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Dwarfed Kidneys in Children: The Classification, Etiology, and Significance of Bilateral Small Kidneys in 11 Children

Dwarfed Kidneys in Children: The Classification, Etiology, and Significance of Bilateral Small... Abstract THE HE RADIOLOGIC demonstration of a single kidney or of bilateral small kidneys in a child presenting with signs and symptoms of renal insufficiency commonly results in the diagnosis of renal hypoplasia. However, small kidneys may be the result of many etiologic factors, including a failure of normal renal differentiation and development, disproportionate growth of the organs, and contraction secondary to scarring. It is difficult to evaluate and clearly identify which of these factors has operated to produce the small kidneys found in a given clinical problem. Furthermore, the terminology as currently applied to describe these conditions is unsatisfactory. A review of the existing literature, and the classifications and definitions which have been employed are needed. Bilateral dwarfed kidneys which on microscopic study were normal have not occurred in our experience. The small kidneys which we have studied have invariably shown histologic evidence of either dysplasia or chronic inflammatory disease References 1. Herbut, P. A.: Urological Pathology , Philadelphia: Lea & Febiger, 1952. 2. Burkland, C. E.: Clinical Considerations in Aplasia, Hypoplasia, and Atrophy of Kidney , J Urol 71:1, 1954. 3. Lowsley, O. S., and Kirwin, T. J.: Clinical Urology , ed 3, Baltimore: The Williams & Wilkins Company, 1956. 4. Ashley, D. J. B., and Mostofi, F. K.: Renal Agenesis and Dysgenesis , J Urol 83:211, 1960. 5. Gutierrez, R.: Surgical Aspects of Renal Agenesis With Special Reference to Hypoplastic Kidney, Renal Aplasia and Congenital Absence of One Kidney , Arch Surg 27:686, 1933.Crossref 6. Eisendrath, D. N.: Clinical Importance of Congenital Renal Hypoplasia , J Urol 33:331, 1935. 7. Ekström, T.: Renal Hypoplasia: Clinical Study of 179 Cases , Acta Chir Scand ( (suppl) ) 203:1, 1955. 8. Slungaard, R. K., and Jaeck, J. L.: Bilateral Dwarfed Kidneys , AMA J Dis Child 97:575, 1959. 9. Baurys, W.: Renal Hypoplasia , Guthrie Clin Bull 17:120, 1948. 10. Graham, A. P.: Hypoplastic Kidney, Bilateral: Case Report , J Urol 60:581, 1948. 11. Coppoletta, J. M., and Wolbach, S. B.: Body Length and Organ Weights of Infants and Children: Study of Body Length and Normal Weights of More Important Vital Organs of Body Between Birth and Twelve Years of Age , Amer J Path 9:55, 1933. 12. Oliver, J. T., et al: Congenital Abnormalities of Urinary System: III. Growth of Kidney in Childhood—Determination of Normal Weight , J Pediat 61:256, 1962.Crossref 13. Spector, W. S., ed.: Handbook of Biological Data , Philadelphia: W. B. Saunders Company, 1956. 14. Rubenstein, M.; Meyer, R.; and Bernstein, J.: Congenital Abnormalities of Urinary System: I. Postmortem Survey of Developmental Anomalies and Acquired Congenital Lesions in Children's Hospital , J Pediat 58:356, 1961.Crossref 15. Ericsson, N. O., and Ivemark, B. I.: Renal Dysplasia and Urinary-Tract Infection , Acta Chir Scand 115:58, 1958. 16. Ericsson, N. O., and Ivemark, B. I.: Renal Dysplasia and Pyelonephritis in Infants and Children: I., II ., AMA Arch Path 66:255, 264, 1958. 17. Pasternack, A.: Microscopic Structural Changes in Macroscopically Normal and Pyelonephritic Kidneys of Children , Ann Paediat Fenn ( (suppl 14) ) 6:1-88, 1960. 