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The unilateral small kidney with special reference to the hypoplastic kidney

Review of the literature and authors' points of view


In connection with the publication of two papers on the clinical features and on the functional pattern in our material of patients with renal hypoplasia, an effort has been made to review the literature dealing with this condition. The frequency of unilateral small kidneys has been found to be about one in 500 autopsies. A kidney may be small because of congenital hypoplasia or pyelonephritic shrinkage or as a combination of both. The hypoplastic kidney is probably predisposed to infections. There are principally two kinds of hypoplastic kidneys: those with remnants of embryological development and those without. Kidneys without remnants of embryological development contain as a rule few calyces but may otherwise be of normal shape and of ordinary microscopical appearance. Primitive ducts and cartilage have been considered to be definite signs of embryological misdevelopment. Colloid cysts resembling thyroid tissue may probably be found both in hypoplastic kidneys without superimposed infections and in atrophic kidneys due to pyelonephritis. Radiologically the hypoplastic kidneys may be found to contain few calyces and the minor calyces may arise directly from the pelvis. The contralateral kidney is often enlarged. Good excretion of contrast medium favours the diagnosis of hypoplasia and makes pyelonephritic shrinkage less plausible. The artery of the hypoplastic kidney is described to be uniformly narrow in its whole length, while in pyelonephritis the mouth of the artery (the point where the renal artery arises from the aorta) has as a rule normal width, although the rest of the artery may be narrow. Split function tests have shown a good concentrating ability in hypoplasia in relation to the reduction in glomerular filtration rate, especially when compared with that in chronic pyelonephritis. Local pain, hypertension and urinary tract infections are common manifestations in renal hypoplasia. Blood pressure may be normalized after nephrectomy. Hypertension seems to be the most dangerous feature. If the blood pressure can be satisfactorily controlled, the prognosis in unilateral renal hypoplasia seems to be rather good.

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  1. 1.

    Allen, A. C.: The Kidney. Medical and Surgical Disease. Grune & Stratton, New York, 1961.

    Google Scholar 

  2. 2.

    Arnold, J. H.: A clinico-histologic consideration of renal malformations.J. Urol. (Baltimore) 84, 510 (1960).

    Google Scholar 

  3. 3.

    Ask-Upmark, E.: Über juvenile maligne Nephrosklerose und ihr Verhältnis zu Störungen in der Nierenentwicklung.Acta path. microbiol. scand. 6, 383 (1929).

    Google Scholar 

  4. 4.

    Baggenstoss, A. H.: Congenital anomalies of the kidney.Med. Clin. N. Amer. 35, 987 (1951).

    Google Scholar 

  5. 5.

    Bailey, R. R., Little, P. J., Rolleston, G. L.: Renal damage after acute pyelonephritis.Brit. med. J., 1, 550 (1969).

    PubMed  Google Scholar 

  6. 6.

    Batzenschlager, A., Blum, E., Mme Weill-Bousson, M.: Le petit rein unilatéral (Étude anatomo-clinique). I: Petit rein unilatéral acquis.Ann. Anat. path. 7, 427 (1962).

    Google Scholar 

  7. 6a.

    Le petit rein unilatéral (Étude anatomo-clinique). II: Petit rein unilatéral congénital.Ann. Anat. path. 7, 539 (1962).

    Google Scholar 

  8. 7.

    Bell, E. T.: Renal Disease. Lea & Febigar, Philadelphia 1947.

    Google Scholar 

  9. 8.

    Bengtsson, C., Falkheden, T., Hansson, L., Hood, B.: Renal hypoplasia. Clinical features and survival.Scand. J. Urol. Nephrol. 4 117 (1970).

    PubMed  Google Scholar 

  10. 9.

    Bengtsson, U., Högdahl, A.-M., Hood, B.: Chronic non-obstructive pyelonephritis and hypertension: a long-term study.Quart. J. Med. 37, 361 (1968).

