Scars of the renal cortex

The small scarred kidney of childhood. A congenital or an acquired lesion?

The vast majority of small segmentally scarred kidneys seen in childhood are now recognised to be associated with vesicoureteric reflux and the term "reflux nephropathy" has been accorded general recognition as a description of this renal lesion. With regard to the pathogenic mechanisms responsible for the scarring process, the possible roles of intrauterine renal maldevelopment, bladder dysfunction, functional urinary obstruction and infection in relation to vesicoureteric reflux and the associated phenomenon of intrarenal reflux must all be considered. It is probable that in different clinical circumstances all of these factors may be important to varying degrees and discussion of their contributions to the spectrum of reflex nephropathy is the basis of this communication.

Renal dysplasia in nephrectomy specimens from adolescents and adults

In a review of 156 total or partial nephrectomy specimens from patients over the age of 12 years, renal dysplasia was found 14 times. The cases were divided initially into five groups on the basis of the predominant pathological changes, namely (1) dysplasia (14 cases), (2) chronic pyelonephritis (31 cases), (3) calculous inflammation (58 cases), (4) hydronephrosis (35 cases), and (5) miscellaneous (18 cases). The diagnosis of dysplasia was made on gross and microscopic criteria and included 12 of segmental dysplasia, one of total dysplasia, and one multicystic dysplastic kidney. The principal differential diagnosis is from the irregularly scarred chronic pyelonephritic kidney. The criteria for the separation of the two are emphasized and, in particular, the distinction from those pyelonephritic kidneys with aglomerular scars. A high incidence of anomalies of drainage was found in association with dysplasia, but such were not always present. It was not thought that intrarenal reflux in infancy was an aetiological factor. Six of the cases presented with urinary infection, but only two had hypertension. It was thought that acquired glomerular damage was more important in the aetiology of hypertension than segmental glomerular agenesis.