Clobazam as adjunctive treatment in refractory epilepsy.

IF~ ~~' Pyelograms from two identical twins. (a) Case 1, showing left chronic pyelonephritis; renal outlines have been pencilled in for clarity. (b) Case 2, showing normal appearances apart from a minor degree of duplex bilaterally. Case reports Case 1-This patient was investigated at the age of 18 for recurrent urinary infection. She had been aware of symptoms only for the preceding few months. The following year intravenous urography showed a normal right kidney and a shrunken left kidney with clubbing of the calyces (fig (a)) consistent with chronic pyelonephritis. On micturating cystography there was reflux up the left ureter as far as the renal pelvis but without dilatation of the renal tract. Cystoscopy showed a localised trigonitis. She was treated initially by urethral dilatation but, after a further recurrence of infection with haematuria, she underwent left nephrectomy at the age of 19. Histo-logical examination confirmed the presence of severe chronic pyelonephritis. She continued to suffer from urinary infection and haematuria in the year after nephrectomy, at which point she was lost to follow up. Case 2 is the twin sister of case 1. They were always regarded as identical, and identity was confirmed in 19 red cell types and the four HLA-A and HLA-B types (courtesy of Dr Ann Collins). She presented to one of us in general practice with a history of recurrent urinary infection, in which the first proved attack was at the age of 24. In view of the family history she was referred for investigation; no evidence of chronic pyelonephritis was seen on intravenous urogram (fig (b)). Micturating cystogram showed reflux up the left ureter of similar extent to that shown in her twin sister and also slight reflux up the right ureter. She was followed up as an outpatient for about three years, during which time she ceased to suffer from urinary infections. Repeat intravenous urography after five years confirmed the normality of the kidneys. Analysis of urine gave consistently normal results, and plasma urea and creatinine concentrations were within normal ranges. Comment The chronic pyelonephritis in case 1 was obvious on the intravenous urogram and its widespread presence in the kidney was confirmed by histological examination. Her twin sister's left kidney was not, of course, examined histologically but it appeared entirely normal on two intravenous urograms giving a good demonstration of the calyceal system and on the nephrogram. The likeliest explanation for the …