Search

On the basis of previous studies in rats, and clinical observations in human renal transplantation and in patients with a renal duplication anomaly, we have postulated two distinct types of renal growth. Compensatory growth is caused by a nephron deficit, while obligatory growth is part of the normal process of growing into adulthood. The former is reversible, and the latter is not. A definitive test of this hypothesis required the transplantation of extra kidneys into baby rats and comparison of their growth with that of normal litter-mate controls. This showed that there is little if any retardation of obligatory renal growth in spite of the presence of an excess of kidneys in the baby.

Delineation of the presence and anatomy of an obstructed, nonfunctioning upper-pole duplex system often requires multiple imaging techniques. Computed tomography (CT) was used to evaluate duplex systems in five adult patients. Independent of renal function, CT allowed assessment of the presence of a duplex system, determination of whether the system was obstructed, assessment of the quantity of residual parenchyma in the upper-pole system, determination of whether the ectopic ureter was intravesical or extravesical, and assessment of the retroperitoneum to look for unusual causes of upper-pole ureteral obstruction.

Neonatal adrenal hemorrhage can usually be diagnosed on excretory urography without resorting to surgical exploration or invasive diagnostic procedures. In the typical case an avascular mass is seen between the liver and kidney. A case is presented in which a vascular rim surrounded the avascular mass, giving an appearance similar to that of an obstructed upper pole renal duplication. This early vascular rim, not as well known as the calcified rim which develops days to weeks after the acute hemorrhage, is probably created by compression and displacement of adrenal tissue by the central hemorrhage.

The rare finding of lower pole ureteropelvic junction obstruction and incomplete renal duplication is discussed in 5 children. The children were divided into 2 groups, with short (less than 0.5 cm.) and long (greater than 4 cm.) lower ureteral segments. Short ureteral segment obstruction was managed by total excision of the narrow ureteral segment and end-to-side pyeloureterostomy. Obstructions associated with long lower ureteral segments were treated by excising the ureteropelvic junction and performing a standard Anderson-Hynes pyeloplasty. A thorough preoperative evaluation is helpful for successful management.

Renal duplication with a nonfunctioning hydronephrotic segment may lead to diagnostic difficulty and misinterpretation as tumor or cyst. Selective renal arteriography is an important adjunct to the diagnosis in such cases. The finding of a deficient arterial supply and a poor nephrogram phase in an area with no visible collecting system should suggest the diagnosis.

SUMMARY A case of bilateral complete duplication of kidneys and ureters in a child is described. She presented with enuresis since infancy, and this disappeared following removal of the upper part of the right kidney together with its related pelvis and ureter and the control of the E. coli infection with chloramphenicol. It is seven months since operation but too early to consider her cured. In this child intravenous pyelography and cystoscopy did not show the exact type of anomaly.

Renal duplication is not an uncommon anomaly of the urinary tract. However, we report a case in which the occurrence of incomplete duplication of a large lower pole, with an unusual side-by-side orientation of the lower pole segments, delayed recognition of the clinically troublesome ipsilateral upper pole duplication.

Herein is reported a case in which congenital ureteropelvic obstruction was complicated by renal duplication. A dismembered pyeloplasty requiring two anastomoses was performed.

This case report is presented in order to emphasize the necessity of careful and complete evaluation of the urinary tract of children with the complaint of enuresis. While most often this problem resolves itself into one of psychogenic origin, this diagnosis must not be made until organic etiology has been ruled out. One of the frequent causes of this symptom in the female is ureteral ectopia, the diagnosis of which may be so elusive as to require prolonged, persistent effort before it can be demonstrated. Grieve and Thomson ' report a case of bilateral renal duplication with incontinence and provide a review of the literature pertaining to this condition. Campbell 2 gives the over-all incidence of ureteral ectopia, as determined from autopsies of children, as about 1 in 1,900, occurring three to four times as often in females as in males. Since the ectopic orifice always lies superior to sphincteric control