Incidental finding of a small scarred kidney (15)

A 60 year old lady has recently been found to have a small scarred right kidney.  This was discovered incidentally when having an abdominal ultrasound scan to investigate slightly deranged LFTs.  Her left kidney is normal.

The scan was arranged by the dermatologists who have been seeing her because of intermittent facial swelling since June 2008.  They think she has angioedema and have started her on various antihistamines.  Other PMH includes self-limiting sarcoidosis, fibromyalgia, hypothyroidism and hypercholesterolaemia, which is well controlled on a statin.

Should I be arranging any more tests on her and if so, which?

What further information would you seek before giving your opinion?

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Results of investigations are as follows;

Blood – Urea 4.2 / Creatinine 82 / eGFR >60,

Urinalysis normal – ACR 2.9.

Last BP 108/60.  No history of hypertension.

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The answer is simple – do nothing.  This is almost undoubtedly the end-stage of a chronic process, quite possibly childhood reflux.  Her left kidney has compensated for the loss of the right without any obvious harm in that her creatinine is normal, she’s not hypertensive and she has no proteinuria.

As she’s managing on only one kidney you need to be vigilant in case of later development of problems such as hypertension, diabetes etc, but at this stage I’d reassure her that she’s done very well, has a relatively common complaint and should not be alarmed.


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