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One atrophic kidney and the other with hydronephrosis

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I am 39, average weight, height overall healthy. I have no other significant health problems. I have 1 atrophic kidney that is half the normal size. My other kidney has hydronephrosis and is twice the size of a normal kidney. I have had multiple recurrent cases of pyelonephritis over the last year or so.

I have had nuclear scans, ct's, ultrasounds, cystoscopy with renal pyelogram, daily antibiotics. Any kind of obstruction has been ruled out. The antibiotics keep infection at bay, but I have had to go to dr again for another case of pyelo. I have constant ache in the flank of the larger kidney.

I have never had any labwork other than urine samples, cultures and sensitivties. (strange I know). My urine always shows protein and hematuria. When I urinate I always see lots of air bubbles to foamy.

Am I safe to think that this is no longer a urological issue and should be examined by nephrology? Am I also safe to think that this should be sooner rather than later? What might some other less serious causes might I be over looking?

Thank you

Category: Nephrologist

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Category: Pediatric Nephrologist
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Thank you for your consult at

As per the history, you have diabetes, hypertension, SLE with lupus nephritis, GERD along with chronic pyelonephritis.

The most common cause of frequent UTI is the inadequate therapy of the very first UTI. As you are a diabetic and must be on immunosuppressive therapy for lupus nephritis, you are more prone for infections. Your tendency for infections keeps you at risk of complications of sepsis as the immune system is inadequate to support you. One of the kidneys got severe pyelonephritis and contracted and other kidney got compensatory hyper trophy. Hydronephrosis of this kidney can be due to UTI and we need to rule an underlying VUR.

Did you ever undergo an investigation called MCUG. For many days you get treated for urine infections? How is your diabetes control? What is your immunosuppressive therapy and I suggest to you that your diabetes should be under good control and immunosuppressive therapy should be the minimum so that the frequency if UTI can come down.

Also you should be under a nephrologist care and monitor your renal functions frequently. You did not mention about s. Creatinine report.

An inflamed kidney can produce hemat iris and protein uric and should not be a cause of concern. However, it is prudent to check for the presence of tuberculosis of the urinary tract as you are getting frequent UTIs.

Hope this helps, please feel free to discuss further.

Dr Raju, MD

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Patient replied :

family history of lynch syndrome, diabetes, htn, cad, sle, gomerulonephritis. None the these above conditions have been tested for in myself.
I did have a normal mcug. Absolutely no labs except urine for infection. I feel time is of the essence. I want to get on the right track and prevent further damage. Thank you so much.

It is good that you don't have any such history. You should be under the care of a nephrologist at the earliest and you should be treated for UTI adequately at least once. Get renal functions done and monitor frequently.


Dr. Sree Bhushan Raju
Category: Pediatric Nephrologist
FISN : Fellowship of Indian Society of Nephrology(ISN), 2012
FIACM : Fellowship of Indian Association of Clinical Medicin(IACM), 2012
FICP: Indian College of Physicians Association of Physicians of India, 2012
Fellowship: DM, DNB, All India Institute of Medical Sciences, New Delhi, 2002
Residency: MD, General Medicine, Nizam's Institute of Medical Sciences, 1998
Medical School: MBBS, Gandhi Medical College, 1994
Dr. Sree Bhushan Raju and 4 other Medical Specialists are ready to help you

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