









































Pa
ge

 
1



Pa
ge

 
10

5

American Journal of  Environmental
Economics (AJEE) 

A Literature Review: Radiological Computed Tomography Assessment for Congenital 
Renal Anomalies

Mohamed Hegazy1*

Volume 3 Issue 1, Year 2024
ISSN: 2833-7905 (Online)

DOI: https://doi.org/10.54536/ajee.v3i1.3101
https://journals.e-palli.com/home/index.php/ajee

Article Information ABSTRACT

Received: August 14, 2024
Accepted: September 16, 2024
Published: September 20, 2024

Congenital renal anomalies represent a diverse group of  structural abnormalities of  the 
kidneys that occur during embryonic development. These anomalies can lead to significant 
morbidity and mortality if  not timely diagnosed and managed. This review aims to explore 
the key role of  Computed Tomography (CT) scans in examining congenital renal anomalies 
by analysing peer-reviewed articles, case studies and clinical guidelines. This review outlines 
common anomalies, assesses CT’s diagnostic accuracy and protocols, and explores its clinical 
implications. A comprehensive literature search from 2019-2023 was conducted using various 
databases and keywords, including “congenital renal anomalies”, “computed tomography”, 
and “imaging protocols” to ensure the inclusion of  pertinent studies. It highlights recent 
advancements in CT technology that address concerns about radiation exposure while 
maintaining diagnostic quality. Ultimately, it provides future research directions for healthcare 
professionals to optimise CT use in diagnosing and managing congenital renal anomalies with 
the goal of  improving patient care.

Keywords

Agenesis, Computed 
Tomography, Congenital Renal 
Anomalies, Imaging Protocols, 
Radiological Assessment

1 Department of  Radiology, Tanta University Hospital, Gharbia, Egypt
* Corresponding author’s e-mail: Mohamedhegazy266@outlook.com

INTRODUCTION
Congenital renal anomalies encompass a wide range of  
kidney structural abnormalities arising from abnormal 
morphogenesis during fetal development (Houat et al., 
2021). These anomalies can involve one or both kidneys 
and may affect the renal parenchyma, vasculature, pelvis, 
or ureters (Jain & Chen, 2019). Early detection and accurate 
characterisation of  these anomalies are essential for proper 
patient management and the prevention of  potential 
complications such as renal dysfunction, hypertension, and 
urinary tract obstruction. Radiological imaging, particularly 
Computed Tomography (CT), has emerged as a valuable 
tool in assessing congenital renal anomalies due to its 

excellent spatial resolution and ability to provide detailed 
anatomical information (Alnazer et al., 2021).

Congenital Renal Anomalies: A Persistent Challenge
Congenital Renal Anomalies (CRAs) encompass a 
spectrum of  structural abnormalities of  kidneys present 
from birth. These anomalies can greatly impact someone’s 
health and quality of  life, ranging from mild problems to 
severe deformities. Patients with CRAs may experience 
a variety of  complications, including renal insufficiency, 
hypertension, and urinary tract problems (Jayaprakasan 
& Ojha, 2022). Table 1 represents key features of  some 
common types of  CRAs.

Table 1: Congenital Renal Anomalies: Types and Key Features
Types of  Congenital 
Renal Anomaly

Description Key Features

Agenesis Complete absence of  
one or both Kidneys.

Unilateral agenesis: One Kidney is missing.
Bilateral agenesis: Both kidneys are missing (incompatible with life).

Hypoplasia Underdeveloped 
kidney with reduced 
functionality.

Smaller than expected kidney size.
Abnormal development of  blood vessels and collecting system.

Dysplasia Abnormal development 
of  the kidney tissue.

Disorganised and immature kidney tissue.
Presence of  cysts or abnormal collecting ducts.

Duplication Presence of  extra 
kidneys or ureters.

One or both kidneys may be duplicated (Complete or Incomplete).
Extra ureter may drain abnormally.

Ectopia Kidney is located in an 
abnormal position.

Kidney positioned outside its usual location (e.g., pelvis chest).

Horseshoe Kidney Two kidneys fused 
together at the lower 
poles

Horseshoe-shaped kidney with a bridge of  tissue connecting the 
two halves.



Pa
ge

 
10

6

https://journals.e-palli.com/home/index.php/ajee

Am. J. Environ Econ. 3(1) 105-115, 2024

Radiological CT Assessment: A Powerful Diagnostic 
Tool
Radiological CT assessment refers to the assessment 
and diagnosis of  congenital renal abnormalities using 
computed tomography (CT) imaging techniques. It plays 
a key role in diagnosing and managing CRAs. The kidneys 
can be seen clearly in cross-sectional detail thanks to the 
advanced medical imaging technology known as a CT 

scan (Huang et al., 2020). The high resolution of  CT 
scans allows for precise visualisation of  renal anatomy, 
facilitating the detection and characterisation of  various 
CRAs. CT can differentiate between different tissue types 
within the kidney, aiding in the diagnosis of  specific 
CRAs. Table 2 below shows the challenges associated 
with diagnosing Congenital Renal anomalies.

Cystic Renal Dysplasia Presence of  cysts 
within the kidney tissue.

Maybe asymptomatic or present with: 
Mass in the abdomen.
High blood pressure.
Proteinuria.
Reduced Urine Output

Table 2: Challenges in Diagnosing Congenital Renal Anomalies (CRAs)
Challenges Description
Varied Clinical 
Presentation

CRAs exhibit a wide spectrum of  presentations, ranging from asymptomatic cases to those with 
severe complications. Symptoms can be vague and non-specific, mimicking other conditions.

Limitations of  
Prenatal Ultrasound 
Technology

Resolution Limitations may hinder the visualisation of  certain abnormalities.
Certain Types of  CRAs may develop later in foetal development beyond the typical 
timeframe for prenatal scans.

