this study was to characterize the renal abnormalities with renal scintigraphy in patients with high anorectal malformation (HARM). Patients and Methods: We retrospectively reviewed 53 patients who had undergone corrective surgery for HARM from July 2011 to January 2017 and who were referred to this department for Technetium-99m dimercaptosuccinic acid (Tc99m-DMSA) scan for evaluation of renal cortical scarring. Scintigraphic evaluation of all 53 patients included both dynamic renography [Tc-99m diethylene triamine penta acetic acid (DTPA) and Tc-99m-L, L-ethylenedicysteine (L-EC) scan] and cortical scintigraphy. A total of 68 scans were done in these 53 patients in which there were 38 Tc-99m DMSA scans, 15 Tc-99m DTPA and 15 Tc-99m EC scans. Tc-99m DTPA scans were done in 15 patients (26 kidneys) to look for glomerular filtration rate and drainage pattern. Results: Mean age of presentation of these 53 patients (86 kidneys or renal units) with HARM was 28.9 months. Out of 53 patients, male comprised 62.26% of cases (n = 33) and female comprised 37.7% of cases (n = 20). Spectrum of urologic abnormalities noted in our patients with HARM included unilaterally non-visualized kidney in 37.7% cases, i.e., 20/53 patients; hydroureteronephrosis in 28.3% of cases, i.e., 15/53 patients; hydronephrosis in 16.98% cases, i.e., 9/53 patients. Scarring was noted in 28.3% cases, i.e., 15/53 patients. Small kidney was noted in 10 patients out of 53, i.e., 18.8% of cases. Ectopic kidney was seen in 5.6% cases, i.e., 3/53 patients, horseshoe kidney in 3.7% (2/53) and duplex kidney was found in 1 patient, i.e., 1.8% of cases. Conclusion: Children with HARM have a high incidence of renal anomalies and these are the most common cause of morbidity and mortality in these patients. It is important to document these renal anomalies early in life and initiate management as early as possible. Apart from routine investigations, such as ultrasound, renal scintigraphy performed with Tc-99m DTPA, Tc-99m EC and Tc-99m DMSA-III are non-invasive investigations that may provide important help in diagnosis, follow-up and management of renal anomalies in these patients.

99mTc-DMSA renal scan and 99mTc-DTPA renography findings in patients with horseshoe kidneys: experience of a single institute

Purpose: Horseshoe kidney is a congenital malformation that is found incidentally in many of the asymptomatic patients undergoing 99mTc- DTPA renography and 99mTc-dimercaptosuccinic acid (DMSA) renal scans in the nuclear nephrology division of National Institute of Nuclear Medicine & Allied Sciences (NINMAS). Scan findings of year 2012 and 2013 are demonstrated in this study. Methods: Few of the patients had known ultrasound reports of ectopic positioned or non-visualized kidney and mostly referred to our institute for 99mTc-DTPA renogram. Each diuretic renogram consisted of dynamic renal scan images obtained with camera in both anterior and posterior positions and15% window centered at 140 keV using 64 X 64matrix. Acquisition started with bolus injection of 99mTc-DTPA and dynamic images were acquired at 16-seconds/ frame for 75 frames. Intravenous injection of furosemide (1 mg / kg body weight) was given between 10-15 minutes of the study. They each underwent a 99mTc-DMSA renal cortical scan to confirm the horseshoe kidney. Results: In a 2-year period, 14 patients (5 children and 9 adults) with horseshoe kidney were found with age ranging from 6 to 43 yrs (mean + SD,23.93 ± 9.19) and a male to female ratio of 9:5.Nearly one third of patients (35.8%) were asymptomatic. Urinary tract infections or infection like symptoms were present in five (35.8 %), whereas few showed vague symptoms like flank pain (7.1 %), abdominal pain (7.1 %), gastrointestinal symptoms such as nausea (7.1 %), abdominal distension and fullness (7.1 %). Three kidneys (21.42 %) showed stasis of radioactive urine in the renal pelvic region prior to diuretic injection, suggesting functional obstruction. Only one kidney (7.17 %) showed frank unilateral hydronephrosis and 2(14.28%) showed obstructive nephropathy. There was no incidence of bilateral hydronephrosis. Gross parenchymal disease was seen in 2 (14.28%) and mild parenchymal insufficiency in 4 (28.57%). In 2 (14.28%) cases normal renal function with low GFR were observed. 35.71% patients show horseshoe kidneys with normal function and GFR with variation of sizes of two distinct kidneys. Of the 14 patients, asymmetrical renal cortical function between the two kidneys was found in10 (71.4%). Conclusion: 99mTc-DMSA renal scan and diuretic renogram with 99mTc-DTPA are the simple techniques for the assessment of the patency of horseshoe shaped kidneys, because they can evaluate functional anatomy and urodynamics. DOI: http://dx.doi.org/10.3329/bjnm.v17i1.22488 Bangladesh J. Nuclear Med. 17(1): 25-29, January 2014

Factors influencing recoverability of renal function after urinary diversion through percutaneous nephrostomy.

