Duplex kidney anomalies and associated pathology: a single centre retrospective review

Authors

  • Debanga Sarma Department of Urology and Renal Transplant, Gauhati Medical College and Hospital, Guwahati, Assam, India
  • Sarbartha Kumar Pratihar Department of Urology and Renal Transplant, Gauhati Medical College and Hospital, Guwahati, Assam, India
  • Rajeev T. P. Department of Urology and Renal Transplant, Gauhati Medical College and Hospital, Guwahati, Assam, India
  • Sasanka K. Barua Department of Urology and Renal Transplant, Gauhati Medical College and Hospital, Guwahati, Assam, India
  • Puskal K. Bagchi Department of Urology and Renal Transplant, Gauhati Medical College and Hospital, Guwahati, Assam, India
  • Mandeep Phukan Department of Urology and Renal Transplant, Gauhati Medical College and Hospital, Guwahati, Assam, India

DOI:

https://doi.org/10.18203/2349-2902.isj20195619

Keywords:

Duplex kidney anomaly, Bifid pelvis, Complete ureteral duplication

Abstract

Background: Duplex kidneys are common developmental renal anomaly with an incidence of 1% in healthy adult population.Adult individuals may present as non-functional moiety, calculus disease or an incidental finding. Duplex kidney is defined as a renal unit comprised of two pelvicalyceal systems. Based on the degree of fusion, it can present as bifid renal pelvis, partial ureteric duplication (Y-shaped ureter), incomplete ureteric duplication with ureters joining near or in bladder wall (V-shaped ureter) and complete ureteric duplication with separate ureteric orifices. The purpose of this study is to retrospectively review the various duplex kidney anomalies and associated pathology.

Methods: This is a retrospective study, performed at Department of Urology, Gauhati Medical College Hospital, a tertiary centre, from September, 2018 to August, 2019. Preoperative imaging, plain intravenous urography or computed tomography intravenous urography was done.

Results: 29 patients were diagnosed with variants of duplex kidney anomaly. It includes right side, left side and bilateral anomalies. Among all the patients 4 had incidental findings. 16 patients had associated renal or ureteral calculus. 5 patients had associated ureteropelvic junction obstruction while 1 patient had ureterovesical junction stricture. We found single patient in each group of duplex kidney anomaly associated with non-functional moiety with renal cell carcinoma, ureterocele with urothelial malignancy and horseshoe kidney with ureteropelvic junction obstruction respectively.

Conclusions: Duplex kidney anomaly in most individuals is of no clinical significance. High index of suspicion along with good quality imaging can accurately detect specific anomaly and associated condition.

Author Biographies

Debanga Sarma, Department of Urology and Renal Transplant, Gauhati Medical College and Hospital, Guwahati, Assam, India

Assistant Professor,Department Of Urology & Renal Translant, Gauhati Medical College and Hospital, Guwahati, Assam, India

Sarbartha Kumar Pratihar, Department of Urology and Renal Transplant, Gauhati Medical College and Hospital, Guwahati, Assam, India

Post-Senior resident.

Doing M.Ch in UROLOGY in  Department Of Urology & Renal Translant, Gauhati Medical College and Hospital, Guwahati, ASSAM, INDIA

Rajeev T. P., Department of Urology and Renal Transplant, Gauhati Medical College and Hospital, Guwahati, Assam, India

Professor & Head of the department,Department Of Urology & Renal Translant, Gauhati Medical College and Hospital, Guwahati, Assam, India

Sasanka K. Barua, Department of Urology and Renal Transplant, Gauhati Medical College and Hospital, Guwahati, Assam, India

Associate Professor ,Department Of Urology & Renal Translant, Gauhati Medical College and Hospital, Guwahati, Assam, India

Puskal K. Bagchi, Department of Urology and Renal Transplant, Gauhati Medical College and Hospital, Guwahati, Assam, India

Associate Professor ,Department Of Urology & Renal Translant, Gauhati Medical College and Hospital, Guwahati, Assam, India

Mandeep Phukan, Department of Urology and Renal Transplant, Gauhati Medical College and Hospital, Guwahati, Assam, India

Assistant Professor ,Department Of Urology & Renal Translant, Gauhati Medical College and Hospital, Guwahati, Assam, India

References

Privett JTJ, Jeans WD, Roylance J. The incidence and importance of renal duplication. Clin Radiol 1976;27:521-30.

