The nodular duodenum in chronic renal failure

A retrospective study of barium meals in 120 patients with chronic renal failure demonstrated duodenal abnormalities in 38 cases (31%). Multiple nodular filling defects were shown in 28 patients (23%), while in 10 cases (8%) peptic ulceration was found on a background of smooth duodenal mucosa. There was no common cause for the renal failure in the group with nodules. The nodular changes were a direct consequence of the uraemia and were unrelated to dialysis, renal transplantation or drug therapy. They were found almost exclusively in males, and in the more severe degrees of uraemia. Associated dyspeptic symptoms were infrequent and there was no apparent relationship between the nodules and peptic ulceration. Radiologically the nodules were typical of Brunner's gland hyperplasia while endoscopic and histological assessment excluded ulceration, infection, duodenitis and malignancy. Hyperplasia of Brunner's glands is commonly associated with chronic uraemia.