Upper calyx reno-vascular obstruction in children: Fraley's syndrome

Abstract

Intrarenal vascular obstruction of the upper calyceal infundibulum has been distinguished by Fraley as an entity separate from an asymptomatic vascular impression. Clinically, this form of intrarenal vascular obstruction presents as nephralgia or hematuria. This infundibular obstruction is caused by normal renal vessels, usually the upper segmental artery: radiologically, the vessels produce a constant well-defined filling defect in the infundibulum at IVP, and, the upper calyx group is distended and shows delay in emptying. We found this condition in 14 children from 1968-1975. Control studies showed no progression in the radiological findings, even over a long period. In one of our cases angiography was indicated to exclude tumour or cyst; in another case, surgery was necessary. Complications are urinary tract infection or stone formation. Therefore, children with Fraley's syndrome require regular clinical examination.