Hunziker M, Kutasy B. Urinary tract anomalies associated with high grade primary vesicoureteral reflux. Pediatr Surg Int. 2012;28:201-4.

Davda S, Vohra A. Adult duplex kidneys:an important differential diagnosis in patients with abdominal cysts. J R Soc Med. 2013;4:1-3.

Gay SB, Armistead JP, Weber ME etal. Left infrarenal region: anatomic variants, pathologic conditions, and diagnostic pitfalls. Radiographics. 1991;11(4):54970.

Rodriguez MM. Congenital anomalies of the kidney and the urinary tract (CAKUT). Fetal Pediatr Pathol. 2014;33:293-320.

Whitten SM, Wilcox DT. Duplex systems. Prenat Diagn. 2001;21:952-7.

Ma R, Wu RD, Liu W, Wang G, Wang T, Xu ZD, et al. A new classification of duplex kidney based on kidney morphology and management. Chin Med J (Engl). 2013;126:615-9.

Hartman GW, Hodson CJ. The duplex kidney and related abnormalities. Clin Radiol. 1969;20:387-400.

Horst M, Smith GHH. Pelvi-ureteric junction obstruction in duplex kidneys. Br J Urol. 2008;101:1580-4.

Fernbach SK, Feinstein KA, Spencer K, Lindstrom CA. Ureteral duplication and its complications. Radiographics.1997;17:109-27.

Share JC, Lebowitz RL. The unsuspected double collecting system on imaging studies and at cystoscopy. Am J Roentgenol. 1990;155:561-4.

Decter RM. Renal duplication and fusion anomalies. Pediatr Clin North Am. 1997;44:1323-41.

Smith P, Dunn M. Duplication of the upper urinary tract. Ann R Coll Surg Engl. 1979;61:281-6.

Horst M, Smith GHH. Pelvi-ureteric junction obstruction in duplex kidneys. Br J Urol. 2008;101:1580-4.

Malek RS, Kelalis PP, Stickler GB, Burke EC. Observations on ureteral ectopy in children. J Urol. 1972;107:308-13.

Weiss JP. Embryogenesis of ureteral anomalies:A unifying theory. Aust N Z J Surg. 1988;58:631-8.

Prakash R, Rajini T, Venkatiah J, Bhardwaj AK, Singh DK, Singh G. Double ureter and duplex system:a cadaver and radiological study. J Urol. 2011;8:145-8.

Chertin B, Mohanan N, Farkas A, Puri P. Endoscopic treatment of vesicoureteral reflux associated with ureterocele. J Urol. 2007;178:1594-7.

Stockland E, Jodal U, Sixt R. Uncomplicated duplex kidneys and DMSA scintigraphy in children with urinary tract infection. Pediatr Radiol. 2007;37:826-8.

Atwell JD, Cook PL, Strong L, Hyde I. The interrelationship between vesiculo-ureteric reflux, trigonal abnormalities and a bifid pelvi-calyceal collecting system:a family study. Br J Urol. 1997;49:97-107.

Kullendorff CM, Wallim L. DMSA scintigraphy in renal duplex system. Eur J Pediatr Surg. 1993;3:83-6.

Elhadi M, Bonomaully M, Sheikh MI, Marsh H. Two pelvises, one stone: A different approach for management of calculi in a duplex renal collecting system. African J Urol. 2018;24(1):34-6.

Gunawardena S, Ranasinghe WK, McCahy P. Beware the stone in the duplex: use of CT intravenous pyelogram (CT IVP) in detecting calculi in duplex ureteric systems. J Clin Urol. 2016;9(2):128-30.

Eisner, BH, Shaikh, M, Uppot, RN. Genitourinary imaging with noncontrast computerized tomography - are we missing duplex ureters? J Urol. 2008;179:1445-48.

Mohan H, Kundu R, Dalal U. Renal cell carcinoma arising in ipsilateral duplex system. Turk J Urol. 2014;40(3):185-8.

Karray O, Khouni H, Charfi M, Boulma R, Debaibi M, Makhlouf R, et al. Ureteral tumor in an ectopic duplex system: A case report. J Med Case Reports. 2019;13:70.

Downloads

Published

2019-12-26

Issue

Section

Original Research Articles