Context:Various factors predict recoverability of kidney function preoperatively. Placement of percutaneous nephrostomy (PCN) and measuring the differential creatinine clearance (diff. %CrCl) is still regarded as a simple and reliable method.Aims:The aim was to evaluate correlation between renal cortical thickness (CT), hydronephrosis, intrapelvic pressure (IPP), PCN output, renal morphological factors such as length, width, echogenicity, corticomedullary differentiation (CMD), status of c/l kidney, and presence of infection which can predict recoverable function.Settings and Design:A prospective study done between July 2013 and June 2014 in Urology Department.Subjects and Methods:Hundred and sixty patients of supravesical obstruction for various causes who need PCN either due to chronic renal failure or nonvisualized kidney on contrast study, were included. IPP was measured during PCN placement. After 4 weeks 24 h urine was sent for CrCl and urine pH.Statistical Analysis Used:Correlation of continuous and categorical variables with dependent variable (diff. %CrCl) was formulated using spearman correlation and Mann–Whitney U test. Simple and multiple linear regression analysis were performed.Results:The study includes 160 patients with median age of 65.5 years. Hydronephrosis were due to stone in 76 (47.5%), pelviureteric junction obstruction (PUJO) in 40 (25%), cancer in 32 (20%), others in 12 cases (7.5%). IPP was <10 cm H2O in 48 (30%); 10–20 cm H2O in 64 (40%) and >20 cm H2O in 48 (30%). There was significant correlation between IPP and diff. %CrCl with correlation coefficient ρ = 0.509 (P = 0.0001).Conclusions:CT, parenchymal echogenicity, CMD, pre-PCN creatinine, and status of c/l kidney are the only independent variables which can predict the renal function while other variables like renal size, urine output, infection, hydronephrosis lost their statistical significance in multivariate analysis. Furthermore, IPP measured before PCN directly correlated with daily urine output and diff. %CrCl.

THE VALUE OF ULTRASOUND GUIDED PERCUTANEOUS ANTEGRADE PYELOGRAPHY IN THE DIAGNOSIS OF OBSTRUCTIVE UROPATHY

Twenty-one patients with non-visualized kidney on intravenous urography (IVU), whose ultrasound (US) examinations showed moderate to severe hydronephrosis (3 of them subjected to non-conclusive retrograde uretropyelography), were included in this study. All of them underwent percutaneous antegrade pyelography (PAGP) under US guidance at Radiology Department, Saddam Teaching Hospital, Basah, form January 2000 to January 2002. Ninty-five percent of them had satisfactory and conclusive results; nine cases with radiolucent stones, 5 with congenital pelvi-ureteric junction (PUJ) obstruction, 5 with ureteric strictures and one case with severe hydrocalyces and contracted pelvis that was proved to be tuberculosis of the kidney. On the other hand, the technique failed in one case. The study included 15 males and 6 females, their ages ranged between 12-71 years and the mean age was 45 years. No complication was recorded. We conclude that this procedure is a relatively simple, safe, and useful technique to visualize the renal collecting system in certain cases allowing the surgeon to choose a more suitable operative approach for that particular condition.

Gadolinium-enhanced Excretory MR Urography: Comparison with MR Urography Using HASTE Technique

