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Kidney Diseases

Kidney enlargement

10/11/2006

Question:

My nephew is 18 years old and as a young boy had frequent urinary infections. These were never properly explained. He recently had to be taken to hospital with severe pain in his right side and back. Despite being told this was atypical of appendicitis, he was submitted to theater for an appendectomy. Since the operation, the original pain is still there, he has had to have a catheter inserted to drain urine (as he is unable to urinate himself) and an ultrasound has shown an enlarged right kidney. I have been told by the consultant treating him that the enlarged kidney is most probably a side effect of the appendectomy and no further investigation is required. I am extremely unhappy with this conclusion and would like to ask how likely is it that his inability to pass urine and the enlarged kidney are side-effects of the appendectomy? The removed appendix was described as "slightly inflamed". Since the operation, he has complained of pain spreading to his left side, occasional pain in his groin and is now running a fever. Reading the information on this site leads me to believe that a CT scan is the very least they should be performing.

Answer:

Although I am not a pediatric kidney specialist and cannot give a definitive answer, it sounds like your nephew may have been born with a disorder called "posterior urethral valves."  In this condition there is an abnormality in the way the urethra (the tube that runs through the penis) connects with the bladder.  This results in enlargement of the bladder and backup of urine into the kidneys, which can result in enlargement/dilation of one or both kidneys, infection of the kidneys, and even kidney failure.  The blockage in urine flow out of the bladder can be treated temporarily with a catheter, and ultimately may be corrected by surgery.

You are absolutely correct that a simple appendectomy does not result in kidney enlargement and inability to pass urine.  In fact, the opposite may occur, that an infection in the right kidney and bladder may cause inflammation in nearby structures such as the appendix. 

In any case, the most important thing is for your nephew to be seen immediately (TODAY!) by a physician.  He sounds like he has an infection in the right kidney, which has spread via the bladder to the left kidney.  He will need blood tests, cultures of the urine and blood, and treatment (probably via IV) with appropriate antibiotics, and most likely will need to be admitted to the hospital.  A CT scan may provide some information, but probably not much more than the ultrasound already has.  Cystoscopy (examination of the bladder with a lighted, flexible, fiberoptic tube inserted through the urethra) can provide the definitive diagnosis.  However, the most important thing right now is for him to have his kidney infection diagnosed and properly treated before it spreads to his bloodstream and/or causes permanent kidney damage.  Good luck, and I would appreciate hearing from you as to how things turn out for him.

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Response by:

Mildred   Lam, MD Mildred Lam, MD
Associate Professor of Medicine
School of Medicine
Case Western Reserve University