Renal Duplication Anomalies

What  is  it?   What  tests  are  performed?  

A   renal   duplication   anomaly   occurs   when   a   kidney   External   examination   is   usually   normal   in   the  
forms  in  two  parts.   patient  with  a  renal  duplication  anomaly.  

Ultrasound  
Background   An   ultrasound   identifies   the   size   of   the   kidney  
The   urinary   tract   is   normally   made   up   of   two   (duplex   kidneys   are   usually   larger   than   normal),  
kidneys,   which   filter   the   blood   and   create   urine   and   may   identify   the   two   collecting   systems   or  
ureters.   One   or   both   of   the   two   systems   may   be  
(the   waste).   The   urine   then   flows   through   the  
collecting   systems   into   the   pelvis   of   each   kidney.     dilated,  which  can  also  be  seen  on  ultrasound.  
From   there,   it   travels   down   the   ureters,   to   the   The  ureters  can  be  dilated  if  there  is   urinary  reflux  
bladder.   When   the   bladder   is   full,   messages   are   into  the  ureter  (usually  to  lower  part  of  kidney),  or  
sent  to  the  brain  and  the  bladder  empties  through   if   there   is   blockage   to   the   drainage   of   the   ureter  
the  urethra.   (usually   to   the   upper   part   of   the   kidney).     This   can  
occur   either   due   to   a   ‘ureterocele’   (seen   as   a  
One   kidney   is   normally   in   the   right   flank   and   the  
other  is  in  the  left  flank,  mostly  under  the  ribs.     bubble  in  the  bladder),  or  ureteral  ectopia  (ureter  
ends  in  the  wrong  place).      
In   up   to   1   in   100   people,   the   kidney   develops   in  
two  parts  with  a  separate  blood  supply  and  ureter   Nuclear  medicine  
for   each   part.   The   two   ureters   may   travel   Nuclear   scans   can   identify   the   function   and  
separately   to   the   bladder.     More   often,   they   join   drainage  of  the  various  parts  of  the  kidney.    
together   to   create   a   ‘Y’   shaped   ureter   and   enter  
These   may   provide   important   information   for  
the  bladder  after  they  have  joined  together.  
planning  treatment.  
Nearly   half   of   people   who   have   a   duplication   of  
Micturating  cystourethrogram  
one  kidney  will  also  have  duplication  of  the  kidney  
on  the  other  side.   In  this  study,  contrast  is  injected  into  the  bladder.  
It  can  demonstrate  urinary  reflux  into  the  ureters.  

How  is  it  diagnosed?  How  does  it   MRI  

present?   This   is   sometimes   needed   when   there   is   a   high  
clinical   suspicion   for   a   duplex   kidney   (such   as  
Duplication   anomalies   are   often   identified   during  
continuous   low-­‐volume   incontinence),   but   it   is  
antenatal  ultrasound  (before  your  child  is  born).  
unable  to  be  found  with  the  other  investigations.  
Other  presentations  may  include:  
Cystoscopy  
- urinary  tract  infection  
This   may   be   needed   for   internal   assessment   of  
- urinary  tract  obstruction   anatomy.     A   retrograde   pyelogram   (contrast  
- prolapsed  tissue  through  the  urethra  (in  a  girl)   injected   up   the   ureter   into   the   kidney)   can   help  
plan   treatment.     Some   treatments   can   also   be  
- constant  dribbling  urinary  incontinence   carried  out  through  the  cystoscope.  

This  information  sheet  is  for  educational  purposes  only.    

Please  consult  with  your  doctor  or  other  health  professional  to  make  sure  this  information  is  valid  for  your  child  
 Renal Duplication Anomalies

What  problems  are  associated  with   What  are  the  treatment  options?  
duplex  kidneys?   Most   duplex   kidneys   are   uncomplicated   and  
Most  duplex  kidneys  are  uncomplicated  and  pose   require  no  treatment.  
no  problems.   The   treatment   for   renal   duplication   anomalies  
Some   duplex   kidneys   have   problems   with   one   or   depends  on  the  clinical  problem.  Options  include:  
both  parts  of  the  kidney:   To  treat  or  relieve  obstruction  
Obstruction   Ureterocele  
Function  of  the  affected  part  of  the  kidney  can  be   - early  incision  in  newborn  period  
threatened   by   obstruction.   Patterns   of  
- later  reconstruction  for  definitive  treatment  
obstruction  are  quite  predictable.  
- removal  of  the  poorly-­‐functioning  part  of  kidney  
Upper  pole  
Pelvi-­‐ureteric  junction  obstruction  (PUJO)  
- Ureterocoele:   causes   lower   end   blockage   of  
ureter,  the  upper  pole  function  is   usually  poor.     -­‐  pyeloplasty  
Biggest  risk  is  infection.    Can  cause  obstruction  
If  there  is  recurrent  infection  
to  bladder  outlet  and  threaten  other  kidney.  
-­‐  prophylactic  antibiotics  are  often  used  
- Ectopia:   can   cause   dripping   incontinence   or  
risk   urinary   tract   infection.     Function   of   these   -­‐  treatment  of  vesicoureteric  reflux,  if  present  
upper  poles  are  often  preserved   -­‐  removal  of  part  or  all  of  an  affected  kidney  
Lower  pole   To  treat  incontinence  due  to  ectopia  
- PUJ  obstruction:  blockage  to  the  top  end  of  the   -­‐  implantation  of  ureter  into  bladder,  if  functions  
ureter  draining  this  system  
-­‐  removal  of  poorly  functioning  part  with  ureter  
Urinary  reflux  
If   there   is   back-­‐wash   of   infected   urine   up   to   a  
What  are  the  outcomes?  
kidney,   the   kidney   can   be   involved   in   the  
infection.     Reflux   most   commonly   involves   the   Outcomes  for  children  with  renal  duplications  will  
lower  pole  of  a  duplex  kidney.   depend   on   their   underlying   kidney   function   and  
precise  anomaly.  The  treatment  is  tailored  to  the  
There   is   a   strong   association   between   severe  
particular   clinical   problem.   Some   children   will  
reflux   (VUR)   and   a   poorly   developed   kidney   which  
need   more   than   one   operation   to   completely  
works   poorly   (dysplasia).     This   pattern   is   seen   in  
manage  their  urinary  tract.  
the  lower  pole  of  duplex  kidneys  too.      
In   a   child   with   a   duplex   kidney   and   recurrent  
urinary   tract   infections,   investigation   for   this   What  is  the  follow-­‐up?  
condition   may   be   warranted   as   sometimes   it   is  
This   will   depend   on   the   precise   anomaly   your  
necessary   to   stop   the   reflux   in   order   to   protect  
child  has  and  any  treatment  undertaken.  
the  kidney  associated  with  the  affected  ureter.  

This  information  sheet  is  for  educational  purposes  only.    

Please  consult  with  your  doctor  or  other  health  professional  to  make  sure  this  information  is  valid  for  your  child