Balancing Diagnostic 
Accuracy with Patient 
Safety

Traditional methods like intravenous pyelography (IVP) involve ionising radiation, raising 
concerns about patient safety, particularly in children and pregnant women.
Repeated exposure to radiation can increase the risk of  future health problems.

Differential Diagnostic 
Challenges

Certain CRAs may share similar symptoms with other urinary tract problems, requiring 
additional tests to confirm the diagnosis.
Differential diagnosis can be time-consuming and require a combination of  tests.

Significance
This review article sheds light on the critical role of  
radiological CT assessment in diagnosing and managing 
congenital renal anomalies (CRAs). It delves into the 
following key aspects:

Clinical Relevance of  CRAs
Numerous health concerns, including renal insufficiency, 
hypertension, and problems with the urinary system, 
can be caused by congenital renal abnormalities (Palma 
et al., 2023). It is essential to comprehend and correctly 
diagnose these anomalies to manage patients and design 
treatments.

Advancements in Imaging
Due to its ability to give precise anatomical data, 
radiological CT assessment has become a cornerstone in 
identifying and evaluating renal abnormalities (Han et al., 
2019). Any innovations, methods, or best practices in this 
field may significantly impact patient care.

Clinical Guidelines
The findings of  a thorough review on this subject may 
help create clinical recommendations or guidelines for 
the use of  CT in the evaluation of  congenital renal 
abnormalities (Houat et al., 2021). Furthermore, a 
thorough review incorporating these cases can contribute 

to developing tailored clinical guidelines for optimal CT 
utilisation in evaluating and managing various congenital 
renal anomalies, promoting standardised and effective 
patient care practices (Houat et al., 2021).
Furthermore, a thorough review incorporating these cases 
can contribute to developing tailored clinical guidelines for 
optimal CT utilisation in evaluating and managing various 
congenital renal anomalies, promoting standardised and 
effective patient care practices. Integrating these case 
studies within the broader discussion of  congenital renal 
anomalies and the role of  radiological CT assessment 
underscores the clinical relevance and diagnostic 
complexity associated with these conditions, emphasising 
the need for multidisciplinary approaches and advanced 
imaging techniques for comprehensive patient care and 
management.

Case Presentation
“Uncommon Anatomical Presentation: Bilateral Duplex 
Kidney with Hydronephrosis and Intramural Ureterocele 
in a 15-Year-Old Male”

History
A 15-year-old male patient with dysuria, pain, or 
discomfort during urination was diagnosed with a 
congenital abnormality. The CT scan revealed bilateral 
duplex kidney and ureters, hydronephrosis, and an 



Pa
ge

 
10

7

https://journals.e-palli.com/home/index.php/ajee

Am. J. Environ Econ. 3(1) 105-115, 2024

intramural ureterocele. These findings suggest a complex 
condition requiring thorough evaluation and management 
by a urologist or pediatric nephrology specialist. The 
patient’s condition may require surgical intervention and 
long-term management to prevent complications like 
renal damage or urinary tract infections. A comprehensive 
assessment of  the patient’s renal function, urinary tract 
anatomy, and overall health status is necessary. The 
treatment plan may involve medical interventions and 
surgical procedures, with close monitoring and follow-up 
to ensure the patient’s well-being.

“Uncommon Renal Configuration Unveiled: Externally 
Rotated Horseshoe Kidneys with Parenchymal Band 
Fusion in a 52-Year-Old Male Presenting with Renal 
Colic”.

History
A 52-year-old male patient with renal colic. A CT scan 
revealed horseshoe kidneys, a congenital anomaly where 
kidneys are connected by renal parenchyma and externally 
rotated. This condition can lead to complications 
like kidney stones, hydronephrosis, or urinary tract 
infections. Treatment involves managing symptoms, 
addressing complications, and monitoring renal function. 
Healthcare teams may recommend pain management, 
urological assessments, and regular follow-up to prevent 
complications.

Figure 1: Bilateral Duplex Kidney with Hydronephrosis 
and Intramural Ureterocele

Figure 2: CT Scan of  Bilateral Duplex Kidney with 
Hydronephrosis and Intramural Ureterocele

Figure 4: CT Scan of  Externally Rotated Horseshoe 
Kidneys with Parenchymal Band Fusion

“Unusual Ureteric Anomaly: Ectopic Insertion into 
Vaginal Vault Causing Urinary Incontinence in a 3-Year-
Old Female”.

History
A 3-year-old female patient with urinary incontinence 
was diagnosed with ureteral ectopia, a congenital anomaly 
causing the ureter to insert into an abnormal location, the 
vaginal vault. This condition can lead to complications 
like urinary tract infections and renal impairment if  not 
managed properly. The healthcare team must assess 
the patient’s renal function and urinary tract anatomy 
and implement a treatment plan involving medical and 
surgical interventions.

Figure 3: CT Scan of  Ectopic Insertion into Vaginal Vault

“Challenging Urinary Obstruction Unraveled: Bilateral 
Hydronephrosis and Marked UPJ Stricture with Non-
Dilated Ureters”.

History
Bilateral moderate hydronephrosis is a condition 
characterised by swelling of  both kidneys due to urine 
accumulation, indicating an obstruction in urine flow. The 
condition is characterised by non-dilated ureters and a 



Pa
ge

 
10

8

https://journals.e-palli.com/home/index.php/ajee

Am. J. Environ Econ. 3(1) 105-115, 2024

marked UPJ stricture at the ureteropelvic junction (UPJ). 
Treatment options may include surgical intervention, 
ureteral stenting, or other procedures. Regular follow-
up and monitoring are crucial to prevent complications 
and ensure the patient’s well-being. Management involves 
urologist assessment and treatment options.

