Derya ÇAYIR, Mehmet BOZKURT, Salih Sinan GÜLTEKİN, Alper Özgür KARACALİOĞLU

RENAL EKTOPİ VE FÜZYON ANOMALİLERININ SİNTİGRAFİK DEĞERLENDİRİLMESİ VE HİLSON PERFÜZYON İNDEKSİ

Amaç: Renal ektopi ve füzyon anomalili hastalarda (1) Hilson perfüzyon indeksi ile böbreklerin perfüzyon fonksiyonunu belirlemek ve (2) dinamik böbrek sintigrafisi ile böbrek fonksiyonlarını değerlendirmek. Gereç ve Yöntem Tc-99m DTPA dinamik böbrek sintigrafisi için başvuran toplam 959 hasta retrospektif olarak incelendi. Böbreklerin fonksiyonlarını ve diüretik yanıtlarını zaman-aktivite eğrileri ile değerlendirdik ve kantitatif analiz yaptık. Böbreklerin perfüzyonunun değerlendirilmesinde Hilson indeksi kullanıldı. Bulgular 29 hastada (%3) renal ektopi ve füzyon anomalisi olduğu belirlendi. Pelvik ektopik böbreklerin ortalama uzunluğu ortotopik böbreklerden anlamlı derecede kısaydı (sırasıyla 91,0 mm ± 18,9 ve 111,0 mm ± 10,3, p = 0,001). Hilson perfüzyon indeksinin ortalama değeri, ortoptopik böbreklere kıyasla ektopik böbreklerde anlamlı olarak daha yüksekti (sırasıyla, 86,4 ± 67,1’e karşılık 36,8 ± 18,0, p = 0,001). Çapraz renal ektopik, pelvik ektopik ve at nalı böbrekler arasında perfüzyon/ekstraksiyon fonksiyonları ile ekskresyon fonksiyonları arasında istatistiksel olarak anlamlı fark yoktu (sırasıyla p = 0,079 ve p = 0,879). Pelvik ektopik böbreklerde ekstraksiyon fonksiyonları, ortotopik böbreklere kıyasla anlamlı derecede bozulmuştu (p = 0,001). Pelvik ektopik böbreklerin ekskresyon fonksiyonları ile ortotopik böbreklerin ekskresyon fonksiyonları arasında anlamlı fark yoktu (p = 0,116). Sonuç Hilson perfüzyon indeksi, renal ektopi ve füzyon anomalisi olan böbreklerin perfüzyon fonksiyonlarının sintigrafik değerlendirmesinde yararlı olabilir.

HILSON’S PERFUSION INDEX AND SCINTIGRAPHIC ASSESSMENT OF RENAL ECTOPIA AND FUSION ANOMALIES

Objective(1) To assess the perfusion functions of the kidneysby Hilson’s perfusion index and (2) to evaluate therenal functions of the patients with renal ectopia andfusion anomalies by dynamic renal scintigraphy.Materials and MethodsA total of 959 patients referred for Tc-99m DTPA dynamic renal scintigraphy were investigated retrospectively. We evaluated the functions and diureticresponse of the kidneys on the time-activity curves(TACs) and performed quantitative analysis. Hilson’sindex was used for the evaluation of perfusion of thekidneys.ResultsRenal ectopia and fusion anomalies were reported in29 (3%) patients. The mean length of the kidneys withpelvic ectopic kidneys were significantly shorter thanthe orthotopic kidneys (91.0 mm ± 18.9 and 111.0 mm± 10.3, respectively, p = 0.001). The mean value ofHilson’s perfusion index was significantly higher inthe kidneys with ectopia compared to the orthotopickidneys (86.4 ± 67.1 vs. 36.8 ± 18.0, respectively, p =0.001). There was no significant difference when wecompared the perfusion/extraction functions and theexcretion functions of the kidneys among crossed-fused renal ectopic (CFRE), pelvic ectopic, and horseshoe kidneys (p = 0.079 and p = 0.879, respectively).Extraction functions were significantly impaired in thepelvic ectopic kidneys compared to the orthotopic kidneys (p = 0.001). There was no significant differencebetween excretion functions of pelvic kidneys and orthotopic kidneys (p = 0.116).ConclusionHilson’s perfusion index may be useful in scintigraphic assessment of perfusion functions of the kidneyswith renal ectopia and fusion anomalies.

