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Urinary Disorders

Remove kidney or not

09/26/2008

Question:

I (female) was just diagnosed at age 47 with severe (left kidney) unilateral hydronephrosis (non functioning at 11%) while rt kidney is normal 89% (all due to congenital UPJ). Back pain`s dull, not severe, abd. mass rec. noticed, worsening fatigue, pale. It`s pressing on stomach, aorta, spleen, pancrease but all these show ok on ct scan. nml. bld work, nml kidney fx., pain not bad at all, but I don`t feel good in general, (nurse) slowing me down. (SOB/stairs,sweaty w/exurtion) healthy in past, ht 5`3,wt 113 no other health issues known) but not sig. tests except bmp, cbc, ct of abd, tried uretal stent, did not help was removed, also had retrograde pylegram & split kidney nuclear scan.

Should the kidney come out?

Answer:

You seem to have a poorly functioning hydronephrotic left kidney. You mention that your CBC and renal labs are OK and your pain is not significant. I assume that the renal scan confirms the diagnosis of UPJ obstruction. It is difficult to know whether your general symptoms (SOB/stairs,sweaty w/exertion) are related to the left kidney (usually not typical for a UPJ obstruction) with overall normal renal function. You also mention that a ureter stent did not help (I assume you are referring to your symptoms). Given this situation it is possible that your general symptoms might not respond to removal of the left kidney. I would suggest that you rule out other causes for these symptoms (medical, cardiac) before assuming that they are due to the left kidney. Once this has been done, then u can discuss the options for the left kidney with your urologist, which could be repair versus nephrectomy.

I have attempted to answer your query based on the information from your mail. You can discuss this further with your urologist who can make a recommendation based on all your imaging studies and clinical findings/situation.

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Response by:

Krishnanath  Gaitonde, MD Krishnanath Gaitonde, MD
Assistant Professor of Clinical Urology
College of Medicine
University of Cincinnati