By David Thomas, Patrick G. Duffy, A.M.K. Rickwood
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Its management is complex and demands the expertise and resources of a skilled multiprofessional team. • Renal transplantation is the treatment of choice for end-stage renal disease in children. • Chronic renal failure and its treatment carries major implications for quality of life and in some situations parents may take the ethically justifiable decision not to initiate treatment. Further reading Barratt TM, Avnel ED, Harmon WE (eds). Paediatric Nephrology, 4th edn. Baltimore: Lippincott Williams and Wilkins, 1999 Kher KK, Makker SP, Schnaper HW (eds).
A) MCU shows reflux into an abnormally sited kidney. (b) MAG3 demonstrates functioning parenchyma in an abnormal pelvic position with rising renogram curve. 11 Horseshoe kidney. (a) DMSA demonstrates the presence of functioning renal tissue across the midline in this patient. (b) Coronal reconstruction from a CT angiogram for vascular anatomy presurgery also demonstrates the configuration of the kidney (a nephrostomy tube is in place in the right moiety). MRI Apart from the lack of ionising radiation, the advantages of MRI over CT are the multiplanar images and the superior delineation of different tissue types.
Beyond this age, general anaesthesia is usually required to permit a satisfactory MRI scan in patients up to about the age of 7 or 8, after which they can lie still on their own. 14). MR angiography (MRA) also makes an informative contribution. 15). 16). 13 Wilms’ tumour. (a) MRI with intravenous contrast in the transverse plane shows bilateral Wilms’ tumour in a horseshoe kidney. (b) DMSA in the same patient showing the bilateral tumours as photopenic areas since they do not contain normally functioning renal tissue.