Purpose: To compare the feasibility of gadolinium-enhanced excretory MR urography(GEMRU) and conven-tional MR urography using the half-Fourier acquisition single-shot turbo spin-echo(HASTE) sequence in patients with hydronephrosis or non-visualized kidney. Materials and Methods: Fifteen patients with hydronephrosis or non-visualized kidney, as demonstrated by ultrasonography or intravenous urography, were enrolled in this study. Nine were men and six were women, and their age ranged from 18 to 77 (mean, 60.6) years. For all MR examinations, a 1.5-T MR unit was employed. For breath-hold MR urography, the HASTE technique(MRU) was used, and reconstruction involved the use of a maximum intensity-projection (MIP) algorithm. For gadolinium-enhanced excretory MR urography, the fast low angle shot(FLASH) 3-D method was used and images were obtained at 5, 10, 20, and 30 minutes, and reconstruction again involved the use of an MIP algorithm. In some cases, additional GEMRU was obtained 24 hours after contrast material injection, and an MIP algorithm was used for reconstruction. MRU and GEMRU were independently interpreted by two radiologists who for quantitative analysis compared SNR with CNR, and at each anatomic level qualitatively analysed morphologic accuracy and diagnostic value of the lesions. Results: In quantitative analysis, SNR and CNR differences between the two sequences at the renal pelvis and the level of the ureter were not significant (p0.05). In qualitative analysis, GEMRU was superior to M-RU for the assessment of evaluated ureter at each level(p0.05), anatomic anomaly and intrinsic tumor. Ureteral stones, however, were more easily diagnosed with MRU. Conclusion: For assessment of the ureter GEMRU is superior to MRU and has the advantage of evaluating renal function. We believe that for evaluation of the urinary tract, especially the distal ureter, GEMRU may be a valuable adjunct to routine MR urography.

RECOVERY OF RENAL FUNCTION AFTER 153 DAYS OF COMPLETE UNILATERAL URETERAL OBSTRUCTION

The length of time that a human kidney may tolerate complete obstruction and yet recover useful function is unknown. There have been few reports of the recovery of renal function in humans after prolonged complete unilateral ureteral obstruction.1.2 In a literature review Shapiro and Bennet noted that the longest period was 150 days.1 We report on a woman in whom renal function recovered after 153 days of complete unilateral ureteral obstruction. CASE REPORT A 42-year-old woman underwent abdominal complete hysterectomy and left salpingo-oophorectomy for leiomyoma of the uterus and endometrial cyst of the left ovary on April 12, 1994. The procedure was uneventful. Sutures of 2-zero silk were used for hemostasis. She was referred to our hospital for right hydronephrosis found at a general evaluation in July. The patient was asymptomatic. Excretory urography (IVP) showed a right nonvisualizing kidney. 99”Technetium dimercaptosuccinic acid renal scintigraphy revealed severely decreased uptake on the right side with the right kidney accounting for 11.4% of total renal function. Retrograde pyelography demonstrated complete obstruction of the distal ureter (fig. 1, A). Computerized tomography (CT) showed well preserved, enhanced right renal parenchyma (fig. 1, B). A percutaneous nephrostomy tube was placed on September 12. Urine volume from the nephrostomy tube was 1,000 to 1,200 ml. daily. Creatinine clearance of the right kidney was 6.8 ml. per minute. Antegrade pyelography also revealed complete distal ureteral obstruction. The patient underwent surgical exploration of the right ureter on September 21. Severe fibrosis was noted around the stenotic portion of the ureter. Although no suture remnants were detected, we concluded that ureteral stricture had probably been caused by suture entrapment. We excised the ureteral stricture and performed right ureteroneocystos

腎盂尿管腫瘍47例の臨床的検討

47 cases including 24 renal pelvic tumors, 20 ureteral tumors and 3 renal pelvic and ureteral tumors treated in our hospital from January, 1980 to December, 1987, were studied clinico-histopathologically. The patients ranged in age from 38 to 81 years (average 65 years) the sex ratio was 3:1 with male predominance over female. Tumor occurred on the right side in 19 cases, on the left side in 27 cases and bilaterally in 1 case. The most frequent sign was hematuria which was observed in 40 cases (85%). The interval from the onset of initial symptoms to the first visit was within one month in 9 cases (19.1%). The major findings of excretory urograms were filling defect in 21 cases (47.1%) and non-visualizing kidney in 15 cases (33.8%). Positive urinary cytology was obtained in 21 cases (44.7%). Operative therapy as performed in 45 cases, namely, nephroureterectomy and partial cystectomy in 30 cases (66.7%) and nephroureterectomy in 9 cases (20%). Histopathologically, all cases but two cases of squamous cell carcinoma and to cases of mixed type carcinoma are transitional cell carcinoma. Subsequent bladder tumors were found in 8 cases (17.7%). The overall survival rate at 1, 3 and 5 years were 80.2%, 41.1% and 41.1%, respectively by Kaplan-Meier method. In this series, the interval from the onset of initial symptoms, the grade and stage of tumor and metastasis of lymph nodes were to be considered in developing prognosis.

