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Potential diagnostic role of renal scintigraphy in the management of patients with high anorectal malformation.

Urological problems are the leading associated anomalies in patients with anorectal malformation (ARM). In this study, we evaluated the role of scintigraphy in managing patients with high ARM. The records of infants with urologic anomalies on abdominal ultrasound and referred for scintigraphic evaluation were retrospectively analyzed. Diuretic renography in these patients was performed using (99m)Tc-diethyl triamine penta-acetic acid ((99m)Tc-DTPA) or (99m)Tc-ethylene cysteine ((99m)Tc-EC) while cortical scintigraphy was performed with (99m)Tc-dimercaptosuccinate (DMSA). Whenever available, EC was preferred in children of age less than 1 year. Forty patients (38 males, 2 females) were analyzed. The mean age of the population was 25 months (range 15 days-21 years). Eighteen of the forty patients were less than 3 months of age. Twenty seven of the patients were less than one year of age. The most common renal anomaly was unilaterally non-visualized kidney affecting 15 out of the 40 patients. The visualised kidney was abnormal in 8/15 patients. Hydronephrotic changes were noticed in 12 of 40 patients of whom 2 had pelvi ureteric junction obstruction that was confirmed and treated surgically. Horse shoe kidney was present in 1 patient while 2 had an ectopic kidney. Scarring/ pyelonephritic changes were found in 7/40 patients. Five patients had already progressed to chronic renal failure at the time of scintigraphy. Only 8 patients of the 40 had bilaterally normal kidneys. In conclusion, this study suggests that urologic abnormalities often found in infants with high ARM may remain clinically silent and eventually lead to chronic renal failure. Proper evaluation by diuretic renography and cortical scintigraphy can lead to early identification of potentially treatable conditions hence reducing the likelihood of developing severe renal damage.