Congenital Cystic Dilatation of the Renal Collecting Tubules

In 1943, while I was in the U. S. Army, a young soldier was referred to me because of gross, painless, total hematuria and a peculiarly abnormal excretion urogram. Except for this gross abnormality which looked as though a bunch of grapes were attached to each minor calyx (Fig. la and lb), no explanation could be found for his hematuria. There was no evidence of calculous disease. There was no pus in his urine. All renal function tests were normal. All blood studies were within normal limits. After retrograde pyelographic study had been repeated twice and excretion urographic studies three times, one could draw no conclusion other than that this man had gross, cystic dilatation of the collecting tubules of both kidneys. It was a condition, which, as far as I could find out, had not yet been described in urological literature.t In reviewing seven hundred complete urographic studies made in my recent private practice, I found that 236 retrograde pyelograms were made and 464 excretion urograms. Of these, 86 patients had had both excretion and retrograde studies. In re-examining the urograms carefully, paying particular attention to the minor calyces, it was found that 52 had to be discarded as the visualization was too poor to see clear-cut minor calyces. Of the remaining 648, visualization was sufficiently adequate to get a good picture of most of the minor calyces. In studying these, I was not surprised to find that the collecting tubules could be visualized in 35, or just over five per cent of the total. In eleven, this was just a faint fan-like area of radio density. In thirteen, it was more marked and here one could see a certain degree of beading along the lines which radiated out from the calyx. In the remaining eleven, the visualization of the collecting tubules would be apparent to even the most casual observer. It is apparent, therefore, that the collecting