E1420. Congenital Anomalies of the Kidney and Urinary Tract: What the Radiologist Needs to Know
  1. Francisco Grilo; Hospital de Braga
  2. Daniela Barros; Hospital de Braga
  3. Ana Goncalves Costa; Hospital de Braga
  4. Filipa Costeira; Hospital de Braga
  5. Fernanda Gomes; Hospital de Braga
  6. Filipa Vilaverde; Hospital de Braga
Congenital anomalies of the kidney and urinary tract, frequently referred to as CAKUT, occur in up to 6 per 1000 live births, being the main cause of end-stage renal disease (ESRD) in children, and accounting for significant morbidity in adults. (1, 2) Different imaging modalities are usually required for the diagnosis of these conditions. Ultrasound (US) is generally used as the first examination, as it is radiation free, non-invasive and easily available, serving as a screening tool. Intravenous urography (IVU) is especially helpful in identifying areas of obstruction or duplex collecting systems. Lastly, Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) add more anatomic detail, thereby helping to better characterize these abnormalities. (2, 3)

Educational Goals / Teaching Points
The main educational goals are to review the most frequent CAKUTs (focusing on the kidney and ureter), to illustrate and discuss their imagiological findings across the different imaging modalities.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
CAKUTs can all be grouped into three categories from an embryological perspective: abnormalities in the development of the renal parenchyma, aberrant embryonic migration and anomalies of the collecting system. (2, 4). The first category encompasses renal hypoplasia, renal agenesis, anomalies in renal shape (persistent fetal lobulation, hypertrophied column of Bertin), and cystic renal diseases. Aberrant embryonic migration includes abnormal location and fusion anomalies, such as horseshoe kidney, pancake kidney, ectopic kidneys, crossed fused renal ectopia. Lastly, anomalies of the collecting system are exemplified by conditions such as pelvi-ureteric junction obstruction (PUJO), duplex collecting systems and megaureters. In this educational exhibit, we decided to focus on the congenital anomalies of the kidney and ureter, showing different examples and highlighting their main findings either in the US, IVU or CT.

Congenital anomalies of the kidney and urinary tract are quite prevalent and require the radiologist to be well accustomed to how they can present in the different imaging modalities, this way contributing to an early diagnosis and appropriate management and to the prevention of the numerous complications and morbidity associated with these malformations.