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Urinary and Genital Disorders (Children)

Enlarged kidneys

04/29/2008

Question:

At twenty weeks of pregnancy, my son was diagnosed with an enlarged left kidney. At the time, it was three times larger than the right. It was monitored regularly through the pregnancy and remained enlarged. The right kidney was also enlarged. Since birth, he had an ultrasound at three days and they said it was at 38mm. He has then had a DSMA scan and three scans where the dye is injected and he is scanned for half an hour. These were done at different hospitals. One hospital was concerned, as they believd that the kidney was not fully functioning and could be causing pressure on the other organs, where as the other said that it was functioning and doing just under half of the work. I asked if the trimethoprim could then be stopped only to be told that the urine was not flushing out properly and it was still needed. My son is now 18 months and he has just been for another ultrasound which has unnerved us as we thought he would be discharged from what the consultant had said, only to be told of the man doing the scan that even in an abnormal kidney, it is abnormally large and it is taking up the majority of the left side. Should I be worried and what are the possibilities?

Answer:

It sounds like your son has significant hydronephrosis, and could have an underlying ureteropelvic junction obstruction, between the ureter and renal pelvis. The scan information is a little confusing. Usually the MAG-3 diuretic renogram is the appropriate test, and it provides information on function between the two kidneys (normally each contributes 50% to overall renal function) and drainage (normally half of the injected material drains out of the kidney within 15-20 minutes of injection of Lasix). A DMSA scan only provides information on comparative function of each kidney. I think that it is important that families have the opportunity to look at the studies with the physician. He should be evaluated by a pediatric urologist, who should provide a clear explanation of what the problem is and whether surgery is necessary.

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Response by:

Jack S Elder, MD, FACS, FAAP Jack S Elder, MD, FACS, FAAP
Clinical Professor of Urology
School of Medicine
Case Western Reserve University