腎盂尿管癌の臨床的病態と予後の検討

During the 13 years from 1976 to 1988, 160 patients with renal pelvic and ureteral cancer were reviewed based on a new general rule for clinical and pathological studies on renal pelvic and ureteral cancer of Japanese Urological Association. There were 71 renal pelvic cancers, 80 ureteral cancers, and 9 cancers in both regions. Patients ranged in age from 35 to 91 years old (average: 63). The involved side was right in 63 and left in 97. The most frequent symptom was hematuria, which was seen in 81.1%. IVP revealed the findings of filling defects, hydronephrosis, and non-visualized kidney in 99.7% of the patients. Total nephroureterectomy with bladder cuff resection was performed in 123 cases, nephroureterectomy in 16 cases, nephrectomy in 5 cases, partial ureterectomy in 10 case, and biopsy in 6 cases. As adjuvant therapies, irradiation was performed in 32 and chemotherapy in 123. Histologically, 156 were with transitional cell carcinoma, one squamous cell carcinoma, one adenocarcinoma and 2 unclear, the over-all survival rate of this study at 1, 3, 5 and 10 years were 86.8%, 73.0%, 65.3% and 45.6%, respectively. No patient with lymph-node metastasis (N+) survived longer than 5 years. All patients with M(1) died within one year. There were no difference of prognosis between renal pelvic cancer and ureteral cancer. Regarding various prognostic factors, our series gave the same results as previous reports. However, it should be stressed that pathological grading was the most important prognostic factor.

Carcinosarcoma of the Renal Pelvis With Extension Into the Renal Vein and Inferior Vena Cava

Abstract Renal tumors other than renal cell carcinoma rarely may invade the main renal vein and inferior vena cava. A case is reported of carcinosarcoma of the right kidney composed of transitional cell and giant cell elements with invasion into the inferior vena cava. Obstruction of the renal vein should be considered in patients with transitional cell carcinoma and an ipsilateral nonvisualized kidney on excretory urography.

Renal transitional cell carcinoma: sonographic and pathologic correlation.

Sonography was utilized to assess six patients with renal transitional cell carcinoma and was correlated with gross pathology in five cases. The neoplasms were seen as discrete, solid masses causing separation of the central renal sinus echoes. The echogenicity of the tumors and the renal parenchyma was similar, but the neoplasms were separated from the renal parenchyma by a linear echogenic zone of renal sinus fat. Pelvicaliceal blood clots, when markedly echogenic, could be differentiated from transitional cell carcinomas. Sonography contributed most in evaluating unilateral nonvisualized kidney or in the presence of nonfilling of the affected pelvicalices on excretory urography.

Computed tomography evaluation of the poorly or nonvisualized kidney

Abstract Computed tomography (CT) can provide a quick and accurate evaluation of the poorly or nonvisualized kidney on intravenous pyelogram. End stage renal disease can be differentiated from hydronephrosis. Chronic pyelonephritis, perirenal abscess and congenital absence of the kidney can also be determined.

Dynamic Renal Scan in the Non-Visualizing Kidney

Thirty-one patients with 35 non-visualizing kidneys on excretory urography were studied with 99mtechnetium-diethylenetriaminepentaacetic acid scintiscanning. In 11 cases good renal blood flow and concentration were demonstrated on nucleide scanning. All patients had significant parenchyma and recoverable renal function after appropriate surgical management. In 20 cases there was little or no blood flow on the scan. These patients either had a congenitally absent kidney or severely destroyed parenchyma. The 99mtechnetium-diethylenetriaminepentaacetic acid dynamic renal scan is a sensitive method for predicting renal salvageability of a kidney that fails to visualize on excretory urography.

超音波実時間ガイド法による経皮的腎盂造影法

An application of ultrasonic real-time guidance technique, which was developed at our clinic in 1978, to antegrade pyelography was described. Eleven cases with non-visualizing kidney were studied. Renal pelvis could be hit with one needling attempt and clear pyelo-ureterogram was obtained in all the cases. No special skill was required. This new technique has overcome disadvantages of antegrade pyelography and will contribute to a remarkable improvement in the diagnosis of the upper urinary tract.

