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Why is my wife's kidney shrinking?

Q: My 43 years old wife is suffering from thyroid disease for the last 7 years. She also suffered from typhoid in childhood and twice in the past 4 years. For the last 3 years she is having recurrent infection in urine for, which she is taking antibiotics. Last year the doctor did a PAP smear and the report showed: AFB x 3 staining smear show No AFB in entire smear – negative, AFB culture is sterile after 6 weeks of incubation, sugar – nil, albumin – positive, erythrocytes - 10-15, Hb g/dl - 12.4, platelets/ul – 277 x 10, ESR mm 1st hour – 25, ESR – 40, Urine TB PCR – negative, liver function test normal, Mantoux - (24 x 26 mm in 72 hrs). Then the doctor started tuberculosis treatment. Now it has been detected that her kidney is shrinking. Seven months back its length was 7.6 cm, calyceal pole was 9 mm, pole measure 9 mm and upper ureter was 11 mm which reduced to 9 mm after 5 months and calcyceal separation was 7 mm, length was 7.5 cm but pole measure remained the same. Now the length is 6.6 cm, calyceal separation is 7 mm, pole measure is 9 mm and upper ureter is 7 mm. The ultrasound impression was: sonographic findings are suggestive of left hydro uretero-nephrosis with small left kidney. CECT impression: CT Scan findings are suggestive of a small-scarred left kidney showing mild hydronephrosis with dilated thickened left ureter. She is also a little aggressive, emotionally sensitive and gets urine infection quite often. What could be the reason for her illness? What should be the line of treatment for her?

A:Review of information is suggestive of possible blockage of the left urinary tract or passage (from the level of kidney outlet, ureter onto bladder) causing back pressure with resultant swelling of left sided ureter and kidney (called hydro- uretero nephrosis). If the blockage or the obstruction from whatever cause remains persistent, it would result in long standing kidney damage on that side, many times obvious from shrinkage of kidney. So the next step should be evaluating further for any obstructive cause along the whole urinary tract including the urinary bladder by invasive tests (like cystoscope) by an Urologist. Also, one would like to study her kidney function by checking: first serum creatinine level and later possibly renal scans study. Renal scan is important to study each kidneys' blood flow and filtering function thereby assessing amount of residual damage done to the left kidney by the longstanding obstruction as what your wife may have endured. Further, though unusual at her age, many times recurrent urinary tract infection may be a fall out of obstruction of urinary tract.

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