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Forum Name: Urology Topics

Question: grossly hydronephrotic right kidney


 lookin4me4eva - Sun Aug 01, 2010 4:38 pm

i have been told my right kidney is grossly hydronephrotic with the renal pelvis measuring 13cm. this kidney does not function. my GFR is 57% but was 47% when i got admitted to hospital. i also have a large mass palpable in right upper quadrant. i am waiting for appt with the renal consultant but have a few questions i would like answering asap.
will the most likely remove this kidney as its not working?
if the liquid collected in the kidney leek could it poison my body?
is this a serious issue/

many thanks

Nikki
 Dr.M.Aroon kamath - Thu Aug 12, 2010 4:57 am

User avatar Hi,
You seem to imply that you have a unilateral severe hydronephrosis (and that the other kidney is mormal). Although in the young adults, urinary stone disease is the most common cause of hydronephrosis, congenital pelviureteric junction obstruction also may present in these individuals.

You indicate that your GFR is 57%. Is it possible that you actually mean
57mL/min/ m2?

Or is the percentage based on radioisotope scanning (split renal function)?

Classification of severity of chronic kidney disease based on the GFR is as follows.

Normal kidney function – GFR above 90mL/min/1.73m2 and no proteinuria
1) CKD1 – GFR above 90mL/min/1.73m2 with evidence of kidney damage
2) CKD2 (Mild) – GFR of 60 to 89 mL/min/1.73m2 with evidence of kidney damage
3) CKD3 (Moderate) – GFR of 30 to 59 mL/min/1.73m2
4) CKD4 (Severe) – GFR of 15 to 29 mL/min/1.73m2
5) CKD5 Kidney failure - GFR less than 15 mL/min/1.73m2 Some people add CKD5D
For most patients, a GFR over 60 mL/min/1.73m2 is considered adequate.

The degree of recovery of renal function of the obstructed kidney following relief of obstruction depends on the severity and duration of obstruction and also the presence of any co-existing infection.

The most important information required for formulating definitive treatment plan in these cases are
- the cause of the obstruction and

- the recovery potential of the obstructed kidney.

If the kidney is so badly damaged that no significant function (the commonly used cutoff point would be <10% of the total function) can be salvaged, the best management may be a simple nephrectomy rather than any lengthy corrective procedure. Thus, in order to make the appropriate management plan, urologists need to know the recovery potential of obstructed kidneys

Many investigational techniques have been used to assess this potential. Commonly used ones include
- ultrasound measurement of renal cortical thickness,
- ultrasound measurement of renal parenchymal volume(has limited repeatability and accuracy),
- radioisotope renography (split renal function study),
- the use of non-contrast helical computerized tomography(for the measurement of renal parenchymal volume) has demonstrated in some studies, to have a reasonable correlation to the differential creatinine clearance),
- renal volume measurement on magnetic resonance (MR) images by using the voxel-count method, and
- quantitative Analysis of functional renal volume using Gadolinium-enhanced MR Angiography.

In your case, before deciding on removing your hydronephrotic kidney, some of these tests need to be done to find out the recovery potential.
Best wishes!

.

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