Abstract
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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References
Allen, A. C.: The Kidney. Medical and Surgical Disease. Grune & Stratton, New York, 1961.
Arnold, J. H.: A clinico-histologic consideration of renal malformations.J. Urol. (Baltimore) 84, 510 (1960).
Ask-Upmark, E.: Über juvenile maligne Nephrosklerose und ihr Verhältnis zu Störungen in der Nierenentwicklung.Acta path. microbiol. scand. 6, 383 (1929).
Baggenstoss, A. H.: Congenital anomalies of the kidney.Med. Clin. N. Amer. 35, 987 (1951).
Bailey, R. R., Little, P. J., Rolleston, G. L.: Renal damage after acute pyelonephritis.Brit. med. J., 1, 550 (1969).
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).
Le petit rein unilatéral (Étude anatomo-clinique). II: Petit rein unilatéral congénital.Ann. Anat. path. 7, 539 (1962).
Bell, E. T.: Renal Disease. Lea & Febigar, Philadelphia 1947.
Bengtsson, C., Falkheden, T., Hansson, L., Hood, B.: Renal hypoplasia. Clinical features and survival.Scand. J. Urol. Nephrol. 4 117 (1970).
Bengtsson, U., Högdahl, A.-M., Hood, B.: Chronic non-obstructive pyelonephritis and hypertension: a long-term study.Quart. J. Med. 37, 361 (1968).
Bigler, J. A., Killingsworth, W. P.: Cartilage in the kidney.Arch. Path. 47, 487 (1949).
Boeminghaus, H.: Nierenhypoplasie und Hochdruck.Z. Urol. 51, 323 (1958).
Boissonnat, P.: What to call hypoplastic kidney?Arch. Dis. Childh. 37, 142 (1962).
Brod, J.: Chronic pyelonephritis.Lancet I, 973 (1956).
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.
Buenger, R. E.: Renal arteriography.Med. Clin. N. Amer. 51, 47 (1967).
Burkland, C. E.: Clinical considerations in aplasia, hypoplasia and atrophy of the kidney.J. Urol. (Baltimore) 71, 1 (1954).
Butler, A. M.: Chronic pyelonephritis and arterial hypertension.J. clin. Invest. 16, 889 (1937).
Eichenberger, H.: Nierenhypogenese und renale Hypertonie. Inaug. Diss. Zürich, 1950.
Eisendrath, D. N.: Clinical importance of congenital renal hypoplasia.J. Urol. (Baltimore) 33, 331 (1935).
Ekström, T.: Renal hypoplasia. A clinical study of 179 cases.Acta chir. scand. Suppl. 203 (1955).
Emmett, J. L., Alvarez-Ierena, J. J., McDonald, J. R.: Atrophic pyelonephritis versus congenital renal hypoplasia.J. Amer. med. Ass. 148, 1470 (1952).
Eriksson, N. O., Ivemark, B. I.: Renal dysplasia and pyelonephritis in infants and children. Part I.Arch. Path. 66, 255 (1958).
Renal dysplasia and pyelonephritis in infants and children. Part II: Primitive ductules and abnormal glomeruli.Arch. Path. 66, 264 (1958).
Fahr, T.: Über pyelonephritische Schrumpfniere und hypogenetische Nephritis.Virchows Arch. path. Anat. 301, 140 (1938).
Gifford, R. W., McCormack, L. J., Poutasse, E. F.: The atrophic kidney: its role in hypertension.Mayo Clin. Proc. 40, 834 (1965).
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.
Hamilton, W. J., Boyd, J. D., Mossman, H. W.: Human Embryology. W. Heffer & Sons Ltd., Cambridge, 1962.
Haschek, H., Schimatzek, A.: Die kleine Niere.Z. Urol. 59, 203 (1966).
Hodson, C. J.: The radiological contribution toward the diagnosis of chronic pyelonephritis.Radiology 88, 857 (1967).
Hodson, C. J., Craven, J. D.: The radiology of obstructive atrophy of the kidney.Clin. Radiol. 17, 305 (1966).
Hodson, C. J., Wilson, S.: Natural history of chronic pyelonephritic scarring.Brit. med. J. 2, 191 (1965).
Hood, B., Bengtsson, C., Falkheden, T., Hollender, A.: The functional pattern of the hypoplastic kidney.Scand. J. Urol. Nephrol., 2, 95 (1968).
