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"Non-functioning” Kidneys in Excretory Urography: Caution is the word!

Ajape AA1 , Kura M2, Ibrahim AG2 Affi liation: 1- Division of Urology, Department of Surgery, University of Ilorin Teaching

Hospital, Ilorin 2- Department of Surgery, Federal Medical Centre, Gombe. Corresponding author: Dr. Abdulwahab A Ajape P.O. Box

4850, Ilorin. Kwara state. E-mail: ajsnrkudimoh@yahoo.co.uk, ajsnrkudimoh@gmail.com

 

Summary

Significant loss of renal function is objectively diagnosed with radioisotope renal scintigraphy. In many developing countries radioisotope study is not readily available and the diagnosis of non-functioning kidney is often based on intravenous urography. We retrospectively reviewed the case notes of three patients that were diagnosed with ‘non-functioning’ kidneys based on intravenous contrast renal imaging but had salvage procedure for the renal moiety. In the absence of radioisotope study, some restrain is advocated for nephrectomy, for ‘non-functioning kidney’, based solely on the result of intravenous urography.

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Introduction

The kidneys, eliminate waste products of metabolism in the form of urine (1). The loss of the kidney function may re-sult from many causes including obstructive uropathy.

 

The degree of the damage that occurs depends on several factors that have been well documented (2-4). Non-invasive radiological investigations, such as ultraso-nographic scan and urinary biomarkers, are invaluable in the diagnosis of the cause and effect of obstructive uropathy (5). Instrumental and advanced radiologic evaluations play complementary role. The intravenous urography (IVU) is available in most centres although its discriminatory abil-ity with respect to the functional reserve in the kidney is only qualitative (6). Differential renal function evaluation using radioisotope renal scintigraphy is the gold standard for confirmation of diagnosis, for determining the residual function of hydronephrotic kidney at presentation, for fol-low up of function over time and, most importantly, for the timing of intervention in the patient (7). Isotopic scanning is not available for most areas in our en-vironment. Many nephrectomies have thus been performed for “non-functioni