
Congenital abnormalities of the kidneys and urinary tract
(CAKUT) are variable, occur in 1 of 500 newborns;
predisposing to development of hypertension, cardiovascular
disease and end-stage renal failure.

It can affect the kidney(s) alone and/or the lower urinary tract.

Radiological investigation is essential for early diagnosis.
PROTOCOL
ULTRASOUND
RENAL PELVIS
>7MM OR
OTHER
ABNORMALITI
ES
NORMAL
VCUG
ULTRASOUND
ABNORMAL
RENAL
PELVIS
>10MM OR
OTHER
ABNORMALI
TIES
NORMAL
NORMAL
STOP
ANATOMIC &
FUNCTIONAL
STUDY
(SCINTIGRAPH
Y, IVU)
ULTRASOUND
(3MONTHS)
RENAL PELVIS
<10MM
STOP
RENAL PELVIS
>10MM
ANATOMIC &
FUNCTIONAL
STUDY
(SCINTIGRAPH
Y, IVU)
Ultrasound is commonly the initial investigation study.
 If the dilatation of the urinary tract is confirmed, VCUG is
performed to identify VUR or other causes of upper tract
dilatation.
 If VUR is excluded, nuclear diuresis renography is the
primary test for identifying obstructed tract anomalies.
 IVU or CT scan can also be used to determine the presence of
anatomic abnormality.
 MR urography can combine superior anatomic and functional
information in a single test that does not use ionizing
radiation.

SUPER NUMERARY KIDNEY:-
PLAIN CT SHOWING NORMAL KIDNEYS IN BILATERAL RENAL FOSSA
WITH THE ADDITIONAL THIRD KIDNEY IN THE LEFT LOWER LUMBAR
REGION.
ABSENCE OF LEFT
KIDNEY
ABSENCE OF LEFT
KIDNEY


PLAIN CT STUDY SHOWING ABSENCE OF LEFT KIDNEY.
MRI T2 HASTE CORONAL IMAGE SHOWING ABSENCE OF LEFT KIDNEY IN SAME
PATIENT.
1. PLAIN CT STUDY SHOWING ABSENCE OF RIGHT KIDNEY IN THE
RIGHT RENAL FOSSA AND SEEN FUSED WITH THE LEFT KIDNEY.
 2. CONTRAST CT STUDY OF THE SAME PATIENT SHOWING RIGHT
KIDNEY FUSED WITH THE LEFT KIDNEY IN THE MIDLINE.


PLAIN CT STUDY SHOWING ABSENCE OF RIGHT KIDNEY IN THE RIGHT
RENAL FOSSA AND SEEN FUSED WITH THE LEFT KIDNEY.


ANTENATAL ULTRASOUND EXAMINATION SHOWING SEVERE
OLIGOHYDRAMNIOS WITH ENLARGED CYSTIC BOTH FETAL KIDNEYS.
MULTIPLE VARIABLE SIZE PREDOMINANTLY PERIPHERALLY PLACED CYSTS
SEEN IN BOTH KIDNEYS .

MRI SHOWING FEW ACUTE HEMORRHAGIC CYSTS IN
BOTH KIDNEYS APPEARING HYPOINTENSE ON T1 AND
T2.

MRI T2 HASTE AXIAL & CORONAL IMAGE
SHOWING RIGHT PELVI-URETERIC JUNCTION
OBSTRUCTION.

MRI T2 HASTE SAGGITAL IMAGE SHOWING
RIGHT PELVI-URETERIC JUNCTION
OBSTRUCTION.

MRI T2 HASTE CORONAL IMAGE SHOWING LEFT
CONGENITAL MEGAURETETR.

MRI T2 HASTE SAGGITAL IMAGE SHOWING LEFT
CONGENITAL MEGAURETETR.

INTRAVENOUS UROGRAPHY & PLAIN CT SHOWING DUPLEX
COLLECTING SYSTEM ON RIGHT SIDE.

INTRAVENOUS UROGRAPHY SHOWING RIGHT HYDROURETERO
NEPHROSIS WITH RETROCAVAL URETER.

CONTRAST CT , T2 HASTE SAGITTAL & CORONAL IMAGES
SHOWING LEFT DOUBLE MOIETY URETER WITH ECTOPIC
URETEROCELE.

Congenital abnormalities of the kidneys and urinary tract are
common in children.

They are a significant cause of morbidity in infancy.

Many morphological renal changes can be evaluated by
imaging studies.

A Right protocol and familiarity with urologic anomalies are
essential for correct diagnosis and appropriate management.





A. Daneman and D. J. Alton, “Radiographic manifestations of renal anomalies,”
Radiologic Clinics of North America, vol. 29, no. 2, pp. 351–363, 1991.
K. Nakanishi and N. Yoshikawa, “Genetic disorders of human congenital
anomalies of the kidney and urinary tract (CAKUT),” Pediatrics International, vol.
45, no. 5, pp. 610–616, 2003.
R. Song and I. V. Yosypiv, “Genetics of congenital anomalies of the kidney and
urinary tract,” Pediatric Nephrology, vol. 26, no. 3, pp. 353–364, 2011.
S. Hattori, K. Yosioka, M. Honda, and H. Ito, “The 1998 report of Japanese
National Registry data on pediatric end-stage renal disease patients,” Pediatric
Nephrology, vol. 17, no. 6, pp. 456–461, 2002.
A. Wiesel, A. Queisser-Luft, M. Clementi et al., “Prenatal detection of congenital
renal malformations by fetal ultrasonographic examination: an analysis of 709,030
births in 12 European countries,” European Journal of Medical Genetics, vol. 48,
no. 2, pp. 131–144, 2005.