History
A 36-year-old male patient with dysuria reported a non-
visualized left kidney and compensatory hypertrophy 
of  the right kidney, indicating aplasia. The patient’s 
management plan includes further evaluation to determine 
the cause of  the non-visualized left kidney and to ensure 
the functionality of  the compensatory hypertrophied 
right kidney. Regular renal function and overall health 
monitoring are crucial to preventing complications and 
addressing urinary symptoms. Close follow-up with a 
urologist or nephrologist is necessary for appropriate 
guidance and treatment.

Figure 5: CT Scan of  Bilateral Hydronephrosis and 
Marked UPJ Stricture with Non-Dilated Ureters

Figure 7: CT Scan of  Hypertrophy of  the Right Kidney 
in Response to Aplastic Left Kidney

“Unusual Kidney Positioning Discovered: Ectopic Left 
Kidney in the Left Lower Iliac Fossa in a 22-Year-Old 
Male Presenting with Dysuria”.

History
A 22-year-old male with dysuria presents with ectopic 
kidneys, a congenital condition where the kidney is 
positioned abnormally outside its normal position. 
The patient’s treatment plan includes a comprehensive 
urologist evaluation, management addressing dysuria 
symptoms, evaluating the kidney’s functionality, and 
monitoring for potential complications. Treatment 
options may include medication, surgical intervention, 
or other measures. Regular follow-up and monitoring 
are crucial for the patient’s well-being and preventing 
complications.

Figure 6: CT Scan of  Ectopic Left Kidney in the Left 
Lower Iliac Fossa

“Renal Anomaly Unveiled: Compensatory Hypertrophy 
of  the Right Kidney in Response to Aplastic Left Kidney 
in a 36-Year-Old Male with Dysuria”.

Congenital renal abnormalities create complex diagnostic 
issues that require advanced imaging techniques like 
CT for correct assessment, as seen by these various 
clinical presentations. It is essential to comprehend the 
subtle differences in anatomical configurations to adopt 
customised therapy techniques and guarantee the best 
possible outcomes for patients, ranging from ectopic 
kidneys and ureteric anomalies to complicated structural 
aberrations like horseshoe kidneys and UPJ strictures.

Objectives
This comprehensive review article aims to compile 
existing knowledge on CT imaging in assessing congenital 
renal anomalies, focusing on peer-reviewed articles, case 
studies, and clinical guidelines. It also aims to identify 
common congenital renal anomalies based on their 
structural characteristics and clinical significance. The 
review describes various radiological CT techniques 
used in assessing congenital renal anomalies, including 
contrast-enhanced CT and multi-detector CT, offering 
insights into the technological aspects of  the field.
The review evaluates the diagnostic accuracy of  CT 
imaging by summarising relevant studies that assess the 
sensitivity, specificity, and overall performance of  CT 
scans in the context of  congenital renal anomalies. It 
also discusses the clinical implications of  CT imaging in 
assessing these anomalies and exploring how CT findings 
influence decision-making, patient outcomes, and long-
term management strategies.
The review highlights recent advancements and 



Pa
ge

 
10

9

https://journals.e-palli.com/home/index.php/ajee

Am. J. Environ Econ. 3(1) 105-115, 2024

innovations in CT technology and protocols, emphasising 
their contribution to improving patient care and refining 
diagnostic capabilities. It also addresses radiation 
exposure and safety concerns associated with CT imaging, 
considering strategies for minimising radiation dose while 
maintaining diagnostic quality.
Lastly, the review provides practical clinical 
recommendations for healthcare professionals based 
on existing evidence and expert consensus, serving as 
valuable guidance in using CT imaging for diagnosing and 
managing congenital renal anomalies.

MATERIALS AND METHODS
Research Design
The study aims to examine the incidence of  renal 
congenital anomalies during daily work in Egypt. This 
objective was achieved by a thorough literature search and 
analysis, as described in the section below.

Data Collection
This review’s primary data sources are scholarly 
articles, research papers, industry reports, and academic 
publications on the impact of  the incidence of  renal 
congenital anomalies during daily work in Egypt. The 
study’s inclusion of  published sources during the past five 
years ensured its applicability.

Selection Requirements
To ensure the rigour of  our research, we implemented 
a stringent screening process. We considered studies 
centred on the Egyptian market for assessing congenital 
renal abnormalities. The chosen studies encompass 
genuine data, statistics, or case studies that delve into the 
incidence of  renal congenital anomalies during daily work. 
Furthermore, our selected studies have been published 
in respected industry publications, notable conference 
proceedings, or peer-reviewed journals.

Search Strategies
To indicate the Radiological Computed Tomography 
Assessment for Congenital Renal Anomalies, a 
comprehensive literature search was conducted 
encompassing peer-reviewed publications from various 
databases, including PubMed, Scopus, Web of  Science, 
Medline and Sage. Numerous studies were selected 
from 2019-2023 using the keywords “Congenital Renal 
Anomalies,” “Radiological CT Assessment,” “Imaging 
Techniques,” “Risk Factors,” “Clinical Guidelines,” 
“Advancements,” ‘Future Challenges,” “Diagnosis,” 
“Treatment.”’ The full texts of  the retrieved articles were 
made accessible.

Data Extraction Results
This review synthesises the current understating 
of  Radiological Computed Tomography (CT) for 
congenital renal anomalies. It incorporates findings from 
observational studies and major clinical trials to present 
a comprehensive picture. While efforts were made 

to include the most relevant and impactful research, 
there’s a possibility of  publication bias favouring smaller 
observational studies with promising yet confirmed 
results.

RESULTS AND DISCUSSION
Imaging Techniques and Protocols
Computed Tomography (CT)
The powerful medical imaging technique, computed 
tomography, or CT, produces incredibly precise cross-
sectional images of  the human body using X-rays and 
cutting-edge computer technology (Khalid et al., 2020). 
When used to diagnose and evaluate a variety of  medical 
disorders, these images offer priceless insights into the 
body’s internal workings. The CT imaging process involves 
several key steps, beginning with patient preparation, 
positioning on the CT table, and image acquisition as 
the machine rotates around the patient, emitting X-rays 
(Jung, 2021). After a computer reconstructs the raw data, 
a radiologist examines the cross-sectional images for 
anomalies or specific conditions. The referring physician 
reviews the diagnostic report that the radiologist 
created with the patient and makes any necessary 
recommendations or treatment suggestions (Howlett et 
al., 2020). 

