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A DMSA scan is a radionuclide scan that uses dimercaptosuccinic acid (DMSA) in assessing renal morphology, structure and function. Radioactive technetium-99m is combined with DMSA and injected into a patient, followed by imaging with a gamma camera after 2-3 hours. [1]
Hydronephrosis is seen as an anechoic fluid-filled interconnected space with enhancement within the renal sinus, and normally, the dilated pelvis can be differentiated from the dilated calyces. [1] Figure 13. Hydronephrosis due to ureteropelvic junction obstruction in a pediatric patient. [1] Several conditions can result in urinary obstruction.
An intravenous pyelogram is used to look for problems relating to the urinary tract. [5] These may include blockages or narrowing, such as due to kidney stones, cancer (such as renal cell carcinoma or transitional cell carcinoma), enlarged prostate glands, and anatomical variations, [5] such as a medullary sponge kidney. [6]
The size of the renal pelvis plays a major role in the grading of hydronephrosis. Normally, the anteroposterior diameter of the renal pelvis is less than 4 mm in fetuses up to 32 weeks of gestational age and 7 mm afterwards. [2] In adults, 13% of the normal population have a transverse pelvic diameter of over 10 mm. [3]
Hydronephrosis describes hydrostatic dilation of the renal pelvis and calyces as a result of obstruction to urine flow downstream. Alternatively, hydroureter describes the dilation of the ureter, and hydronephroureter describes the dilation of the entire upper urinary tract (both the renal pelvicalyceal system and the ureter).
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Without another way for urine to drain, pressure would rise within the urinary system and the kidneys would be damaged. [4] The most common cause of blockage necessitating a nephrostomy is cancer, especially ovarian cancer and colon cancer. Nephrostomies may also be required to treat pyonephrosis, hydronephrosis and kidney stones. [5]
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