Dilemma of small pyelonephritic kidney associated with vesicoureteral reflux

Nineteen children with severe unilateral pyelonephritic scarring secondary to reflux and infection were followed up for at least five years after ureteral reimplantation. The small kidneys in these children grew at a rate which paralleled expected normal, and this growth was independent of the degree of hypertrophy in the contralateral kidney or the size difference between each pair of renal units. The authors differentiate between obligate and compensatory renal growth and conclude that children with a small pyelonephritic kidney should undergo reimplantation rather than nephrectomy because of the recuperative powers of the growing kidney and its ability to become a potentially life-sustaining organ in the future.