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Suggest Treatment For Loss Of Corticomedullary Differentiation In Both Kidneys

Posted on Thu, 30 Jun 2022

Question: Dear i have a kid 10 years and his ultrasound report was as follows :

U/S - URINARY TRACT: Findings: " Both kidneys increased in size measuring 11.5 x 6.5 cm with cortical thickness of 1.2 cm with loss of corticomedullary differentiation. Evidence of moderate-to-severe hydronephrotic changes. " Both ureters are seen significant dilated tortuous however, both ureters could represent changes of reflux. Voiding cystourethrogram is advised as the patient diagnosed "eagle XXXXXXX syndrome". " Urinary bladder dilated /enlarged with prevoid 1300 ml and post void 320 ml.

Is this early stage of renal failure? After the surgery for fixing the reflux / obstruction, kidney could be recovered to be normal? or effects on kidney parenchyma couldn't be retrieved?

" loss of corticomedullary differentiation " this is non-recoverable?

What is the treatment and next steps?

Answered by Dr. Dr. P. T. Patil (1 hour later)

Brief Answer:
You need to do few more tests

Detailed Answer:

Hello,

Based on the facts and report of Ultrasound Scanning of your son it seems that your son has Bilateral Vesico Ureteral Reflux (VUR).

I'd suggest consulting a Urologist for clinical assessment and get following basic tests done to ascertain the extent of the function of both the kidneys and to take a decision whether he needs surgery or can be managed by the conservative line of treatment.
1) Renal Function Tests
2) Intra Venous Pyelography (IVP)
3) DMSA Scan
4) Micturating Cysto Urethrogram (MCU)

As regards your query about the recovery after surgery for correction of VUR. In a majority of cases, regeneration of functioning Renal units (Nephrons)in children takes place to near normal level and these children can have a normal life.

Hope I have answered your query. Please do write if you have any questions. I shall be happy to help you.

Thanks
Regards,
Dr. Patil

Above answer was peer-reviewed by : Dr. Arnab Banerjee

Follow up: Dr. Dr. P. T. Patil (3 hours later)

Thank you .
" loss of corticomedullary differentiation " what is that mean ?

Answered by Dr. Dr. P. T. Patil (1 hour later)

Brief Answer:
Kidney function is normal

Detailed Answer:

Hello,

All the important parameters pertaining to kidney function are normal ..
Low Vitamin D levels can be corrected by medications.

Kidney has two parts Solid outer portion called Cortex is the main portion of the kidney that contains functioning renal units (Nephron) and Medula that is a collecting system where urine is collected. Normally the ratio of thickness of Cortex to Medulla is constant through out the life but this ration is distorted whenever there is obstruction to urine flow down in to bladder causing collecting system to dilate leading to pressure over cortex which gets compressed which is reported as loss of cortico-medullary differentiation.

Thanks.
Regards,
Dr. Patil

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Dr. P. T. Patil (9 hours later)

Dear Doctor,

Thank you. The ureters and bladder are enlarged and dilated , what will be the procedure for this if we will go to make a surgery to fix the reflux ? the dilation will be eliminated and both ureters and bladder will return back to their normal sizes after surgery ?

Answered by Dr. Dr. P. T. Patil (5 hours later)

Brief Answer:
The nature of surgery is decided on the grade of Hydroureteronephrosis

Detailed Answer:

Hello,

The nature of surgery is decided by the treating Urologist on the grade of dilatation of ureter Hydroureteronephrosis as revealed on IVP and MCU.

It involves tailoring of dilated ureters and re implant in bladder at other site with creation of anti reflux mechanism by passing a terminal part of ureter through a tunnel made in bladder wall. In most cases, ureter dilatation regresses to near normal size over a period of few years.

Thanks.
Regards,
Dr. Patil

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Above answer was peer-reviewed by : Dr. Nagamani Ng