18. Rocha, H., et al: Experimental Pyelonephritis: III. Influence of Localized Injury in Different Parts of Kidney on Susceptibility to Bacillary Infection , Yale J Biol Med 30:341, 1958. 19. Quinn, E. L., and Kass, E. H., ed.: Biology of Pyelonephritis , Boston: Little, Brown & Co. Ltd., 1960. 20. Bernstein, J., and Meyer, R.: Congenital Abnormalities cf Urinary System: II. Renal Cortical and Medullary Necrosis , J Pediat 59:657, 1961.Crossref 21. Taft, L. I.: Neonatal Nephritis , Aust Ann Med 5:113, 1956. 22. Bell, E. T.: Renal Diseases , ed 2, Philadelphia: Lea & Febiger, 1950. 23. Landing, B. H., and Hughes, M. L.: Analysis of Weight of Kidneys of Children , Lab Invest 11:452, 1962. 24. Neumann, C. G., and Pryles, C. V.: Pyelonephritis in Infants and Children: Autopsy Experience at Boston City Hospital 1933-1960 , Amer J Dis Child 104:215, 1962.Crossref 25. Kass, E. H., in Angiotensin Systems and Experimental Renal Disease: 14th Annual Conference on Kidney , J. Metcoff, ed., Boston: Little Brown and Co. 1963, p 131 and ff. 26. Guze, L. B.: Consideration of Certain Host Factors in Pathogenesis of Pyelonephritis , Bull NY Acad Med 37:468, 1961. 27. Gall, E. A.: Pyelonephritis , Bull NY Acad Med 37:367, 1961. 28. Collins, R. D.: Chronic Glomerulonephritis in Newborn Child , Amer J Dis Child 87:478, 1954. 29. Thompson, A. C.: Neonatal Glomerulonephritis , W Virginia Med J 47:16, 1951. 30. Pollak, V. E., et al: Asymptomatic Persistent Proteinuria: Studies by Renal Biopsies , Guy Hosp Rep 107:353, 1958. 31. Vernier, R. L.: Structure and Function of Renal Glomerular Capillaries in Health and Disease , Pediatrics 32:480, 1963. 32. Litman, N. N.: Asymptomatic Proteinuria in Children , Clin Res 9:106, 1961. 33. Hedlund, P.: Clinical and Experimental Studies on C-Reactive Protein (Acute Phase Protein) , Acta Med Scand ( (suppl 361) ) 161:1-71, 1961. 34. Vernier, R. L., et al: Chronic Renal Disease in Children: Correlations of Clinical Findings With Morphologic Characteristics Seen by Light and Electron Microscopy , AMA J Dis Child 96:306, 1958.Crossref 35. Emery, J. L., and Mithal, A.: Weights of Kidneys in Late Intra-Uterine Life and Childhood , J Clin Path 13:490, 1960.Crossref 36. Potter, E. L., and Thierstein, S. T.: Glomerular Development in Kidney as Index of Fetal Maturity , J Pediat 22:695, 1943.Crossref 37. Arataki, M.: On Postnatal Growth of Kidney, With Special Reference to Number and Size of Glomeruli (Albino Rat) , Amer J Anat 36:399, 1926.Crossref 38. Vernier, R. L., and Birch-Andersen, A.: Studies of Human Fetal Kidney: I. Development of Glomerulus , J Pediat 60:754, 1962.Crossref 39. Bloom, P. M.; Hartmann, J. F.; and Vernier, R. L.: Electron Microscopic Evaluation of Width of Normal Glomerular Basement Membrane in Man at Various Ages , Anat Rec 133:251, 1959. 40. Rubin, M. I.; Bruck, E.; and Rapoport, M.: Maturation of Renal Function in Childhood: Clearance Studies , J Clin Invest 28:1144, 1949.Crossref 41. Calcagno, P. L.; Rubin, M. I.; and Bruck, E.: True Effective Renal Plasma Flow and Filtration Fraction in Young Infants as Determined by Extraction Ratios With Renal Vein Catherization , Amer J Dis Child 100:576, 1960. 42. Hodson, C. J., et al: Renal Size in Normal Children, Radiographic Study During Life , Arch Dis Child 37:616, 1962.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Diseases of Children American Medical Association

Dwarfed Kidneys in Children: The Classification, Etiology, and Significance of Bilateral Small Kidneys in 11 Children