    PubMed  Google Scholar 

  11. 10.

    Bigler, J. A., Killingsworth, W. P.: Cartilage in the kidney.Arch. Path. 47, 487 (1949).

    Google Scholar 

  12. 11.

    Boeminghaus, H.: Nierenhypoplasie und Hochdruck.Z. Urol. 51, 323 (1958).

    PubMed  Google Scholar 

  13. 12.

    Boissonnat, P.: What to call hypoplastic kidney?Arch. Dis. Childh. 37, 142 (1962).

    PubMed  Google Scholar 

  14. 13.

    Brod, J.: Chronic pyelonephritis.Lancet I, 973 (1956).

    Google Scholar 

  15. 14.

    Brun, C., Raaschou, F.: Percutaneous renal biopsy in pyelonephritis. In: CIBA Foundation Symposium on Renal Biopsy. Clinical and Pathological Significance, J. & A. Churchill Ltd., London, 1961.

    Google Scholar 

  16. 15.

    Buenger, R. E.: Renal arteriography.Med. Clin. N. Amer. 51, 47 (1967).

    PubMed  Google Scholar 

  17. 16.

    Burkland, C. E.: Clinical considerations in aplasia, hypoplasia and atrophy of the kidney.J. Urol. (Baltimore) 71, 1 (1954).

    Google Scholar 

  18. 17.

    Butler, A. M.: Chronic pyelonephritis and arterial hypertension.J. clin. Invest. 16, 889 (1937).

    Google Scholar 

  19. 18.

    Eichenberger, H.: Nierenhypogenese und renale Hypertonie. Inaug. Diss. Zürich, 1950.

  20. 19.

    Eisendrath, D. N.: Clinical importance of congenital renal hypoplasia.J. Urol. (Baltimore) 33, 331 (1935).

    Google Scholar 

  21. 20.

    Ekström, T.: Renal hypoplasia. A clinical study of 179 cases.Acta chir. scand. Suppl. 203 (1955).

  22. 21.

    Emmett, J. L., Alvarez-Ierena, J. J., McDonald, J. R.: Atrophic pyelonephritis versus congenital renal hypoplasia.J. Amer. med. Ass. 148, 1470 (1952).

    Google Scholar 

  23. 22.

    Eriksson, N. O., Ivemark, B. I.: Renal dysplasia and pyelonephritis in infants and children. Part I.Arch. Path. 66, 255 (1958).

    Google Scholar 

  24. 22a.

    Renal dysplasia and pyelonephritis in infants and children. Part II: Primitive ductules and abnormal glomeruli.Arch. Path. 66, 264 (1958).

  25. 23.

    Fahr, T.: Über pyelonephritische Schrumpfniere und hypogenetische Nephritis.Virchows Arch. path. Anat. 301, 140 (1938).

    Google Scholar 

  26. 24.

    Gifford, R. W., McCormack, L. J., Poutasse, E. F.: The atrophic kidney: its role in hypertension.Mayo Clin. Proc. 40, 834 (1965).

    PubMed  Google Scholar 

  27. 25.

    Hamburger, J., Richet, G., Crosnier, J., Funck-Brentano, J. L., Antoine, B., Ducrot, H., Mery, J. P., de Montera, H.: Nephrology. W. B. Saunders Company, Philadelphia, London, Toronto, 1968.

    Google Scholar 

  28. 26.

    Hamilton, W. J., Boyd, J. D., Mossman, H. W.: Human Embryology. W. Heffer & Sons Ltd., Cambridge, 1962.

    Google Scholar 

  29. 27.

    Haschek, H., Schimatzek, A.: Die kleine Niere.Z. Urol. 59, 203 (1966).

    Google Scholar 

  30. 28.

    Hodson, C. J.: The radiological contribution toward the diagnosis of chronic pyelonephritis.Radiology 88, 857 (1967).