Xanthogranulomatous pyelonephritis masquerading as occult malignancy

Xanthogranulomatous pyelonephritis (XGP) can present with weight loss, anemia, leukemoid reaction, and generalized debility; there may be no signs or symptoms referable to the urinary tract. Confusion between XGP and renal adenocarcinoma is well recognized, but other malignancies can also be simulated. Case histories of patients with proved XGP whose clinical presentations suggested occult malignancies are recorded. Proteus urinary tract infection, calculi, and a nonvisualizing kidney on intravenous pyelogram should suggest the correct diagnosis. The pathology, bacteriology, diagnosis, and treatment are reviewed.

The influence of computed tomography on clinical decision making in the evaluation of a nonvisualizing kidney

Nonvisualization of a kidney in an elderly man was investigated by computed tomography (CT). Simple low lying ureteral obstruction was excluded, multiple pathologic abnormalities were identified and causes for the nonvisualization are postulated. This case report demonstrates the important effect CT scanning produced on the clinical management of the patient in question.

Ultrasonic evaluation of the unilateral nonvisualized kidney

There are several techniques for evaluating the nonvisualized kidney. Nephrotomography may be helpful in those patients who have some remaining renal function. Radionuclide renal flow and imaging studies are more sensitive than nephrotomography in detecting hydronephrosis, the most common cause of unilateral renal nonvisualization, but also require some renal function to be of diagnostic value. Diagnostic ultrasound, since it is independent of renal function, is an even more sinsitive indicator of urinary obstruction, detecting those cases where no functioning renal parenchyma is present. This non-invasive technique can accurately guide percutaneous puncture of the collecting system, permitting antegrade localization of the obstructing lesion. When ultrasonography demonstrates a solid mass in the renal fossa, angiography is recommended for definitive diagnosis. When no kidney is identified renal venography may be useful in differentiating between a small nonfunctioning kidney and renal agenesis.

Association of subcapsular hematomas with the nonfunctioning kidney.

When an enlarged nonvisualizing kidney seen on excretory urography is associated with a relatively normal retrograde pyelogram and renal angiogram, the most likely diagnosis is a subcapsular hematoma. Differential diagnosis is important because patients may be expected to respond favorably to conservative management with return to normal in appearance and function of the kidney. Three cases are presented.

The nonvisualized kidney: the value of nephrotomography.

The term “nonfunctioning#x201D; kidney is commonly used to describe the non-visualized kidney after the intravenous injection of contrast material. As the urologist appreciates, urine at times can be observed coming from this kidney, and the intravenously injected dyes, methylene blue and indigo carmine, may be seen issuing from the ureteric orifice. In addition, with large quantities of opaque medium, the radiologist may visualize the renal substance and/or the collecting system. Although a considerable amount of attention has been given to bilateral poor visualization of the kidneys in patients with impaired renal function, little interest has been shown in the nonvisualized kidney, other than the identification of the dilated urinary tract (8). After the lack of visualization with the recommended 25 cc dose of contrast material, a common procedure has been to double the dose, and the term“double-dose intravenous pyelography” thus came into use. This technic led to the diagnosis of the cause of an obstr...

PROGNOSTIC SIGNIFICANCE OF PREOPERATIVE NONVISUALIZING KIDNEY IN PATIENTS RECEIVING PELVIC EXENTERATION.

PROGNOSTIC SIGNIFICANCE OF PREOPERATIVE NONVISUALIZING KIDNEY IN PATIENTS RECEIVING PELVIC EXENTERATION.

The Nonvisualizing Kidney: A Pathologic Study of 83 nephrectomy Specimens

No AccessJournal of Urology1 Feb 1961The Nonvisualizing Kidney: A Pathologic Study of 83 nephrectomy Specimens Harlan J. Spjut, and Charles H. Nicolai Harlan J. SpjutHarlan J. Spjut More articles by this author , and Charles H. NicolaiCharles H. Nicolai Present address: 607 N. Grand Blvd., St. Louis 3, Mo. More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)65294-7AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail © 1961 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited ByLalli A (2018) The Roentgen Diagnosis of Renal Vein Invasion by TumorJournal of Urology, VOL. 95, NO. 1, (8-9), Online publication date: 1-Jan-1966.Duggan M (2018) Acute Renal InfarctionJournal of Urology, VOL. 90, NO. 6, (669-676), Online publication date: 1-Dec-1963. Volume 85Issue 2February 1961Page: 115-118 Advertisement Copyright & Permissions© 1961 by The American Urological Association Education and Research, Inc.MetricsAuthor Information Harlan J. Spjut More articles by this author Charles H. Nicolai Present address: 607 N. Grand Blvd., St. Louis 3, Mo. More articles by this author Expand All Advertisement PDF DownloadLoading ...