Total nephrectomy in children: a clinicopathological review

The records of 85 children undergoing total nephrectomy have been reviewed. Diagnoses ranged between pyelonephritis (37 patients), renal tumours (25), renal dysplasia and multicystic kidney (16), obstructive uropathy (6) and renal vein thrombosis (1). In the pyelonephritic group a contributory ipsilateral abnormality was demonstrated in 36 of the 37 children. Vesicoureteric reflux (VUR) was the most common abnormality in this cohort and was usually of a severe grade. Calculus disease was present in 9 patients, only 1 of whom had VUR. Of the remaining 7 patients with pyelonephritis, 6 had evidence of obstruction to the upper tracts. Calculus disease poses a more severe threat to the childhood kidney than the well known risk factors of vesicoureteric reflux and obstructive uropathy.