    PubMed  Google Scholar 

  31. 29.

    Hodson, C. J., Craven, J. D.: The radiology of obstructive atrophy of the kidney.Clin. Radiol. 17, 305 (1966).

    PubMed  Google Scholar 

  32. 30.

    Hodson, C. J., Wilson, S.: Natural history of chronic pyelonephritic scarring.Brit. med. J. 2, 191 (1965).

    Google Scholar 

  33. 31.

    Hood, B., Bengtsson, C., Falkheden, T., Hollender, A.: The functional pattern of the hypoplastic kidney.Scand. J. Urol. Nephrol., 2, 95 (1968).

    PubMed  Google Scholar 

  34. 32.

    Howard, J. E., Connor, T. B., Thomas, W. C., Jr.: A functional test for detection of hypertension produced by one kidney. Preliminary studies.Trans. Ass. Amer. Phycns. 69, 291 (1956).

    Google Scholar 

  35. 33.

    Howard, J. E., Connor, T. B.: Use of differential renal function studies in the diagnosis of renovascular hypertension.Amer. J. Surg. 107, 58 (1964).

    PubMed  Google Scholar 

  36. 34.

    Johnson, M. C., Wayman, B. T.: Congenital hypoplasia and secondary atrophy of the kidney.Urol. cut. Rev., 40, 841 (1936).

    Google Scholar 

  37. 35.

    Kanasawa, M., Moller, J., Good, R. A. Vernier, R. L.: Dwarfed kidneys in children. The classification, etiology and significance of bilateral small kidneys in 11 children.Amer. J. Dis. Child. 109, 130 (1965).

    PubMed  Google Scholar 

  38. 36.

    Kato, T., Tanabe, Y., Shiraishi, T., Fukushige, M., Shimada, T., Kazuta, M., Ogawa, M., Tanaka, H.: Statistical studies on malformations of the kidney, renal pelvis and ureter.Acta urol. jap. (Kyoto) 12, 349 (1966).

    Google Scholar 

  39. 37.

    Kissane, J. H.: Congenital malformations. In: Pathology of the Kidney. Little, Brown and Company, Boston, 1966.

    Google Scholar 

  40. 38.

    Mathé, C. P.: The diminutive kidney. Congenital hypoplasia and atrophic pyelonephritis.Calif. Med., 84, 110 (1956).

    PubMed  Google Scholar 

  41. 39.

    Meine, J. L.: Die einseitigen Schrumpfnieren. Häufigkeit, Nosologie und Beziehungen zur Hypertonie. Statistische Untersuchungen an 10000 Sektionen.Schweiz. med. Wschr. 95, 799 (1965).

    PubMed  Google Scholar 

  42. 40.

    Michel, J. R., de Montera, H., Plainfossé, M. C.: La radiologie dans les hypoplasies rénales partielles.Ann. Radiol. 10, 21 (1967).

    Google Scholar 

  43. 41.

    Michie, A. J., Michie, C. R.: Kidney function in unilateral pyelonephritis. I: Clinical data.Amer. J. Med. 22, 179 (1957).

    PubMed  Google Scholar 

  44. 42.

    Michie, A. J., Michie, C. R., Ragni, M. C.: Kidney function in unilateral pyelonephritis. II: Physiologic interpretations.Amer. J. Med. 22, 190 (1957).

    PubMed  Google Scholar 

  45. 43.

    Moëll, H.: Kidney size and its deviation from normal in acute renal failure. A roentgendiagnostic study.Acta radiol. (Stockh) Suppl. 206 (1961).

  46. 44.

    Mozzioconacci, P., Attal, C., Boisse, J., Pham-Huu Trung, M. T., Guy-Grand, D., Durand, C.: Hypoplasie segmentaire du rein avec hypertension artérielle.Ann. Pédiat. 44, 1405 (1968).

    Google Scholar 

  47. 45.

