Hypertension due to Ask-Upmark kidney

Renal Hypoplasia, From Grossly Insufficient to Not Quite Enough: Consideration for Expanded Concepts Based Upon the Author's Perspective With Historical Review

Hypoplasia is defined in the Merriman-Webster dictionary as "a condition of arrested development in which an organ, or part, remains below the normal size, or in an immature state." The degree of reduced size is not definitional. Renal hypoplasia, however, has historically been defined as a more marked reduction in renal mass such that presentation in childhood is the norm. There are 3 commonly recognized types of renal hypoplasia, simple hypoplasia, oligomeganephronic hypoplasia (oligomeganephronia) and segmental hypoplasia (Ask-Upmark kidney). They have in common a reduction in the number of renal lobes. A fourth type, not widely recognized, is cortical hypoplasia where nephrogenesis is normal but there is a reduction in the number of nephron generations. Recently there has been great interest in milder degrees of reduced nephron mass, known as oligonephronia because of its association with risk of adult-onset hypertension and chronic kidney disease. Since the last pathology review of this topic was published by Jay Bernstein in 1968, an update of the renal pathology findings in renal hypoplasia is provided with a review of 18 new cases. The renal hypoplasias are then framed within the modern concept of oligonephronia, its diverse causes and prognostic implications.

[Ask-Upmark kidney: description of a case and review of the literature]

We present a 15-year-old male patient diagnosed histopathologically as suffering from Ask-Upmark kidney, in the absence of vesicoureteral reflux and with hypertension. The first clinical manifestation was completely atypical: right loin pain, with so many agudisation treated at our emergency serve that justified a thorough study. The pathogenesis of the Ask-Upmark kidney is still unknown; some authors defend the congenital malformation hypothesis, as it was first described in 1929, but there are groups who support the Ask-Upmark kidney as a form of reflux nephropathy. After our description we present a review of the literature.

Ask-Upmark kidney associated with renal and extrarenal arterial aneurysms

Reports of Ask-Upmark kidney, initially described as a congenital defect in renal development, are uncommon. We report a case with the features of bilateral asymmetrical segmental atrophy in a patient with childhood-onset hypertension. As an adult, she developed cerebral, celiac, and renal artery aneurysms. She underwent successful clipping of the cerebral aneurysm and renal artery repair with preservation of renal function. Novel radiologic techniques make possible the noninvasive diagnosis of segmental atrophy and its complications.

Segmental renal hypoplasia of vascular origin causing renal hypertension in a 3-year-old girl

A rare case of renal hypertension in a 3-year-old girl caused by segmental renal hypoplasia of vascular origin is presented. Resection of the hypoplastic segment of the kidney permitted successful treatment of the high blood pressure with preservation of renal function. Elevated plasma renin activity in the renal vein of the affected side and biochemical investigations demonstrated that the resected segment of the renal cortex was the source of the renin leading to hypertension by activation of the renin-angiotensin-aldosterone system.