Techniques
Multi-detector CT (MDCT), one of  the most recent 
techniques for CT imaging, gathers multiple slices of  data 
concurrently for quicker imaging and better resolution 
(Usanase et al., 2023). By acquiring pictures at several 
energy levels, Dual-Energy CT (DECT) improves tissue 
characterisation and provides details on the composition 
of  the materials (Sodickson et al., 2021). Cone Beam 
CT is utilised in dentistry and interventional radiology, 
and it offers 3D pictures for dental evaluations and 
surgical planning (Elgarba et al., 2023). Reduced radiation 
exposure has been achieved by developing low-dose CT 
procedures, crucial for routine and pediatric screening. 
To improve the efficiency and accuracy of  diagnosis, 
artificial intelligence (AI) is progressively included in CT 
imaging for tasks including image reconstruction and 
noise reduction (Gore, 2020).

Diagnostic Criteria for Congenital Renal Anomalies 
Several criteria are essential for an accurate diagnosis and 
suitable care of  various disorders. The ability to accurately 
and thoroughly diagnose congenital renal abnormalities 
has substantially improved as a result of  advancements 
in medical imaging, notably the use of  cutting-edge 
methods like computed tomography (CT) and magnetic 
resonance imaging (MRI) (Yanase & Triantaphyllou, 
2019). Diagnostic procedures frequently combine clinical 
assessment, laboratory investigations, and medical 
imaging. The visualisation of  the renal structures, made 
possible by imaging techniques like CT scans and MRIs, 
aids in detecting anomalies such as renal agenesis, 
horseshoe kidneys, and renal cysts (Raina et al., 2021). 



Pa
ge

 
11

0

https://journals.e-palli.com/home/index.php/ajee

Am. J. Environ Econ. 3(1) 105-115, 2024

Genetic testing may be used to determine the hereditary 
elements of  congenital renal abnormalities in addition 
to sophisticated imaging. The diagnostic standards for 
congenital renal abnormalities are essential for early 
recognition and treatment. The capacity to recognise and 
treat congenital renal abnormalities more successfully is 
being enhanced by integrating contemporary imaging 
technology and genetic understanding (Kitzler & Chun, 
2023).

Renal Agenesis
A disorder known as renal agenesis occurs when either 
one or both kidneys do not correctly form during 
foetal development. Bilateral renal agenesis denotes 
the absence of  both kidneys, whereas unilateral renal 
agenesis refers to the formation of  only one kidney 
(Jelin, 2021). The management of  renal agenesis may 
involve monitoring, handling linked health issues, and 
dealing with any connected complications. The reasons 
for renal agenesis might be hereditary or environmental 
(Ugurlucan et al., 2020).

Renal Hypoplasia
On the other side, renal hypoplasia describes a kidney 
that is underdeveloped or is smaller in size than the other 
kidney. One or both kidneys may be affected by congenital 
renal hypoplasia, which is normally present from 
birth. It frequently results from genetic or intrauterine 
environmental effects. A number of  conditions, including 
infections, kidney trauma, and chronic kidney disease, can 
lead to acquired renal hypoplasia (Klaus & Lange-Sperandio, 
2022). Monitoring, resolving relevant health conditions, 
and, in extreme circumstances, kidney transplantation may 
all be part of  the treatment and care process.

Renal Dysplasia
A congenital kidney developmental abnormality is 
known as renal dysplasia. It takes place when aberrant 
tissue replaces the normal kidney tissue, resulting in 
morphological and functional problems (Lemos & 
Thakker, 2020). One or both kidneys may be affected by 
this illness, which is normally present at birth; however, 
only one kidney is more frequently affected. When 
symptoms first appear in early childhood or during 
prenatal ultrasounds, renal dysplasia is frequently found.

Causes 
Environmental and genetic factors can contribute to 
renal dysplasia. An individual can be predisposed to renal 
dysplasia if  certain genes are mutated. The syndrome 
can also be influenced by environmental variables during 
pregnancy, such as maternal drug or alcohol use, infections, 
or exposure to specific toxins  (Ţarcă et al., 2021).

Pathophysiology 
The normal kidney tissue does not properly grow 
during prenatal development in renal dysplasia. Instead, 
unhealthy kidney structures are replaced by cysts and non-

functioning tissue (Gonchar et al., 2019). These cysts may 
be liquid-filled and result in kidney enlargement. Reduced 
kidney function as a result of  the disordered tissue can 
cause a number of  renal and urinary tract issues.

Clinical Features 
Renal dysplasia can manifest with a wide range of  
symptoms and clinical features. Some people may show 
no symptoms at all and get a diagnosis unintentionally 
while having medical imaging for another problem. 
High blood pressure, proteinuria (protein in the urine), 
hematuria (blood in the urine), and recurrent urinary 
tract infections are just a few of  the symptoms that some 
people may encounter as a result of  kidney failure. 

Diagnosis
A renal scan using a radiotracer can provide information 
about kidney function, and genetic testing may be considered 
in cases where there is a family history of  renal dysplasia 
or when there are other congenital anomalies (Gunther et 
al., 2023). Diagnosing renal dysplasia typically involves a 
combination of  imaging studies, such as ultrasound, CT 
scans, or MRI, to visualise the kidney’s structure.

Treatment and Management
The severity of  the condition and how it affects kidney 
function determine how to treat renal dysplasia. Regular 
monitoring and treating the accompanying symptoms 
may be adequate in moderate situations where renal 
function is largely normal. Addressing related problems, 
including high blood pressure and urinary tract infections, 
is part of  management.

