A renal riddle

doi:10.1136/bmj.b1424

Published 17 June 2009, doi:10.1136/bmj.b1424
Cite this as: BMJ 2009;338:b1424

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A renal riddle

Thomas C Booth, specialist registrar in radiology , Rikin Hargunani, specialist registrar in radiology

¹ Department of Radiology, Royal Free Hospital NHS Trust, London, NW3 2QG

Correspondence to: TC Booth tombooth@doctors.org.uk

The first 150 words of the full text of this article appear below.

A routine prenatal ultrasound scan found an abnormality in thefetus’s right kidney. The neonate had normal renal function,but postnatal ultrasonography of the kidney was indicated. Thefindings (fig 1) called for further imaging tests.

1 What does the postnatal ultrasound show (fig 1

View larger version (40K):

Fig 1 Longitudinal ultrasound of kidney

2 What does the nuclear medicine scan show (fig 2

), and whyis this an important test?

View larger version (23K):

Fig 2 ^99mTc-MAG3 diuresis renogram

3 Why might this asymptomatic neonate be investigated for vesicoureteralreflux?

1 The ultrasound image (fig 1

) shows hydronephrosis of the upperpole of a duplex collecting system.

2 The ^99mTc-MAG3 diuresisrenogram (fig 3

) shows that the upperpole of the collectingsystem in the right duplex kidney isfunctioning but obstructed,as shown by the radioisotope stillin the pelvicalyceal systemof the right kidney at 25 minutes(red arrow) . . . [Full text of this article]