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Publisher
American Medical Association
Copyright
Copyright © 1965 American Medical Association. All Rights Reserved.
ISSN
0002-922X
DOI
10.1001/archpedi.1965.02090020132008
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Abstract

Abstract THE HE RADIOLOGIC demonstration of a single kidney or of bilateral small kidneys in a child presenting with signs and symptoms of renal insufficiency commonly results in the diagnosis of renal hypoplasia. However, small kidneys may be the result of many etiologic factors, including a failure of normal renal differentiation and development, disproportionate growth of the organs, and contraction secondary to scarring. It is difficult to evaluate and clearly identify which of these factors has operated to produce the small kidneys found in a given clinical problem. Furthermore, the terminology as currently applied to describe these conditions is unsatisfactory. A review of the existing literature, and the classifications and definitions which have been employed are needed. Bilateral dwarfed kidneys which on microscopic study were normal have not occurred in our experience. The small kidneys which we have studied have invariably shown histologic evidence of either dysplasia or chronic inflammatory disease References 1. Herbut, P. A.: Urological Pathology , Philadelphia: Lea & Febiger, 1952. 2. Burkland, C. E.: Clinical Considerations in Aplasia, Hypoplasia, and Atrophy of Kidney , J Urol 71:1, 1954. 3. Lowsley, O. S., and Kirwin, T. J.: Clinical Urology , ed 3, Baltimore: The Williams & Wilkins Company, 1956. 4. Ashley, D. J. B., and Mostofi, F. K.: Renal Agenesis and Dysgenesis , J Urol 83:211, 1960. 5. Gutierrez, R.: Surgical Aspects of Renal Agenesis With Special Reference to Hypoplastic Kidney, Renal Aplasia and Congenital Absence of One Kidney , Arch Surg 27:686, 1933.Crossref 6. Eisendrath, D. N.: Clinical Importance of Congenital Renal Hypoplasia , J Urol 33:331, 1935. 7. Ekström, T.: Renal Hypoplasia: Clinical Study of 179 Cases , Acta Chir Scand ( (suppl) ) 203:1, 1955. 8. Slungaard, R. K., and Jaeck, J. L.: Bilateral Dwarfed Kidneys , AMA J Dis Child 97:575, 1959. 9. Baurys, W.: Renal Hypoplasia , Guthrie Clin Bull 17:120, 1948. 10. Graham, A. P.: Hypoplastic Kidney, Bilateral: Case Report , J Urol 60:581, 1948. 11. Coppoletta, J. M., and Wolbach, S. B.: Body Length and Organ Weights of Infants and Children: Study of Body Length and Normal Weights of More Important Vital Organs of Body Between Birth and Twelve Years of Age , Amer J Path 9:55, 1933. 12. Oliver, J. T., et al: Congenital Abnormalities of Urinary System: III. Growth of Kidney in Childhood—Determination of Normal Weight , J Pediat 61:256, 1962.Crossref 13. Spector, W. S., ed.: Handbook of Biological Data , Philadelphia: W. B. Saunders Company, 1956. 14. Rubenstein, M.; Meyer, R.; and Bernstein, J.: Congenital Abnormalities of Urinary System: I. Postmortem Survey of Developmental Anomalies and Acquired Congenital Lesions in Children's Hospital , J Pediat 58:356, 1961.Crossref 15. Ericsson, N. O., and Ivemark, B. I.: Renal Dysplasia and Urinary-Tract Infection , Acta Chir Scand 115:58, 1958. 16. Ericsson, N. O., and Ivemark, B. I.: Renal Dysplasia and Pyelonephritis in Infants and Children: I., II ., AMA Arch Path 66:255, 264, 1958. 17. Pasternack, A.: Microscopic Structural Changes in Macroscopically Normal and Pyelonephritic Kidneys of Children , Ann Paediat Fenn ( (suppl 14) ) 6:1-88, 1960. 