PDF

___

1. Kelly CR, Landman J. Anatomy of the Urinary Tract. In: Kelly CR, Landman J. The Netter Collection of Medical Illustrations-Urinary System e-Book (2nd Ed), Philadelphia, Elsevier Health Sciences, 2012; 1-28.
2. Bauer SB. Anomalies of the upper urinary tract. In: Wein A, editors. Campbell-Walsh Urology (11th Ed), Philadelphia, Saunders Elsevier, 2016; 2985-6.
3. Amis ES, Newhouse JH. Congenital anomalies. Essentials of Uroradiology. In: Dunnick NR, Sandler CM, Newhouse JH. Textbook Uroradiology (4th Ed), Philadelphia, Lippincott Williams & Wilkins, 2013; 57-61.
4. Donat SM, Donat PE. Intrathoracic kidney: a case report with a review of the world literature. J Urol. 1988;140(1):131-3.
5. Ten Broek MRJ, Te Beek ET, Stuurman-Wieringa RE. 99mTcMAG3 Renography of Intrathoracic Renal Ectopia. Clin Nucl Med. 2019;44(1):78-80.
6. Abeshouse BS, Bhisitkul I. Crossed renal ectopia with and without fusion. Urol Int. 1959;9(2):63-91.
7. Shapiro E, Bauer SB, Chow JS. Anomalies of the upper urinary tract. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA. Campbell-Walsh Urology (10th Ed), Philadelphia, 2016;2975-3005.
8. Cinman NM, Okeke Z, Smith AD. Pelvic kidney: associated diseases and treatment. J Endourol. 2007;21(8):836-42.
9. Benjamin JA, Schullian DM. Observations on fused kidneys with horseshoe configuration: the contribution of Leonardo Botallo (1564). J Hist Med Allied Sci. 1950;5(3):315-26.
10. Kalra D, Broomhall J, Williams J. Horseshoe kidney in one of identical twin girls. J Urol. 1985;134(1):113.
11. Khan MN, Walsh WF. Bladder agenesis, ectopic ureters and a multicystic dysplastic horseshoe kidney in one twin newborn with normal amniotic fluid index in utero. BMJ Case Rep. 2016;8:2016.
12. Birmole B, Borwankar S, Vaidya A, Kulkarni BK. Crossed renal ectopia. J Postgrad Med. 1993;39(3):149-51.
13. Modi P, Rizvi S, Gupta R, Patel S. Retroperitoneoscopic nephrectomy for crossed-fused ectopic kidney. Indian J Urol. 2009;25(3):401-3.
14. Gordon I, Ransley P, Hubbard CS. 99mTc DTPA Scintigraphy Compared with Intravenous Urography in the Follow-up of Posterior Urethral Valves. Br J Urol. 1987;60(5):447-9.
15. Hilson AJ, Maisey MN, Brown CB, Ogg CS, Bewick MS. Dynamic renal transplant imaging with Tc-99m DTPA (Sn) supplemented by a transplant perfusion index in the management of renal transplants. J Nucl Med. 1978;19(9):994-1000.
16. Goldfarb CR, Srivastava NC, Grotas AB, Ongseng F, Nagler HM. Radionuclide imaging in urology. Urol Clin North Am. 2006;33(3):319-28.
17. Brock JW 3rd, Braren V, Phillips K, Winfield AC. Caudal regression with cake kidney and a single ureter: a case report. J Urol. 1983;130(3):535-6.
18. Doménech-Mateu JM, Gonzalez-Compta X. Horseshoe kidney: a new theory on its embryogenesis based on the study of a 16-mm human embryo. Anat Rec. 1988;222(4):408-17.
19. Hill GS. Renal and ureteral anomalies. In: Hill GS, editors. Uropathology, vol I. New York: Churchill Livingstone,1989; 1-80.
20. Gleason PE, Kelalis PP, Husmann DA, Kramer SA. Hydronephrosis in renal ectopia: incidence, etiology, and significance. J Urol. 1994;151(6):1660-1.
21. Gray SE, Skandalakis JE. Embryology for surgeons-The embryological basis for the treatment of congenital defects. Philadelphia, London, Toronto, W. B. Saunders Co, 1972; 472-4.
22. Hollis HW Jr, Rutherford RB, Crawford GJ, Cleland BP, Marx WH, Clark JR. Abdominal aortic aneurysm repair in patients with pelvic kidney. Technical considerations and literature review. J Vasc Surg. 1989; 9(3): 404-9.
23. de Virgilio C, Gloviczki P, Cherry KJ, Stanson AW, Bower TC, Hallett JW Jr, et al. Renal artery anomalies in patients with horseshoe or ectopic kidneys: the challenge of aortic reconstruction. Cardiovasc Surg. 1995;3(4):413-20.
24. Guarino N, Tadini B, Camardi P, Silvestro L, Lace R, Bianchi M. The incidence of associated urological abnormalities in children with renal ectopia. J Urol. 2004;172(4):1757-9.
25. Khan SH, Rather TA, Khan MA. Tc-99m DTPA renal scintigraphy and renal ectopia: A retrospective analysis. Indian J Nucl Med. 2005;20(1):9-13.
26. Britton K, Nimmon C, Whitfield H, Hendry WF, Wickham JEA. Obstructive nephropathy: successful evaluation with radionuclides. Lancet 1979;1(8122):905-7.