ESPN 53rd Annual Meeting

ESPN 2021


 
A case report of duplex kidney: massive dilatation of the upper moiety without vesicoureteral reflux
MIRIAM ACUNZO 1 ALESSANDRA MARI 1 PATRIZIA CARLUCCI 1 VALENTINA FABIANO 1 GIORGIO SELVAGGIO 2 GIAN VINCENZO ZUCCOTTI 1

1- PEDIATRIC DEPARTMENT, V. BUZZI CHILDRENS HOSPITAL, UNIVERSITY OF MILAN, VIA CASTELVETRO 32, 20154 MILAN, ITALY
2- PEDIATRIC SURGERY DEPARTMENT, V. BUZZI CHILDRENS HOSPITAL, UNIVERSITY OF MILAN, VIA CASTEL-VETRO 32, 20154 MILAN, ITALY.
 
Introduction:

Duplicated renal collecting system is one of the congenital anomalies of the kidney and of the urinary tract (CAKUT), which are the most common cause of chronic renal disease in children.

Material and methods:

S. is a 7-month-old male infant, born at term with an antenatal diagnosis of bilateral, complete duplex system. Renal ultrasound at birth confirmed the diagnosis and antibiotic prophylaxis with amoxicillin-clavulanate was started in the first week of life.A month later, voiding cystourethrography was instead normal, with no evidence of passive or active vesicoureteral reflux (VUR).Abdominal MRI showed an ectopic outlet into prostatic urethra of both the upper ureters, leading to an obstruction of urine flow and to a massive dilatation of these systems, associated with normal bilateral lower systems. A Technetium-99m-MAG3 Scan detected a good function of upper bilateral mojety.

Results:

Corrective elective surgery was performed at 6 months of age by carrying out a right termino-lateral ureteroureterostomy with stent placement.Due to a multiresistant P. aeruginosa urinary tract infection though, S. was admitted to hospital to remove the ureteral stent and to start IV antibiotic therapy with meropenem.Renal function and BP were within normal range.Contralateral hydropyonephrosis required an invasive approach with percutaneous nephrostomy, left in place until left ureteroureterostomy was carried out.Clinical conditions improved and no other intercurrent episode of UTI occurred.

Conclusions:

The most common complications of duplex kidney are obstruction of the upper moiety and VUR from the lower one. S. did not present the latter, but the severity of the first one required surgical intervention. Upper ureteroureterostomy is a safe and conservative alternative to upper pole heminephrectomy.Prenatal diagnosis is of crucial importance as it allows to plan a multidisciplinary intervention with diagnostic workup, and, if needed, elective corrective surgery. In our case, an early start of antibiotic prophylaxis allowed us to have a safer surgical timing.