Expert: Dr Graham Smith - 10/20/2009

Question
Dear Sir,
my nephew Andrea is 3,5 y old.He had antenatal hydronephrosis at his L kidney.
1m old reflux gr 4. He was put on ceclor for 2,5years.
12m old Reflux GR 2, DMSA R kidney function 30% and smaller size, L 70% function.
3y old Radionuclide retrograde urography-no reflux.
At this point we changed pediatrician for convenience reasons and he was worried for this 33% and smaller size.He suggested  Ultrasound(we could not find the first one)and MAG-3.
Ultrasound:both kidneys in normal position. L kidney at lower limit of normal in size(length 6,5 cm, a-p:2,3cm, transverse: 1,8cm ), with thinning of parenchyma, normal echogenicity and extrarenal pelvis with small dilatation(a-p diam 14mm).R kidney larger, (length  8cm, ap:3,3cm, transv: 2,8cm), bladder normal,renal arteries, nor flow, no sign of stenosis (RI R kidney: 0,68  L: 0,69).
MAG-3: L kidney smaller size,and paler. function R: 64%, L: 36%,
TTP: R=2,5 min, L=2,5 min .
There is normal pelvis imaging in the begging but as the investigation proceeds there is small stasis of urine at the pelvices bilaterally that responds excellently to the diuretic. In the end both kidneys show adequate capacity to remove urine.
T1/2: R=6,9 min  L=5,9 min
Clearance MaG-3:total=127ml/min/1,73m2
               R=70
               L=56
He has never had a urinary tract infection.He is growing normaly and blood tests done 6m ago showed normal urea, creatinine and creatinine clearance(I do not have the values).
Do we need to do something more? Is he a candidate for surgery?
Thank you for your time and advice.
Maraia


Answer
The results are a bit confusing as first DMSA scan shows left kidney with more function than the right while later MAG3 is exact opposite. From what you say, it is likely that one kidney was always a bit small and that there is nothing more to do, other than just keeping a check on blood pressure. I normally recommend an annual check.