multicystic–dysplastickidney-AmericanUrological.pptVIP

* * * * * * * * * * * * * * * * * * * * * * * * * * * How did you do? This is the perfusion panel. Notice that the time intervals are in seconds. Both kidneys show prompt uptake, but the right kidney doesn’t get quite as bright. Drainage Panel The left kidney shows prompt drainage, but the right kidney retains the radionuclide even in the last image. Curves / Analysis The right kidney contributes 42.6% of total renal function. The right kidney has a prolonged T ? (42.8 min). Case Summary The right kidney shows slightly less perfusion and significantly slower drainage than the left. This boy has a significant obstruction of his right kidney. The most common cause of hydronephrosis in a child is a ureteropelvic junction obstruction. You perform a dismembered pyeloplasty, relieving the obstruction. His parents are so grateful that they establish a research foundation in your name. Case History You are called to see a newborn male. Prenatal ultrasounds have shown an abnormality of the right kidney. Unfortunately, neither the ultrasound images nor the report is available. The baby was born at 40 weeks gestational age with APGARs of 9/9/9. Exam is completely normal. His pediatrician orders an ultrasound. Remember how to read an ultrasound? Ultrasound Interpretation Size Right: 6.6 cm. Why is this kidney so large? (Nl = 4 cm) Left: 5.2 cm. Why is this kidney so large? Shape Right: Reniform Left: Reniform You can learn more about reading ultrasounds by taking the AUA’s Uroradiology Tutorial 1 and 2. Ultrasound Interpretation Parenchyma? Right: What parenchyma? Left: Normal Hydronephrosis? Right: What do you think? Multiple round cystic areas in the left kidney don’t appear to communicate Left: None Renal Function? What type of nuclear scan would be appropriate to determine function and possible obstruction of the kidneys? Filtered agent Demonstrates perfusion and obstruction Excreted agent Function and perfusion (indirectly) Cortical agent Renal mass We ordered a