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Education - Case Histories |
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| F X Keeley and H B Joshi |
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| A 32-year-old female first presented in 1992 with a pyonephrosis in the upper moiety of a right sided duplex kidney. Investigation confirmed a non-functioning upper moiety but the lower moiety was fairly healthy and provided the patient with most of her renal function. A renogram revealed that her left kidney was in fact hypoplastic and only contributed about 20% of her overall renal function. Originally, treatment was to have been to drain the pyonephrosis in the upper moiety of the right kidney and then to carry out a partial nephrectomy. However, it became clear during surgery that the blood supply of the lower moiety was not especially distinct from the upper moiety. It would have been risky to attempt to remove the upper moiety without risking the blood supply of the lower moiety. Therefore, a large tube drain was inserted into the upper moiety renal pelvis which drained it for about 6 weeks. The drainage from this gradually dried up and the tube drain was removed. The patient remained fit and well with no more problems (including 2 successful pregnancies) until last year when she developed a number of urinary tract infections. A repeat IVU showed that she had grown a staghorn calculus in the lower moiety of the right kidney that was previously stone free. She also appeared to have a couple of calculi in the upper moiety of the duplex on the right while the left kidney was unchanged. |
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