Prognosis
The severity of  the abnormalities and the level of  
kidney malfunction affect the prognosis for those with 
renal dysplasia (Isert et al., 2020). Renal dysplasia CT 
scans provide crucial information on the anatomical 
and functional abnormalities inside the afflicted kidneys 
(Menon et al., 2022). The existence of  non-functioning 
cysts, which show up on a CT scan as fluid-filled sacs 
inside the kidney, is one of  the disease’s defining 
characteristics. These cysts, which have grown in the 
place of  the healthy nephrons, are unable to carry out 
crucial filtration and urine management tasks. On CT 
scans, the renal parenchyma exhibits a disorganised state 
with disrupted typical renal structures and a chaotic and 
irregular appearance. These CT results are crucial in the 
diagnosis of  renal dysplasia and give medical practitioners 
important information to develop effective therapy plans 
for people with this congenital kidney ailment.

Polycystic Kidney Disease
Cysts that develop inside the kidneys are a hallmark of  
the genetic illness known as polycystic kidney disease 
(PKD) (McConnachie et al., 2021). As these cysts grow 
and take the place of  healthy kidney tissue, structural and 
functional problems result. 



Pa
ge

 
11

1

https://journals.e-palli.com/home/index.php/ajee

Am. J. Environ Econ. 3(1) 105-115, 2024

Recent Advances
Genetic Understanding: Recent developments in genetics 
have made it possible to gain a greater understanding 
of  the PKD-causing genetic alterations. In particular, 
the discovery of  the PKD1 and PKD2 genes has shed 
light on the disease’s genetic basis (Olaizola et al., 2022). 
Gene therapy and gene editing methods are now being 
researched as potential treatments.

Targeted Therapies
Targeted therapeutics are being developed to reduce cyst 
formation and maintain renal function (Bais et al., 2022). 
These treatments could include medications that target 
particular biological pathways or mechanical methods to 
stop cyst growth.

Precision Medicine
Treatment for PKD is increasingly using the principles 
of  precision medicine (Subramanian et al., 2020). 
The effectiveness of  therapies may be increased by 
customising treatment regimens to each person’s genetic 
profile thanks to developments in genomic profiling.

Clinical Trials
Clinical trials are being conducted to evaluate the 
efficacy and safety of  various therapies, such as drugs 
and interventions that focus on particular parts of  the 
condition. Computed tomography (CT) is a medical 
imaging technique that aids in the diagnosis of  Polycystic 
Kidney Disease (PKD) by generating detailed visualisations 
of  the kidneys (Ali et al., 2023). In the context of  PKD 
diagnosis, CT scans provide a comprehensive view of  
the kidneys, enabling the identification of  multiple cysts 
that vary in size within these organs. By visualising these 
cysts, CT plays a pivotal role in confirming the diagnosis 
of  PKD, allowing healthcare professionals to assess the 
extent of  cyst formation and plan appropriate treatment 
and management strategies for affected individuals.

Renal Fusion Anomalies
Horseshoe kidneys are a congenital disorder that first 
appears during foetal development, known as renal fusion 
abnormalities (Houat et al., 2021). These defects cause the 
kidneys’ bottom poles to fuse, giving rise to a peculiar 
kidney configuration that resembles a horseshoe or a U. 
Notably, horseshoe kidneys can have rotated orientations 
and may be positioned lower in the belly than regular 
kidneys. While many people with horseshoe kidneys 
may go their entire lives without showing any symptoms, 
some may develop problems, including recurrent urinary 
tract infections, kidney stones, or ureteral blockages. 
Medical imaging, such as ultrasonography, CT scans, or 
MRI, which show the distinctive kidney horseshoe shape, 
is often used to make diagnoses (Aljabri & AlGhamdi, 
2022). For those with urinary tract issues, treatment 

options range from observation in asymptomatic 
instances to medicines, surgical interventions, or other 
procedures. Many people with horseshoe kidneys can 
live healthy, normal lives with the right medical care and 
monitoring, highlighting the significance of  resolving any 
issues to maintain kidney health and general well-being 
(Kubihal et al., 2021).

Ureteric Anomalies
The term “ureteric anomalies” refers to a variety of  
structural deviations and irregularities affecting the 
ureters, the narrow tubes that carry urine from the 
kidneys to the bladder (Arumugam et al., 2020). Kidney 
stones and tumours are just two causes of  ureteral 
obstructions, which can block urine flow and potentially 
harm the kidneys. The leakage of  urine from the 
bladder into the ureters is known as ureteral reflux, or 
vesicoureteral reflux (VUR), and it can cause recurrent 
urinary tract infections, especially in children (Köse et al., 
2020). Urinary incontinence and associated symptoms, 
which are frequently more prevalent in females, are 
caused by an ectopic ureter, another aberration that 
links to tissues outside the bladder, such as the urethra 
or vagina. For treating congenital anomalies and avoiding 
problems, early identification and adequate management 
are essential.
Computed Tomography (CT) imaging is a crucial tool 
for identifying and diagnosing ureteric anomalies, 
enabling precise diagnoses and tailored treatment plans 
(Abdelrahman & Viriri, 2023). Three such anomalies 
include ureteropelvic junction obstruction (UPJ 
obstruction), ureterocele, and duplex collecting systems. 
UPJ obstruction, a narrowing or blockage at the ureter-
renal pelvis connection, can be accurately assessed 
using CT scans, providing a detailed understanding 
of  its location and extent (Maffi & Lima, 2019). CT 
imaging also clearly visualises the ureterocele’s size and 
relationship with the bladder, guiding treatment decisions. 
In duplex collecting systems, CT scans are essential 
for assessing the anatomical arrangement, identifying 
potential complications, and formulating comprehensive 
management strategies. CT imaging’s high-resolution, 
cross-sectional views of  the abdominal and pelvic regions 
ensure accurate diagnosis and characterisation of  ureteric 
anomalies, ensuring individuals receive appropriate and 
effective care (Dunn et al., 2019).

