Category 2: 29 subjects with different renal issues (obstructive nephropathy, bilateral nephropathy, hydronephrosis, reduced or non-function kidney, and/or atrophic kidney
Repeat renal function tests were normal, but renal Doppler on review after the treatment of 10 days was suggestive of right atrophic kidney
. Baby was discharged on anti-hypertensives and enoxaparin with plan to continue and taper off over next 6 months.
(2) It is important to recognize that the apparently absent kidney on MRI does not entirely exclude the possible presence of a small and/or atrophic kidney
The usual indications are calculus disease, chronic infections, obstruction, trauma, dysplastic / atrophic kidney
or renovascular hypertension due to the renal artery stenosis or severe unilateral parenchymal damage from nephrocalcinosis, pyelonephritis, reflux or congenital dysplasia.2 Nowadays laparoscopic nephrectomy has replaced the open procedures, especially in the developed world.3,4 But in a developing country like ours, in many centres, most of the nephrectomies are still being performed by open surgical techniques.
This 70-year-old diabetic Cree woman presented to a community urologist with chronic recurrent bacterial urinary tract infections and was referred to our tertiary stone centre for PCNL of her "staghorn stone" in the left atrophic kidney
. A review of her medical records showed that she was treated for pulmonary TB at the age of 40, with a 1-year course of isoniazid, ethambutol, and streptomycin, and was kept in a sanitarium for some time.
(1) The atrophic kidney
exhibits segmental loss of parenchyma due to renal scarring, and compensatory hypertrophy in the remnant parenchyma.
In our study, we demonstrate for the first time that unilateral renal artery stenosis (RAS) also leads to a significant increase in the AGE levels both in the plasma and in the clipped atrophic kidney
. Moreover, increased concentration of AGE becomes tightly associated with increased level of 4-hydroxynonenal (4-HNE), a known marker of oxidative stress .
Indications for nephrectomy included chronic pyelonephritis in 2 (13.3%) patients, hydronephrotic atrophy due to ureteropelvic junction obstruction in 2 (13.3%) patients, calculous kidney with chronic pyelonephritis in 3 (20%) patients, renal vascular hypertension in 1 (6.6%) patient, atrophic kidney
in 3 (20%) patients, and protracted loin pain in non-functioning kidney in 4 (26.6%) patients.
Other detected anomalies were: bladder outlet obstruction 15 (12.8%), echogenic kidneys 13 (11.1%), ectopic ureteral implantation 2 (1.7%), renal cysts 1 (0.8%), pelvic kidney 3 (2.6%), double collecting system 1 (0.8%), and unilateral atrophic kidney
The weight reduction, in spite of the presence of cysts and their content, is due to the fact that cysts develop not from a normal kidney but from a severely atrophic kidney
associated with ESRD.
Upon exploration, the left atrophic kidney
was found with excessive dilated ureter at the right side, just superior to the bladder.
In the setting of only mild hydronephrosis and the absence of atrophic kidneys
, potentially reversible causes of kidney disease must be sought after in children with seemingly advanced CKD.