Gardevski, M.

Kulov, N.

Maistorski, A.

Nenov, D.

Sapundjiev, H.

Uzunov, G.

English

Varna Medical University Press: Journals

S I L E N T K I D N E Y AND TUMOURS OF T H E UROGENITAL SYSTEM D. Nenov, N. Kulov, G. Uzunov, A. Maistorski, M. Gardevski, H. Sapundjiev The "silent kidney" as a diagnostical and therapeutical problem conti-nues to exist with a lot of still unsolved items. The importance of this prob-lem is determined not only by the interesting and still uncleared aspects, but also by its practical significance. The question of the terminology of the "si-lent kidney" is complex and arguable for the time being. The concepts "non-functioning", "invisible", "non-visualizing" kidney are not specified and sa-tisfactorily distinguished. That is why they are not always being used cor-rectly. The "silent kidney' is commonly used in nowadays-practice. This termin, interpreted as a clinical concept, doesn't reflect the nature of the pathologi-cal process. In some cases this concept can lead to error about the status of the renal parenchyma. Important questions in cases of "silent" kidney are: 1. Is the loss of function definite or temporary? 2. What is the reason for the lack of function? 3. What our behaviour should be? The diagnosis of renal or urinary tract tumours iri some cases is a result of the reveal of the "silent kidney" and the search for the reason of this pheno-menon. This fact is quite important because the tumours of the urinary sys-tem are often found out by accident on the basis of a few symptoms: macros-copic hematuria, fever or palpable addominal tumour. Unfortunately, the loss of the renal function in cases with neoplasms is not an early symptom. However, this can be early observed when there is a tumour of the ureter, and the bladder because tumours of small size cause an obstruction of the ureter or of its bladder orifice. Another important point in the cases with malignant renal and urinary tract tumours, this is the necessity of surgical treatment when distant meta-stases are not established. The diagnosis of the tumour as a reason for non-func-tioning kidney has an essential significance for the patient. That is why, as early as the correct diagnosis is settled as favorable the prognosis of the di-sease is. We observed 250 patients with "silent kidney". The reason for it in 41 of the cases were tumours of the urogenital system — 16.4%. This fact means that ?mong the reasons for the "silent kidney" the tumours of the urogenital system occupies second place after urolithiasis and before renal tuberculosis (see table I ) . According of the kind of the tumour in our cases the renal adenocarcinoma and the urinary bladder carcinoma are the most often neoplasms (see table 2). The tumours left are rare but of great interest. In 2 cases the cancer ori-ginates from the pyelon, in 2 cases there is Wilms' tumour and in 4 cases — metastases from female genital neoplasms. There is one case with testicular Silent kidney and tumours. 119 T a b l e 1. "Silent kidney" E t i o l o g y number % 1. Urolithiasis 2. Tumours of the urinary system 3. Renal tuberculosis 4. Congenital malformations 5. Inflammations 6. Cysts 7. Unknown 8. Others (trauma etc.) 141 41 23 18 15 5 4 3 56.4 16.4 9.2 -7.2 6.0 2.0 1.6 1.2 Total 250 100 T a b l e 2. "Silent kidney" in the urinary systeM tumours Kind of the tumour number % I . Pr imary tumours: 1. Rena l tumours a) adenocarcinoma b) Wi lms ' tumours 2. Renal pelvic tumours 3. Ureteral tumours 4. Urinary bladder tumours I I . Metastatic tumours: 1. Women genital tumours 2. Testicle's tumour 15 2 2 2 15 4 1 6.0 0.8 0.8 0.8 6.0 1.6 0.4 Total 41 16.4 teratoblastoma. A l l but four of the cases are confirmed histologically and af-ter the surgical treatment. In 1826 G, Konig was the first who described two cases with "medullary sarcoma" of the kidney. Later P . Grawitz (1883) gives an account to a malig-nant tumour of the renal parenchyma, and since then one begins to call the renal tumoursjafter him "Grawitz's" tumours. It is proved that the hypernephroma is a renal tumour coming from the renal tubules which is called adenocarci-noma of the kidney. Conclusions: 1. In cases of "silent kidney" tumours of the urinary system occupy se-cond place— 16.4% — after urolithiasis. This is of great importance for the urgent surgical treatment and the prognosis. 2. The most frequently observed tumours are renal adenocarcinoma and urinary bladder tumours. 120 D. Nenov, N . Kulov, G. Uzunov. R E F E R E N C E S 1. Е d v a l , C. A . The "silent kidney": evalution of quality of parenchyma in non-excreting kidney by renal vein catetarization. J. Urol., 1959, 82, I , 15—17. — 2. H a t t e -r y , R . R . , W . С h a r b о n е a n, Е. C. E r n s t . Spectrum of ultrasound findings in renal cell carcinoma and a variety of other renal tumours. Amer. J. Roentgenol., 1981, 137, 200. — 3. S h e r m a n , R . , M. В 1 a u f о x . Obstructive uropathy in patients w i t h nonvisualization of renal scan. Nephron, 1980, 25, 2, 82—86. — 4. S p j u t, H . , J . , С. H . N i k o l a i . The nonvisualizing kidney: a pathologic study. J. Urol., 1961, 85, 2, 115—118. «НЕМАЯ» ПОЧКА ПРИ ОПУХОЛЯХ МОЧЕПОЛОВОЙ СИСТЕМЫ Д. Ненов, Н. Кулов, Г. Узунов, А. Майсторски, М. Гардевски, Хр. Сапунджиев Р Е З Ю М Е В работе описывается 250 больных с т. н. немой почкой. Подчеркивается, что опу­холи мочеполовой системы занимают второе место среди причин афункции одной почки вслед за мочекаменной болезнью, что имеет весьма существенное значение как для лече­ния (необходимость в неотложном хирургическом вмешательстве), так и для прогноза. Среди опухолей , вызывающих «немую» почку наиболее часты почечный аденокарцином и р а к мочевого пузыря. 

SILENT KIDNEY AND TUMOURS OF THE UROGENITAL SYSTEM

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SILENT KIDNEY AND TUMOURS OF THE UROGENITAL SYSTEM

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