Strengths and Limitations of  CT
Table 3 below summarises the key strengths of  radiological 
CT assessment for diagnosing congenital renal anomalies 
(CRAs). These strengths include high spatial resolution, 
rapid image acquisition, contrast enhancement capabilities 
and 3D reconstruction, offering significant advantages 
for accurate and efficient evaluation of  CRAs, ultimately 
leading to improved patient care.



Pa
ge

 
11

2

https://journals.e-palli.com/home/index.php/ajee

Am. J. Environ Econ. 3(1) 105-115, 2024

Table 3: Strengths of  Radiological CT Assessment for Congenital Renal Anomalies
Strengths Description Benefits of  Diagnosing CRAs
High Spatial 
Resolution

CT scans produce detailed, well-
defined images of  the kidneys.

Allows for precise visualisation of  kidney structures 
and identification of  even subtle abnormalities.

Rapid Image 
Acquisition

CT scans can be completed quickly. Enables speedy evaluation in emergencies, critical for 
prompt diagnosis and care.

Contrast-
Enhanced CT

Contrast material can be used to highlight 
specific structures or abnormalities.

Useful for evaluating vascular anomalies (blood vessel 
issues) and blood flow (perfusion) within the kidneys.

3D CT 
Reconstruction

Specialised software creates 3D 
models from CT scan data.

Provides a comprehensive view and surrounding 
structures from various angles, improving anatomical 
understanding and aiding in surgical planning.

Table 4: Limitations of  CT Scan for Renal Evaluation
Limitations Description Impact on CRA Diagnosis
Ionising 
Radiation 
Exposure

CT scans utilise ionising radiation, which can 
damage cells and potentially increase cancer 
risk, particularly in more sensitive children.

Raises concerns about safety, especially for 
repeated scans or use in pediatric patients. May 
necessitate modalities for certain individuals.

Limited 
Functional 
Information

CT scans primarily provide anatomical 
details. While they can visualise structural 
abnormalities, they may not offer detailed 
information about kidney function compared 
to modalities like MRI.

May require additional tests, such as renal 
function scans, to assess overall kidney health 
alongside structural evaluation.

Contrast Media 
Risks

Contrast agents used in CT scans cause allergic 
reactions in some patients, ranging from mild 
to severe. 

May necessitate pre-scan screening for allergies 
and close monitoring during the procedure. In 
some cases, alternative contrast agents or imaging 
techniques may be needed. 

Table 4 below outlines the limitations of  CT scans for 
evaluating the kidneys, particularly in the context of  
diagnosing congenital renal anomalies (CRAs).

Comparison with Other Imaging Modalities
Table 5 below offers a comparative analysis of  Computed 

Tomography (CT) and Magnetic Resonance Imaging 
(MRI) scans, highlighting their features in the context 
of  diagnosing congenital renal anomalies (CRAs). While 
both modalities are valuable tools, understanding their 
distinct characteristics is crucial for selecting the most 
suitable imaging technique for each patient.

Table 5: Comparison between CT and MRI
Feature CT Scan MRI
Imaging 
Technique

Uses X-rays to form detailed cross-sectional 
images of  the body.

Uses magnetic field and radio waves to 
generate detailed images.

Contrast 
Resolution

Most suitable for visualising bone and 
calcifications due to high-density contrast.

Superior soft tissue contrast, making it ideal 
for differentiating between tissues like cysts 
and solid masses.

Benefits of  CRA 
Diagnosis

Detects minor anatomical abnormalities (e.g., 
small lesions, kidney structure details)

Differentiate between different kidney tissues, 
identifying subtle changes

Imaging Speed Faster scan times, beneficial for patients who may 
have difficulty remaining still during imaging.

Slower scan times may be challenging for patients 
with claustrophobia or movement disorders.

Cost Generally less expensive Generally more expensive
Detection 
of  Vascular 
Anomalies

Limited in detecting subtle vascular 
abnormalities compared to MRI angiography 
techniques.

Superior in detecting vascular anomalies and 
assessing renal blood flow with techniques like 
MR angiography.

Functional 
Evaluation

Limited ability to assess renal function directly, 
often requires additional tests like contrast-
enhanced CT or nuclear medicine tests.

Can provide functional information through 
techniques like diffusion-weighted imaging 
and dynamic contrast-enhanced MRI.



Pa
ge

 
11

3

https://journals.e-palli.com/home/index.php/ajee

Am. J. Environ Econ. 3(1) 105-115, 2024

Table 6 presents a comparison of  CT and Ultrasound for 
evaluating CRAs. Understanding these differences can 
help determine the most suitable imaging modality for 
each patient.

Future Directions
Advancements in CT technology, such as lower-dose 
protocols and dual-energy techniques, will continue to 
improve the safety and diagnostic accuracy of  radiological 
CT assessment for congenital renal anomalies. Future 
research should focus on refining image post-processing 
techniques, incorporating artificial intelligence algorithms 
for automated anomaly detection, and establishing 
standardised reporting guidelines to enhance clinical 
decision-making and patient outcomes.

CONCLUSION
In conclusion, radiological CT assessment is an 
indispensable component in the diagnosis and 
management of  congenital renal anomalies. Its unique 
ability to provide detailed anatomical information 
complements other imaging modalities, ensuring 
comprehensive evaluation and optimal patient care. 
However, efforts should be made to minimise radiation 
exposure and further integrate innovative techniques to 
improve diagnostic capabilities continually.

List of  Abbreviations
Computed Tomography (CT)
Congenital Renal Anomalies (CRAs) 
Intravenous Pyelography (IVP)
Ureteropelvic Junction (UPJ)
Multi-detector CT (MDCT)
Dual-Energy CT (DECT) 

Artificial Intelligence (AI)
Magnetic Resonance Imaging (MRI)
Polycystic Kidney Disease (PKD)
Vesicoureteral Reflux (VUR)

REFERENCES
Abdelrahman, A., & Viriri, S. (2023). FPN-SE-ResNet 

Model for Accurate Diagnosis of  Kidney Tumors 
Using CT Images. Applied Sciences, 13(17), 9802. 

