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My male child is 4 months old. Since 7th month of his mother's pregnancy, ultrasound scan indicated mild renal pelvis dilatation (< 8 mm on both sides). After the child's birth (child's date of birth - 2nd Jan 2015), we have gotten his ultrasound done 3 times as per the details below:

1) Ultrasound KUB on 9th Jan 2015:
Renal Pelvis dilatation measurement: Left - 8 mm, Right - 6 mm

2) Ultrasound KUB on 16th Feb 2015:
Renal Pelvis dilatation measurement: Left - 8 mm, Right - 5.6 mm

3) Ultrasound KUB on 2nd May 2015:
Renal Pelvis dilatation measurement: Left - 6-7 mm, Right - negligible (not reported)
Impression: Mobile echogenic organized sediments within the left renal pelvis without any posterior acoustic shadowing detected

So, as per the latest ultrasound report, while there is no significant dilatation on right renal pelvis, dilatation on left renal pelvis has reduced slightly to 6-7 mm now. However, mobile echogenic sediments were detected. The radiologist asked us to contact a urologist. When we contacted a urologist, he suggested we get a DTPA Renogram done on the baby. I am attaching last three KUB Ultrasound reports and urologist's prescription. I am writing to you for your opinion whether DTPA on a 4 month old baby is advisable at this time, and also whether there are any side effects. Looking forward to your prompt response and opinion.

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Category: Pediatric Nephrologist

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Category: Pediatric Nephrologist
Dr. Sree Bhushan Raju is online now

Expert:  Dr. Sree Bhushan Raju replied 4 Days.

Dear Mr. Bharat,
Thank you for your query at DoctorSpring.com

Your son's diagnosis is reasonably clear. He has bilateral hydronephrosis with bilateral PUJ (pelvi-ureteric junction) obstruction.
Your son's ultrasound reports suggest the diagnosis. The concern is the echogenic sediment. Is it infectious? Is it due to microcrystalline aggregation? Is it an imaging artefact? Needs to be checked and confirmed with a renal ultrasound by an alternate expert.
The DTPA scan involves an injection of isotope (in the form of a liquid solution) into a vein in your child's arm or hand (cream is put on an hour before to make the skin numb so that it doesn't hurt). The isotope is an inert substance which is excreted by the kidneys and so shows up the function of the kidneys as well as the degree of the obstruction, when they are scanned using a scanner machine. The scan can take up to an hour as repeated scans are taken to follow the isotope through the kidneys, ureters, and bladder but again is completely painless.
To put it in non-medical terms, ultrasound is like taking a photograph of a person. Looking at the photograph, you can only deduce a few physical aspects. You cannot guess how well the person can work. The same is true for kidneys. We have their ultrasounds (similar to a photograph) but need to find about functional status to decide if this obstruction is causing functional flow problems. In this child DTPA renogram would help assess functional status.
In case of young infants and neonates, some experts prefer alternate renotope scan, MAG-3. This does the same thing but probably slightly better in the younger age group. Both these agents can cause allergic reactions in any age group. Need to be prepared for such an eventuality. You need to get a renal function test also ( blood urea nitrogen and serum creatinine). Otherwise, overall the scan is safe for your son.

Dr. Sree Bhushan Raju
Category: Pediatric Nephrologist
FISN : Fellowship of Indian Society of Nephrology(ISN), 2012
FIACM : Fellowship of Indian Association of Clinical Medicin(IACM), 2012
FICP: Indian College of Physicians Association of Physicians of India, 2012
Fellowship: DM, DNB, All India Institute of Medical Sciences, New Delhi, 2002
Residency: MD, General Medicine, Nizam's Institute of Medical Sciences, 1998
Medical School: MBBS, Gandhi Medical College, 1994
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