    Munck, O.: Radioisotope renography versus Howard test in renovascular hypertension.Scand. J. clin. Lab. Invest. 22, 4 (1968).

    PubMed  Google Scholar 

  48. 46.

    Murgia, A.: Le ipoplasie renali.Osped. Ital-Chir. 6, 237 (1962).

    Google Scholar 

  49. 47.

    Obeditsch-Mayer, I.: Ein Beitrag zur Frage der Nierenhypoplasie.Verh. dtsch. Ges. Path. 40, 187 (1956).

    Google Scholar 

  50. 48.

    Ognibene, A. J.: Congenital hypoplasia of the kidney.N. Y. St. J. Med. 63, 3415 (1963).

    Google Scholar 

  51. 49.

    Oliver, J.: Nephrons and kidneys. Harper & Row, New York, Evanston and London, 1968.

    Google Scholar 

  52. 50.

    Örsten, P. Å.: Asymmetry of renal function with special reference to chronic pyelonephritis.Acta med. scand. Suppl. 447 (1966).

  53. 51.

    Persky, L., Izant, R., Bolande, R.: Renal dysplasia.J. Urol. (Baltimore) 98, 431 (1967).

    Google Scholar 

  54. 52.

    Pickering, G.: Congenital hypoplasia of a kidney. In: High Blood Pressure. J. & A. Churchill Ltd., London, 1968.

    Google Scholar 

  55. 53.

    Raaschou, F.: Dissociation between glomerular and tubular renal function in cases of pyelonephritis.Acta med. scand. 114, 414 (1943).

    Google Scholar 

  56. 54.

    Royer, P.: Renal hypoplasia. In: Nephrology. W. B. Saunders Company, Philadelphia, London, Toronto, 1968.

    Google Scholar 

  57. 55.

    Schiøler, M., Pedersen, A., Baunøe, B., Hansen, P. F.: Sygdomme i nyrer og nyrekar hos 205 patienter med hypertension.Ugeskr. Laeg. 125, 1509 (1963).

    PubMed  Google Scholar 

  58. 56.

    Sjövall, E.: Über die anatomischen Formen der Nephrosclerose.Acta med. scand. 65, 484 (1927).

    Google Scholar 

  59. 57.

    Smith, H. W.: Unilateral nephrectomy in hypertensive disease.J. Urol. (Baltimore) 76, 685 (1956).

    Google Scholar 

  60. 58.

    Templeton, A. W., Thompson, I. M.: Aortographic differentiation of congenital and acquired small kidneys.Arch. Surg. 97, 114 (1968).

    PubMed  Google Scholar 

  61. 59.

    Vourinen, P.: Anomalies and malformations of the upper urinary tract detected at intravenous urography in a series of 2000 patients.Ann. Chir. Gynaec. Fenn. 50, 407 (1961).

    PubMed  Google Scholar 

  62. 60.

    Weiss, S., Parker, F. Jr.: Relation of pyelonephritis and other urinary-tract infections to arterial hypertension.New Engl. J. Med. 223, 959 (1940).

    Google Scholar 

  63. 61.

    Zollinger, H. U.: Pathogenese und Folgen einseitiger Zwergnieren bei Jugendlichen. Frühinfantile Pyelonephritis oder Hypogenese?Schweiz. med. Wschr. 87, 990 (1957).

    PubMed  Google Scholar 

  64. 61a.

    Differentialdiagnose der Schrumpfnieren.Path. et Microbiol. (Basel). 24, 258 (1961).

  65. 61b.

    Differentialdiagnose der Schrumpfnieren.Deutsch. med. Wschr. 87, 2457 (1962).

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Bengtsson, C., Hood, B. The unilateral small kidney with special reference to the hypoplastic kidney. International Urology and Nephrology 3, 337–351 (1971).

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  • Renal Artery
  • Pyelonephritis
  • Thyroid Tissue
  • Split Function
  • Contralateral Kidney