Ali, H., Naim, M., Senum, S. R., AlSahow, A., Bahbahani, 
Y., Abu-Farha, M., Abubaker, J., Mohammad, A., Al-
Hunayan, A., & Asbeutah, A. M. (2023). The genetic 
landscape of  autosomal dominant polycystic kidney 
disease in Kuwait. Clinical Kidney Journal, 16(2), 355-
366. 

Aljabri, M., & AlGhamdi, M. (2022). A review on the use 
of  deep learning for medical images segmentation. 
Neurocomputing, 487, 34-56. 

Alnazer, I., Bourdon, P., Urruty, T., Falou, O., Khalil, 
M., Shahin, A., & Fernandez-Maloigne, C. (2021). 
Recent advances in medical image processing for the 
evaluation of  chronic kidney disease. Medical Image 
Analysis, 69, 101960. 

Arumugam, S., Subbiah, N. K., & Senthiappan, A. M. 
(2020). Double ureter: incidence, types, and its applied 
significance—a cadaveric study. Cureus, 12(4). 

Bais, T., Gansevoort, R. T., & Meijer, E. (2022). Drugs 
in clinical development to treat autosomal dominant 
polycystic kidney disease. Drugs, 82(10), 1095-1115. 

Dunn, E. A., Kasprenski, M., Facciola, J., Benz, K., Maruf, 
M., Zaman, M. H., Gearhart, J., Di Carlo, H., & Tekes, 
A. (2019). Anatomy of  classic bladder exstrophy: 
MRI findings and surgical correlation. Current urology 
reports, 20, 1-7. 

Table 6: Comparison between CT and Ultrasound for Diagnosing Congenital Renal Anomalies
Feature CT Scan Ultrasound
Imaging 
Technique

Uses X-rays to create detailed cross-sectional 
images of  the body.

Uses high-frequency sound waves to 
generate real-time images.

Contrast 
Resolution

Suitable for visualising bone and calcification due 
to high-density contrast.

Limited soft tissue contrast, may not 
differentiate between tissues as effectively 
as CT or MRI.

Benefits of  CRA 
Diagnosis

Excellent for detecting anatomical abnormalities, 
and visualising small structures.

Useful for initial evaluation, detecting 
hydronephrosis (kidney swelling), and 
assessing blood flow.

Imaging Speed Faster scan times, beneficial for patients who have 
difficulty remaining still during the imaging process.

Real-time imaging allows for dynamic 
assessment of  renal structures and function.

Cost Generally more expensive. Generally less expensive.
Detection 
of  Vascular 
Anomalies

Limited in detecting subtle vascular abnormalities 
compared to MRI angiography techniques.

Limited in evaluating vascular structures 
compared to CT or MRI angiography.

Functional 
Evaluation

Limited ability to assess renal function directly, 
often requires additional tests like contrast-
enhanced CT or nuclear medicine scans.

Limited ability to assess renal function 
directly but can provide functional 
information through techniques like 
Doppler ultrasound.



Pa
ge

 
11

4

https://journals.e-palli.com/home/index.php/ajee

Am. J. Environ Econ. 3(1) 105-115, 2024

Elgarba, B. M., Van Aelst, S., Swaity, A., Morgan, N., 
Shujaat, S., & Jacobs, R. (2023). Deep learning-based 
segmentation of  dental implants on cone-beam 
computed tomography images: A validation study. 
Journal of  Dentistry, 137, 104639. 

Gonchar, M., Alenina, I., & Omelchenko, O. (2019). 
Differentiated diagnosis of  inflammatory kidney 
diseases in children: recommendations for students. 

Gore, J. C. (2020). Artificial intelligence in medical imaging. In 
(Vol. 68, pp. A1-A4): Elsevier.

Gunther, K., Imseis, E. M., Samuel, J. P., Hillman, E. 
A., Ojala, T. H., Jahnukainen, T., & Hillman, P. R. 
(2023). Renal‐hepatic‐pancreatic dysplasia type 2: 
Perinatal lethal condition or a multisystemic disorder 
with variable expressivity. Molecular Genetics & Genomic 
Medicine, 11(7), e2135.  

Han, X., Xu, K., Taratula, O., & Farsad, K. (2019). 
Applications of  nanoparticles in biomedical imaging. 
Nanoscale, 11(3), 799-819. 

Houat, A. P., Guimarães, C. T., Takahashi, M. S., Rodi, 
G. P., Gasparetto, T. P., Blasbalg, R., & Velloni, F. G. 
(2021). Congenital anomalies of  the upper urinary 
tract: a comprehensive review. Radiographics, 41(2), 
462-486. 

Howlett, D. C., Drinkwater, K. J., Mahmood, N., Illes, J., 
Griffin, J., & Javaid, K. (2020). Radiology reporting of  
osteoporotic vertebral fragility fractures on computed 
tomography studies: results of  a UK national audit. 
European Radiology, 30, 4713-4723. 

Huang, L., Han, R., Ai, T., Yu, P., Kang, H., Tao, Q., & 
Xia, L. (2020). Serial quantitative chest CT assessment 
of  COVID-19: a deep learning approach. Radiology: 
Cardiothoracic Imaging, 2(2), e200075. 

Isert, S., Müller, D., & Thumfart, J. (2020). Factors 
associated with the development of  chronic kidney 
disease in children with congenital anomalies of  the 
kidney and urinary tract. Frontiers in Pediatrics, 8, 298. 

Jain, S., & Chen, F. (2019). Developmental pathology of  
congenital kidney and urinary tract anomalies. Clinical 
Kidney Journal, 12(3), 382-399. 

