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If the kidney is small in size should it be removed?

Answered by: Vijay Kher
Consultant Nephrologist
Indraprastha Apollo Hospital
New Delhi

Q. I am a 29 years old girl. I used to have headache off and on, but never bothered about it until one day in the office I had severe headache and giddiness. I was immediately rushed to a hospital where my blood pressure was found to be 230/110 and was diagnosed with hypertension and also brain haemorrhage. Following this I had mild paralytic attack on my right side. After two months I recovered completely and the doctor advised me BP medication. Though now even after 3 months I feel my right leg weaker than the left leg. On latest BP checkup my BP was found to be 160/110 with medication. I also had undergone renal angiography and DTPA scan for right renal function. Doctor’s observation was as follows: The right kidney is small. It shows poor perfusion and poor cortical uptake. There is drainage of tracer into bladder. The left kidney appears enlarged. It shows good perfusion, good cortical uptake, normal intra-cortical transit time and good drainage of tracer into bladder. The differential renal function is Right kidney-27% and Left kidney-73%. Impression: Small right kidney with poor function. Enlarged left kidney with good function. In view of this, please advise me whether I should go for right kidney removal.

A.  You have a small kidney with poor function. Since you have undergone a renal angiography also, I guess the right and left renal arteries are normal, though you have not provided me these details. The causes for right small kidney with poor function are either a small dysplastic kidney you may have been born with or chronic pyelonephritis of right kidney which can be confirmed by a DMSA scan, done the same way as DTPA scan. The third cause could be renal artery narrowing which should have been picked up by renal angiography if present. The treatment is to keep BP under control with antihypertensive medicines. You also need to get 24 hour urine protein estimated.

A.  You have a small kidney with poor function. Since you have undergone a renal angiography also, I guess the right and left renal arteries are normal, though you have not provided me these details. The causes for right small kidney with poor function are either a small dysplastic kidney you may have been born with or chronic pyelonephritis of right kidney which can be confirmed by a DMSA scan, done the same way as DTPA scan. The third cause could be renal artery narrowing which should have been picked up by renal angiography if present. The treatment is to keep BP under control with antihypertensive medicines. You also need to get 24 hour urine protein estimated.

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