Unilateral total renal dysplasia in children

Giant hydronephrosis presenting as unilateral iliofemoral vein thrombosis

We report a case of left iliofemoral vein thrombosis with extension to the inferior vena cava associated with giant right hydronephrosis secondary to ureteropelvic junction obstruction. Surgery revealed marked infrarenal vena caval compression and deviation to the left side caused by the dilated right renal pelvis, with resultant kinking of the origin of the left iliac vein. It is postulated that the reduction in blood flow caused by this compression and distortion predisposed this patient to venous thrombosis.

Renal cell carcinoma originating from dysplastic kidney

A case of renal cell carcinoma developing from a unilateral dysplastic kidney is presented. The patient was a 33-year-old woman who had lumbago one year and a half prior to death. Multiple abnormal uptakes of 67Ga were seen by scintigraphy. Bone marrow biopsy indicated adenocarcinoma but the primary site was unknown despite extensive examination. At autopsy the carcinoma was wide-spread but no obvious primary-appearing lesion was detected in all the organs except the left kidney. Incidentally the patient had unilateral (left) renal dysplasia. An elaborate study revealed the primary site of the carcinoma within the cystic structure of the dysplastic kidney. This tumor showed reactivity with Dolichos biflorus agglutinin associated antigen (DBA-Ag), soybean agglutinin (SBA), and peanut agglutinin (PNA) which have reactivity with renal tubules.

Correction of congenital hydronephrosis in utero III. Early mid-trimester ureteral obstruction produces renal dysplasia

Is the renal dysplasia (RD) commonly seen in babies with urinary tract obstruction a developmental consequence of the obstruction or is it an associated embryologic malformation? We produced complete unilateral ureteral obstruction in six 58- to 66-day old lamb fetuses by clipping a silastic ring on the ureter. Three fetuses survived to term. All obstructed kidneys were not only grossly hydronephrotic but dysplastic by histologic criteria; ie, parenchymal disorganization, primitive epithelial structures, and marked fibrosis. The contralateral unobstructed control kidneys were normal. The changes were similar to those seen in the human neonate with obstruction and RD, suggesting that in this model RD was caused by obstruction to the flow of urine early in fetal development.

Renal ultrasound in the neonatal period

Ultrasound was used for imaging the kidneys in 55 neonates. The normal kidney in a neonate is characterized by prominent medulla and fetal lobulation, the main renal vessels are frequently demonstrated. Of 29 infants with normal kidneys by ultrasound, 4 had renal disease (3 acute tubular necrosis, one partial renal artery thrombosis) and one had a pelvic kidney. In 24 infants congenital abnormalities or acquired renal disease was diagnosed. Multicystic dysplastic kidney and hydronephrosis were the most frequently observed abnormalities. Polycystic kidneys at the early stage (both adult type and infantile) appeared as enlarged hyperechoic kidneys. In 2 neonates the kidneys were normal but they had adrenal mass lesions.

Diagnostic puncture in renal cystic dysplasia (multicystic kidney). Evidence on the aetiology of the cysts

Five cases of cystic dysplastic (multicystic) kidney occurring in infancy are described, in whom diagnostic puncture was used to confirm the suspected diagnosis. The characteristic finding on contrast injection was that the cystic spaces communicated via tubular structures, presumably nephronic, so ruling out the possibility of hydronephrosis. This finding also supports the view that cysts in multicystic kidney derive from nephrons and are not due to dilated calices. Although urography and ultrasonography both give appearances highly suggestive of multicystic kidney, the appearances on renal puncture are pathognomonic. When such appearances are demonstrated there is no urgent need for operative removal, except when necessitated by the size of the mass.

Renal dysplasia with sacral-perineal location

We report a case of renal dysplasia associated with a large non-renal lumbosacral and perineal mass. A huge sacral-perineal mass and malformation of the scrotum and penis were noted at birth. The mass was thought to be a lumbosacral teratoma. The patient also suffered from respiratory distress and he died 5 days after birth. At autopsy 2 small dysplastic kidneys were found. The kidneys and the sacral mass showed the same histological features of typical renal dysplasia.

Congenital renal dysplasia: Osathanondh-Potter type ii polycystic kidneys

Congenital renal dysplasia represents a group of nonhereditary kidney malformations frequently encountered in infants and children. The dysplasia may involve one or both kidneys totally or segmentally. The clinical presentation and prognosis depend on the extent of renal involvement and further development of the dysplastic renal tissue as well as the severity of coexisting malformations in other organs. The unifying factor in each instance is the characteristic histologic appearance of the dysplastic renal tissue. Congenital multicystic kidney and multilocular renal cyst are the best known members of the group. Radiologic features in conjunction with the clinical picture can suggest the correct diagnosis in most cases.