Jayaprakasan, K., & Ojha, K. (2022). Diagnosis 
of  congenital uterine abnormalities: practical 
considerations. Journal of  clinical medicine, 11(5), 1251. 

Jelin, A. (2021). Renal agenesis. American Journal of  
Obstetrics & Gynecology, 225(5), B28-B30. 

Jung, H. (2021). Basic physical principles and clinical 
applications of  computed tomography. Progress in 
Medical Physics, 32(1), 1-17. 

Khalid, H., Hussain, M., Al Ghamdi, M. A., Khalid, T., 
Khalid, K., Khan, M. A., Fatima, K., Masood, K., 
Almotiri, S. H., & Farooq, M. S. (2020). A comparative 
systematic literature review on knee bone reports 
from mri, x-rays and ct scans using deep learning and 
machine learning methodologies. Diagnostics, 10(8), 518. 

Kitzler, T. M., & Chun, J. (2023). Understanding the 
Current Landscape of  Kidney Disease in Canada to 
Advance Precision Medicine Guided Personalized 
Care. Canadian Journal of  Kidney Health and Disease, 10, 

20543581231154185. 
Klaus, R., & Lange-Sperandio, B. (2022). Chronic 

Kidney Disease in Boys with Posterior Urethral 
Valves–Pathogenesis, Prognosis and Management. 
Biomedicines, 10(8), 1894. 

Köse, T., Özgür, S., Coşgun, E., Keskinoğlu, A., & 
Keskinoğlu, P. (2020). Effect of  missing data 
imputation on deep learning prediction performance 
for vesicoureteral reflux and recurrent urinary tract 
infection clinical study. BioMed Research International, 
2020. 

Kubihal, V., Razik, A., Sharma, S., & Das, C. J. (2021). 
Unveiling the confusion in renal fusion anomalies: 
role of  imaging. Abdominal Radiology, 46, 4254-4265. 

Lemos, M. C., & Thakker, R. V. (2020). 
Hypoparathyroidism, deafness, and renal dysplasia 
syndrome: 20 Years after the identification of  the 
first GATA3 mutations. Human Mutation, 41(8), 1341-
1350. 

Maffi, M., & Lima, M. (2019). Congenital ureteropelvic 
junction obstruction. In Neonatal surgery: Contemporary 
strategies from fetal life to the first year of  age (pp. 515-525). 
Publisher. 

McConnachie, D. J., Stow, J. L., & Mallett, A. J. (2021). 
Ciliopathies and the kidney: a review. American Journal 
of  Kidney Diseases, 77(3), 410-419. 

Menon, J., Shanmugam, N., Vij, M., Rammohan, A., 
& Rela, M. (2022). Multidisciplinary management 
of  Alagille syndrome. Journal of  Multidisciplinary 
Healthcare, 353-364. 

Olaizola, P., Rodrigues, P. M., Caballero-Camino, F. J., 
Izquierdo-Sanchez, L., Aspichueta, P., Bujanda, L., 
Larusso, N. F., Drenth, J. P., Perugorria, M. J., & 
Banales, J. M. (2022). Genetics, pathobiology and 
therapeutic opportunities of  polycystic liver disease. 
Nature Reviews Gastroenterology & Hepatology, 19(9), 
585-604. 

Palma, P. L., Sessa, A. D., Passaro, A. P., Palladino, E., 
Furcolo, G., Barlabà, A., Rivetti, G., Lucia, M. D., 
Miraglia del Giudice, E., & Guarino, S. (2023). 
Effects of  Lockdown for COVID-19 Pandemic on 
Chronic Kidney Disease Progression in Children with 
Congenital Anomalies of  the Kidney and Urinary 
Tract: A Retrospective Pilot Study. Children, 10(1), 123. 

Raina, R., Chakraborty, R., Sethi, S. K., Kumar, D., 
Gibson, K., & Bergmann, C. (2021). Diagnosis and 
management of  renal cystic disease of  the newborn: 
core curriculum 2021. American Journal of  Kidney 
Diseases, 78(1), 125-141. 

Sodickson, A. D., Keraliya, A., Czakowski, B., Primak, A., 
Wortman, J., & Uyeda, J. W. (2021). Dual energy CT 
in clinical routine: how it works and how it adds value. 
Emergency Radiology, 28, 103-117. 

Subramanian, M., Wojtusciszyn, A., Favre, L., 
Boughorbel, S., Shan, J., Letaief, K. B., Pitteloud, N., 
& Chouchane, L. (2020). Precision medicine in the 
era of  artificial intelligence: implications in chronic 
disease management. Journal of  translational medicine, 



Pa
ge

 
11

5

https://journals.e-palli.com/home/index.php/ajee

Am. J. Environ Econ. 3(1) 105-115, 2024

18(1), 1-12. 
Ţarcă, E., Roșu, S. T., Cojocaru, E., Trandafir, L., Luca, A. 

C., Rusu, D., & Ţarcă, V. (2021). Socio-epidemiological 
factors with negative impact on infant morbidity, 
mortality rates, and the occurrence of  birth defects. 
Healthcare, 9(3), Article 123.  

Ugurlucan, F. G., Dural, O., Yasa, C., Kirpinar, G., & 
Akhan, S. E. (2020). Diagnosis, management, and 
outcome of  obstructed hemivagina and ipsilateral 
renal agenesis (OHVIRA syndrome): Is there a 

correlation between MRI findings and outcome? 
Clinical imaging, 59(2), 172-178. 

Usanase, N., Uzun, B., Ozsahin, D. U., & Ozsahin, 
I. (2023). A look at radiation detectors and their 
applications in medical imaging. Japanese Journal of  
Radiology, 1-13. 

Yanase, J., & Triantaphyllou, E. (2019). A systematic 
survey of  computer-aided diagnosis in medicine: 
Past and present developments. Expert Systems with 
Applications, 138, 112821.


