Robert L. Lebowitz, M.D. Children' s Hospital, Harvard Medical School Boston, Massachusetts

8 1/2-month-old baby boy whose prenatal ultrasonography showed left hydronephrosis. Ultrasonography after delivery showed a normal right kidney and a small, but otherwise normal-appearing left kidney. (Figure 1) (Figure 2) A VCUG showed a left duplex kidney with grade 3 upper pole reflux and grade 4 lower pole reflux. (Figure 3) DMSA renal scan showed that 73% of the uptake was on the right, 24% in the upper pole of the left, and 3% in the lower pole of the left. (Figure 4) He underwent left lower pole nephroureterectomy and left upper pole cross-trigonal reimplant. The post-op IVP showed a nice cross-trigonal tunnel. (Figure 5)

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