Incidental finding of abnormal renal ultrasound (13)

A 47 year old man recently had an ultrasound scan, and the report stated: right kidney could not be identified in the renal bed or right pelvic region. Left kidney =16.6cm, presumably due to compensatory hypertrophy. The left kidney appears normal in echopattern with no hydronephrosis or renal calculi. 

He is not aware of having had his kidney removed. The scan was requested as he had a dull ache in both renal angles and abdominal bloating.  He still gets a dull ache over his right loin a couple of times per week, lasting a few hours.  He does not need to take analgesia for this discomfort.  No aggravating factors.  He wonders himself if he could have pulled a muscle as he works delivering food.  He sometimes feels pulling in right groin when he bends forward.

Does he need any kind of follow up with regards to having 1 kidney, such as regular blood tests to check his kidney function?

 What further information would you seek before giving your opinion?

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Results of investigations are as follows;

Bloods: FBC and U+Es normal

 BP: 148/87

We discussed lifestyle advice regarding his blood pressure, as he is not keen to start medication.  I have arranged to repeat the blood pressure reading in 2 months and if still elevated commence him on amlodipine.

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This man just needs sensible attention to general healthcare and cardiovascular risk.

Single kidneys are common and, as in this case, the opposite one compensates for the loss of the other.  He will almost undoubtedly do well but probably should know that anything else that comes along in the next few decades that injures kidneys e.g. worsening hypertension, diabetes, NSAIDS,etc should probably be looked at with care and attention.

I would treat his hypertension as you are doing and repeat his bloods perhaps yearly as you might do for anyone with hypertension.


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