Overview
Congenital duplication of the renal collecting system involves the presence of two ureteric orifices arising from a single kidney, often leading to varying degrees of renal function impairment and potential urinary tract complications 1.Diagnosis
Key Diagnostic Criteria: Presence of two ureteric orifices on physical examination or imaging.
Recommended Tests:
- Computed Tomography (CT): Highly diagnostic for identifying the nubbin sign, indicating loss of parenchyma in the lower pole mimicking a mass 1.
- Ultrasonography (US): Less definitive; may struggle to conclusively diagnose without additional imaging 1.Management
First-Line Treatments:
- Surgical Intervention: Often required for symptomatic cases, including vesicoureteric reflux or urinary tract obstruction 1.
Adjunctive Treatments:
- Antibiotics: Used for recurrent urinary tract infections (UTIs) to prevent complications 1.Special Populations
Pediatrics: Early diagnosis and management are crucial to prevent long-term renal damage and recurrent UTIs 1.Key Recommendations
Utilize computed tomography for definitive diagnosis of duplicated collecting systems due to its diagnostic accuracy in identifying the nubbin sign 1 (Evidence: Strong).
Consider surgical correction in symptomatic pediatric patients to prevent renal impairment and recurrent infections 1 (Evidence: Moderate).
Employ antibiotics judiciously in managing recurrent urinary tract infections associated with duplicated collecting systems 1 (Evidence: Moderate).References
1 Blair D, Rigsby C, Rosenfield AT. The nubbin sign on computed tomography and sonography. Urologic radiology 1987. link