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).
Howard, J. E., Connor, T. B.: Use of differential renal function studies in the diagnosis of renovascular hypertension.Amer. J. Surg. 107, 58 (1964).
Johnson, M. C., Wayman, B. T.: Congenital hypoplasia and secondary atrophy of the kidney.Urol. cut. Rev., 40, 841 (1936).
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).
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).
Kissane, J. H.: Congenital malformations. In: Pathology of the Kidney. Little, Brown and Company, Boston, 1966.
Mathé, C. P.: The diminutive kidney. Congenital hypoplasia and atrophic pyelonephritis.Calif. Med., 84, 110 (1956).
Meine, J. L.: Die einseitigen Schrumpfnieren. Häufigkeit, Nosologie und Beziehungen zur Hypertonie. Statistische Untersuchungen an 10000 Sektionen.Schweiz. med. Wschr. 95, 799 (1965).
Michel, J. R., de Montera, H., Plainfossé, M. C.: La radiologie dans les hypoplasies rénales partielles.Ann. Radiol. 10, 21 (1967).
Michie, A. J., Michie, C. R.: Kidney function in unilateral pyelonephritis. I: Clinical data.Amer. J. Med. 22, 179 (1957).
Michie, A. J., Michie, C. R., Ragni, M. C.: Kidney function in unilateral pyelonephritis. II: Physiologic interpretations.Amer. J. Med. 22, 190 (1957).
Moëll, H.: Kidney size and its deviation from normal in acute renal failure. A roentgendiagnostic study.Acta radiol. (Stockh) Suppl. 206 (1961).
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).
Munck, O.: Radioisotope renography versus Howard test in renovascular hypertension.Scand. J. clin. Lab. Invest. 22, 4 (1968).
Murgia, A.: Le ipoplasie renali.Osped. Ital-Chir. 6, 237 (1962).
Obeditsch-Mayer, I.: Ein Beitrag zur Frage der Nierenhypoplasie.Verh. dtsch. Ges. Path. 40, 187 (1956).
Ognibene, A. J.: Congenital hypoplasia of the kidney.N. Y. St. J. Med. 63, 3415 (1963).
Oliver, J.: Nephrons and kidneys. Harper & Row, New York, Evanston and London, 1968.
Örsten, P. Å.: Asymmetry of renal function with special reference to chronic pyelonephritis.Acta med. scand. Suppl. 447 (1966).
Persky, L., Izant, R., Bolande, R.: Renal dysplasia.J. Urol. (Baltimore) 98, 431 (1967).
Pickering, G.: Congenital hypoplasia of a kidney. In: High Blood Pressure. J. & A. Churchill Ltd., London, 1968.
Raaschou, F.: Dissociation between glomerular and tubular renal function in cases of pyelonephritis.Acta med. scand. 114, 414 (1943).
Royer, P.: Renal hypoplasia. In: Nephrology. W. B. Saunders Company, Philadelphia, London, Toronto, 1968.
Schiøler, M., Pedersen, A., Baunøe, B., Hansen, P. F.: Sygdomme i nyrer og nyrekar hos 205 patienter med hypertension.Ugeskr. Laeg. 125, 1509 (1963).
Sjövall, E.: Über die anatomischen Formen der Nephrosclerose.Acta med. scand. 65, 484 (1927).
Smith, H. W.: Unilateral nephrectomy in hypertensive disease.J. Urol. (Baltimore) 76, 685 (1956).
Templeton, A. W., Thompson, I. M.: Aortographic differentiation of congenital and acquired small kidneys.Arch. Surg. 97, 114 (1968).
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).
Weiss, S., Parker, F. Jr.: Relation of pyelonephritis and other urinary-tract infections to arterial hypertension.New Engl. J. Med. 223, 959 (1940).
Zollinger, H. U.: Pathogenese und Folgen einseitiger Zwergnieren bei Jugendlichen. Frühinfantile Pyelonephritis oder Hypogenese?Schweiz. med. Wschr. 87, 990 (1957).
Differentialdiagnose der Schrumpfnieren.Path. et Microbiol. (Basel). 24, 258 (1961).
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). https://doi.org/10.1007/BF02082282
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DOI: https://doi.org/10.1007/BF02082282