Hanan Fathy

Ass. lecturer
Pediatric nephrology department
• Male patient, 3.5 years old, from ElBehera.

• Generalized edema
3 days before admission
• Hematuria
• Headache
• The patient suffered from gradual onset of edema
that started by morning puffiness.

• The mother noticed abdominal distension, and

change in the color of urine.

• The patient also complained of headache.

• Upon seeking medical advice; U/S abdomen, renal

functions and urine analysis were requested.
• The patient was puffy, he looked ill.

• He was hypertensive, no fever.

• Weight was slightly less than expected for

age, and the patient was short.

• There was generalized edema and moderate

ascites.
• The patient had impaired renal functions.

• Urine analysis revealed the presence of

smoky colored urine, there was protinuria,
hematuria and granular casts.

• Urine culture was sterile.

• The patient also had a low C3.

Trend of progression of renal functions

250 Dialysis
200

150

urea
100

50

0
Day1 Day2 Day3 Day4
U/S abdomen at a private clinic:

The Rt kidney shows grade II hydronephrosis ,

dilated ureter,
evidence of supra renal mass
partially solid partially cystic.

The left kidney is atrophic with dilated ureter.

 The left kidney was not visualised,
The left ureter was seen dilated.
The right kidney shows malrotation,
Atrophic thinned out parenchyma, grade III
Hydronephrosis and dilated ureter.
Medical Urologic
problem illness
• The patient was dialyzed.

• He was given pulse steroid therapy to halt

pathology progression.

• He was given pulse cyclophosphamide as the pulse

steroids didn't stop deterioration of renal function.

• We had to do five sessions of plasma pharesis on

account of unsatisfying results of previous two
measures.
There is crossed fused ectopia,
where each kidney is malrotated
and located in the right
hypchondrium, each showing
grade II-III hydro nephrosis
No supra renal masses
HOW DID THE CASE PROGRESS

• Following intensive medical measures to control

deterioration in renal functions, the patient didn't
show marked improvement.

• Dialysis was done twice after cessation of pharesis

sessions.

• A urinary catheter was fixed in place, initial

improvement in renal functions, however after a
short while renal function deteriorated and we had
to dialyze again.
HOW DID THE CASE PROGRESS

• The patient was put on non dialytic therapy and

chemoprophylaxis.

• A DMSA scan was done that showed very poor

function in both kidneys (worse on the left).

• DTPA revealed a GFR in the Rt kidney 11.3 ml/min

and in the Lt kidney 2.3 ml/min and a non
obstructive pattern.
Urinary catheter was removed

The patient was sent home on non dialytic therapy and

chemoprophylaxis

He was scheduled for a regular follow up and diyalysis

when needed regimen( he has was polyuric, was not
dialysis dependent)
 In his follow up visits,
no further deterioration of renal functions was noted
Last BUN:46 mg/dl
S.Cr:1.7 mg/dl
We didn't have to re dialyze ever since he was sent home