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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Unilateral cysts as an incidental finding (14)

A 79 year old gentleman had an abdominal ultrasound scan due to the incidental finding of abnormal LFTS.  This was reported to show slightly increased echogenicity of the liver in keeping with fatty infiltration.  He was also noted to have small, simple cortical cysts, with the largest measuring 36mm by 31mm, in his left kidney.  The visualised pancreas, aorta, right kidney, gall bladder and biliary tree all appeared normal and the spleen measured 9.8 cm, which was also normal.

The reason I write is to establish whether any further action is required regarding his cysts in his left kidney or whether in fact they can be ignored as they are not causing him any symptoms at present and should be viewed as an incidental finding only?

 What further information would you seek before giving your opinion?

See more of the history or available results?

Results of investigations are as follows;

 Blood – Urea 7 / Creatinine 102 / eGFR >60 / Electrolytes within normal ranges

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This should be viewed as an incidental finding and you can essentially just ignore the result.  It is not an uncommon finding and not expected to give rise to any symptoms or indicate an adverse renal prognosis.  Of note, complex cysts can indicate malignancy but this is not what is being described here.


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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?

See more of the history or available results?

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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