Can the opposite kidney findings be a warning for “losing ground” in infants under 1 year of age with unilateral hydronephrosis?
M Hüseyinov*, R Özcan*, Ş Emre*, N Canpolat**, H Sayman***, S Kuruğoğlu****, M Eliçevik*, Y Söylet*, SNC Büyükünal*, H Emir*
*Istanbul University Cerrahpasa Medical Faculty Department of Pediatric Surgery Division of Pediatric Urology
**İstanbul University, Cerrahpasa Medical Faculty, Department of Pediatric Nephrology
***İstanbul University Cerrahpaşa Medical Faculty, Department of Nucleer Medicine
****Istanbul University Cerrahpasa Medical Faculty, Department of Radiology
Aim: To assess the
changes in normal opposite kidney in patients followed up for unilateral
hydronephrosis and to investigate its association with dysfunction of affected
kidney.Patients and Method:
Records of patients younger than 1 year of age admitted to our clinic between
2005 and 2016 and diagnosed with ureteropelvic junction obstruction (UJO) were
reviewed retrospectively. Patients’ ultrasonographic and scintigraphic findings
for kidneys with UJO and normal opposite kidneys were compared. Findings: 111 patients
in total were included in the study. Compensatory hypertrophy was developed in
the healthy kidneys of 31 patients in the preoperative period. Compensatory hypertrophy was found to be
associated with low function and/or reduced perfusion in the unhealthy kidney
in 24 (74%) of these patients. 18 out of these 24 patients had mild hydronephrosis
(PAP:5-14mm) present before compensation in their kidneys with compensatory
hypertrophy. Mild hydronephrosis developed at a mean age of 3.2 months (range 1
- 8 months) and compensatory hypertrophy progressed at a mean age of 6 months
(range 2 – 12 months). The average time from development of mild hydronephrosis
on healthy side to surgery was 7 months (range 2 – 13 months).Deterioration in function and perfusion capability of the unhealthy
kidney was present in the preoperative period in 7 patients out of these 18,
who developed minimal hydronephrosis and compensatory hypertrophy. In 2 of the
other patients, although no functional changes occurred due to mild
hydronephrosis, function of the kidney reduced by 10% at the end of follow-up,
while deterioration of perfusion was present 3 patients. Renal functions of
these 18 patients continued to decrease also in the postoperative period, and
the perfusion capabilities of 5 patients whose functions did not change were
reduced.
Results: In our study, mild
hydronephrosis and compensatory hypertrophy developing in the healthy kidney of
patients followed up for unilateral hydronephrosis was found to be associated
with “losing ground” in affected kidney. Identifying mild hydronephrosis
detected in normal kidney 4 months prior surgery decision, which is a finding
that has not yet been defined in the literature, was evaluated as an early
symptom of deterioration in the affected kidney. Comprehensive studies are
needed on this subject.
Keywords: