
Dr. Anil Takvani
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24 Nov 2024 01:27:43 PMAntenatal right HN- Postnasal investigations- How early surgery?
2 months healthy boy with history of antenatal HN presented with following investigations-;
USG- 3days and 1 month
Diuretic renal scan done at 2 months
Please discuss diagnosis?
Will you suggest anymore investigations to support your diagnosis?
If surgery- how early?

Comments(8)
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Dr. Anil Takvani
14 Jun 2020 04:56:25 PMI am putting case details again.
Antenatal detection of severe right HN in third trimester.Now two months, healthy.Mother feels lump in right flank at times.Three uses done. Images of two available. One month and recent one. Attaching both. Renal scan done at 2 months, already posted.Please discuss the further management.Pyeloplasty? How early?Your preferred approach in 2 months child. Weight of child is 5.7kg.Thanks -
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Uday Sankar Chatterjee
14 Jun 2020 05:12:35 PMSupranormal function in Rt kidney with obstructive curve.In this situation pyeloplasty may not show any improvement both in wash out curve and in SRF... So wait and watch with USG renometry. Renogram to be done as dictated by the Renometric parameters... Parents need to be counselled, that Pyeloplasty would be necessary on deterioration of SRF > 5% . -
Dr. Anil Takvani
14 Jun 2020 05:25:50 PMSir,
Kidney is palpably enlargedPelvic dilatation is almost 40 mm. Cortex is thinned out.CTT is very much delayed.Why not to operate? I think any delay can be responsible for increase in nephron damage...Thanks -
Uday Sankar Chatterjee
14 Jun 2020 06:55:19 PMIf you think, the preop parameters (particulaly CTT) would be reversed; then you may do Pyeloplasty.But I would like to wait for deterioration of SRF after counselling the parent. -
shriram joshi
17 Jun 2020 10:17:57 AMI would advise parents for a pyeloplasty after getting ok from paediatrician, anaestheologist. The reasons are :
A history from mother of intermittent palpable rt kidney. This occurs when there is brisk diuresis after breast feeding or any other fluid. With PUJOpelvis balloons up and kidney becomes palpable, but settles down after sometime when pelvis empties.B USG shows AP diameter of 38 mm +Significant dilatation of calyces + thinning of parenchyma to 4.5 mm + no ureter is seen. Pelvis shows no debris within suggesting no infectionWith these findings if you do pyeloplasty soon there is 90% chance of full recovery.It would have been nicer if AP diameter of pelvis in supine & prone position. Just another clue regarding severity of PUJOC. Renogram shows delayed cortical transit time (CTT) + an ascending curve not touching base line + retention of dye in delayed film + Supra normal differential function of 52% (>50%} , all suggesting PUJOmind you renogram is a total body radiation for a child. One can follow the child on USG and assess progression if any instead of repeat renogramFor above reasons I would recommend pyeloplasty.SSJ -
Dr. Anil Takvani
24 Jun 2020 07:31:21 PMI am posting operative images of hydropelvis and HN kidney with long adynaemic PUJ.
These images proves there was no point in waiting anymore in this case.How much he will show improvement in USG parameters depends on how proper dependent pyeloplasty done and function of nephrons. Will post follow up USG images and if possible follow up diuretic scan to see how much CTT improved?Post is open for many relevant discussions on operative indications and post operative outcomes and ofcourse technique of pyeloplasty in infants.Thanks
Dr. Anil Takvani
13 Jun 2020 01:51:36 PMUploading renal scan