18. Rocha, H., et al: Experimental Pyelonephritis: III. Influence of Localized Injury in Different Parts of Kidney on Susceptibility to Bacillary Infection , Yale J Biol Med 30:341, 1958. 19. Quinn, E. L., and Kass, E. H., ed.: Biology of Pyelonephritis , Boston: Little, Brown & Co. Ltd., 1960. 20. Bernstein, J., and Meyer, R.: Congenital Abnormalities cf Urinary System: II. Renal Cortical and Medullary Necrosis , J Pediat 59:657, 1961.Crossref 21. Taft, L. I.: Neonatal Nephritis , Aust Ann Med 5:113, 1956. 22. Bell, E. T.: Renal Diseases , ed 2, Philadelphia: Lea & Febiger, 1950. 23. Landing, B. H., and Hughes, M. L.: Analysis of Weight of Kidneys of Children , Lab Invest 11:452, 1962. 24. Neumann, C. G., and Pryles, C. V.: Pyelonephritis in Infants and Children: Autopsy Experience at Boston City Hospital 1933-1960 , Amer J Dis Child 104:215, 1962.Crossref 25. Kass, E. H., in Angiotensin Systems and Experimental Renal Disease: 14th Annual Conference on Kidney , J. Metcoff, ed., Boston: Little Brown and Co. 1963, p 131 and ff. 26. Guze, L. B.: Consideration of Certain Host Factors in Pathogenesis of Pyelonephritis , Bull NY Acad Med 37:468, 1961. 27. Gall, E. A.: Pyelonephritis , Bull NY Acad Med 37:367, 1961. 28. Collins, R. D.: Chronic Glomerulonephritis in Newborn Child , Amer J Dis Child 87:478, 1954. 29. Thompson, A. C.: Neonatal Glomerulonephritis , W Virginia Med J 47:16, 1951. 30. Pollak, V. E., et al: Asymptomatic Persistent Proteinuria: Studies by Renal Biopsies , Guy Hosp Rep 107:353, 1958. 31. Vernier, R. L.: Structure and Function of Renal Glomerular Capillaries in Health and Disease , Pediatrics 32:480, 1963. 32. Litman, N. N.: Asymptomatic Proteinuria in Children , Clin Res 9:106, 1961. 33. Hedlund, P.: Clinical and Experimental Studies on C-Reactive Protein (Acute Phase Protein) , Acta Med Scand ( (suppl 361) ) 161:1-71, 1961. 34. Vernier, R. L., et al: Chronic Renal Disease in Children: Correlations of Clinical Findings With Morphologic Characteristics Seen by Light and Electron Microscopy , AMA J Dis Child 96:306, 1958.Crossref 35. Emery, J. L., and Mithal, A.: Weights of Kidneys in Late Intra-Uterine Life and Childhood , J Clin Path 13:490, 1960.Crossref 36. Potter, E. L., and Thierstein, S. T.: Glomerular Development in Kidney as Index of Fetal Maturity , J Pediat 22:695, 1943.Crossref 37. Arataki, M.: On Postnatal Growth of Kidney, With Special Reference to Number and Size of Glomeruli (Albino Rat) , Amer J Anat 36:399, 1926.Crossref 38. Vernier, R. L., and Birch-Andersen, A.: Studies of Human Fetal Kidney: I. Development of Glomerulus , J Pediat 60:754, 1962.Crossref 39. Bloom, P. M.; Hartmann, J. F.; and Vernier, R. L.: Electron Microscopic Evaluation of Width of Normal Glomerular Basement Membrane in Man at Various Ages , Anat Rec 133:251, 1959. 40. Rubin, M. I.; Bruck, E.; and Rapoport, M.: Maturation of Renal Function in Childhood: Clearance Studies , J Clin Invest 28:1144, 1949.Crossref 41. Calcagno, P. L.; Rubin, M. I.; and Bruck, E.: True Effective Renal Plasma Flow and Filtration Fraction in Young Infants as Determined by Extraction Ratios With Renal Vein Catherization , Amer J Dis Child 100:576, 1960. 42. Hodson, C. J., et al: Renal Size in Normal Children, Radiographic Study During Life , Arch Dis Child 37:616, 1962.Crossref

Journal

American Journal of Diseases of ChildrenAmerican Medical Association

Published: Feb 1, 1965

References