DMSA Scan in Congenital Kidney Anomalies

Dear Ask The Doctor: Hello doctor my brother was just diagnosed with an ectopic kidney. He is 15 years old and he has had several exams done such as an ultrasound, CT, and a vcug. Both kidneys are in his left side they appear to not be fused. However he has high blood pressure and recently they found out that his surgar was a bit low. What do you think the next step could be because all the other exam came out good exept for the kidney being on the other side. Do you think a DMSA scan would be a good option? Because i dont know if the blood pressure medicine would be good for him the rest of his life.

Your brother’s condition is one of the rare ones. But he is still lucky because his kidneys do not appear fused, that is still some good news. A DMSA scan involves a radioactive solution being injected into the veins; this radioactive solution will go to the bloodstream and eventually reach the kidneys. Once there, pictures of the kidneys will be taken wherein the intricate structure of the kidney can be visualized. Scarring, inflammation or any kidney damage can be more elucidated through this procedure. By then, I think the doctors will decide on what to do next. It will be a case to case basis: he may be closely monitored first with close follow up of blood tests and imaging procedures or if the kidneys are too damaged, or one kidney is practically not functional and is doing more harm than good, then that kidney may have to be removed. The kidneys have a central role in regulating blood pressure. An individual can survive with one kidney and live a relatively normal life with dietary and lifestyle restrictions. May I ask what kind of BP meds your brother has? Because he may be given ACE (angiotensin converting enzyme) inhibitors (generic drug names ending in –pril) or ARBs (angiotension receptor blockers, generic drug names ending in -sartan). These drugs act on the blood supply of the kidneys; their effect is it constricts the blood vessels supplying the kidneys, thereby reducing the amount of blood being filtered by the kidneys. It would have also been helpful if you mentioned what kind of BP meds he is having because I am only presuming that these are the kinds of BP meds given to your brother. There could be one or more reasons why your brother is being given BP meds. Whether or not he will be taking it for the rest of his life, it will be a case-to-case basis. If being given BP meds for the rest of his life will have more benefits (delaying kidney failure, delaying heart failure or heart disease as a result of kidney failure, etc), then it is far from a bad idea. True, all medicines have side effects but in most cases, there are usually more benefits than risks. I think for now, it is beneficial to have the DMSA scan. Once the results are in, the next step can be discussed. I do hope this helps. Regards to your brother and take care always.