Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Nephrol. Jan 25, 2022; 11(1): 30-38
Published online Jan 25, 2022. doi: 10.5527/wjn.v11.i1.30
Unilateral hypoplastic kidney in adults: An experience of a tertiary-level urology center
Rabea Ahmed Gadelkareem, Nasreldin Mohammed
Rabea Ahmed Gadelkareem, Nasreldin Mohammed, Department of Urology, Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
Author contributions: Gadelkareem RA designed the research, searched and collected the data, and wrote the paper; Mohammed N contributed to study design and manuscript writing and revision, and supervised the work; both authors approved the paper.
Institutional review board statement: This study was approved on November 25, 2021 by the Medical Ethics Committee of the Faculty of Medicine, Assiut University, Egypt as a topic in a research project titled "Experience of a tertiary-level urology center in the clinical urological events of rare and very rare incidence: a retrospective research project." The institutional review board number is 17300684.
Informed consent statement: This article is a retrospective one with only descriptive anonymous data. Patients were not required to give informed consent to the study because the manipulated data were anonymous and were obtained after each patient agreed to treatment by consent.
Conflict-of-interest statement: The authors have no financial relationships to disclose.
Data sharing statement: No additional data are available. All the processed data are included in the study.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Rabea Ahmed Gadelkareem, MD, Associate Professor, Department of Urology, Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Elgamaa Street, Assiut 71515, Egypt. dr.rabeagad@yahoo.com
Received: March 26, 2021
Peer-review started: March 26, 2021
First decision: July 31, 2021
Revised: August 7, 2021
Accepted: December 21, 2021
Article in press: December 21, 2021
Published online: January 25, 2022
Processing time: 299 Days and 12.2 Hours
Abstract
BACKGROUND

Unilateral small-sized kidney is a radiological term referring to both the congenital and acquired causes of reduced kidney volume. However, the hypoplastic kidney may have peculiar clinical and radiological characterizations.

AIM

To evaluate the clinical presentations, complications, and management approaches of the radiologically diagnosed unilateral hypoplastic kidney.

METHODS

A retrospective review of the records of patients with a radiological diagnosis of unilateral hypoplastic kidney between July 2015 and June 2020 was done at Assiut Urology and Nephrology Hospital, Assiut University, Egypt.

RESULTS

A total of 33 cases were diagnosed to have unilateral hypoplastic kidney with a mean (range) age of 39.5 ± 11.2 (19-73) years. The main clinical presentation was loin pain (51.5%), stone passer (9.1%), anuria (12.1%), accidental discovery (15.2%), or manifestations of urinary tract infections (12.1%). Computed tomography was the most useful tool for radiological diagnosis. However, radioisotope scanning could be requested for verification of surgical interventions and nephrectomy decisions. Urolithiasis occurred in 23 (69.7%) cases and pyuria was detected in 22 (66.7%) cases where the infection was documented by culture and sensitivity test in 19 cases. While the non-complicated cases were managed by assurance only (12.1%), nephrectomy (15.2%) was performed for persistent complications. However, symptomatic (27.3%) and endoscopic (45.6%) approaches were used for the management of correctable complications.

CONCLUSION

Unilateral hypoplastic kidney in adults has various complications that range from urinary tract infections to death from septicemia. Diagnosis is mainly radiological and management is usually conservative or minimally invasive.

Keywords: Congenital anomalies; Hypoplastic kidney; Kidney size; Small sized kidney; Solitary kidney; Urolithiasis

Core Tip: The study reviewed the clinical characteristics, complications, and management of the unilateral hypoplastic kidney in adults. The various clinical presentations are due to the different complications including urolithiasis, obstruction, urinary tract infections (UTIs), and life-threatening morbidities such as anuria and septicemia. Renal radioisotope scanning is indicated for cases with sizable kidneys, verification of the decision of surgical intervention, and patient preference. Conservative and endoscopic approaches should be tried first for the management of complications. However, laparoscopic nephrectomy is recommended for the treatment of persistent complications such as hypertension and recurrent UTIs or urolithiasis.