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| Year : 2012 | Volume
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| Issue : 3 | Page : 594-597 |
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| Congenital renal lesions |
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Saurabh Garge, RK Mathur, RS Raikwar, Arif Amed Asari
Department of Surgery, M.Y. Hospital, Indore, India
Click here for correspondence address and email
| Date of Web Publication | 7-May-2012 |
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How to cite this article:
Garge S, Mathur R K, Raikwar R S, Asari AA. Congenital renal lesions. Saudi J Kidney Dis Transpl 2012;23:594-7 |
To the Editor,
Congenital anomalies of the upper urinary tract comprise a diversity of abnormalities, ranging from complete absence to aberrant location, orientation and shape of the kidney as well as aberrations of the collecting system and blood supply. The horseshoe kidney is probably the most common of all renal fusion anomalies. Ectopia of the kidney is another anomaly encountered and may be confused with the horseshoe kidney. Finally, autosomal-dominant polycystic kidney disease (ADPCKD) is a fairly common cause of kidney failure in adults.
The above three different congenital anomalies were incidentally diagnosed in three of our patients. The first patient who had crossed renal ectopia came with a paraumbilical hernia, the second who had horseshoe kidney came with a pyocoele of gall bladder and the third who had polycystic kidney disease came with a history of recurrent urinary tract infection. They presented with typical radiographic features in computed tomographic intravenous urography, (CT IVU), ultrasonography (USG) and intravenous urography. All the patients were typically asymptomatic except for few episodes of urinary tract infection.
Half a million people in the United States are estimated to have polycystic kidney disease. It has a prevalence of 1 in 400 to 1 in 1000 adults in the white population. [1] Horseshoe kidney is the most common fusion anomaly, occuring in every 400 births, and is seen in approximately 1 out of 300 pyelographies. [2],[3] The horseshoe kidneys usually produce no symptoms because there is normal development of its collecting system.
Initially, during the intrauterine life, the kidneys are located in the pelvis caudal to aortic bifurcation. During 7-8 months of intrauterine life, they migrate and ascend out of the pelvis and also rotate medially so that the anteriorly facing pelvis turns medially. [4] A slight alteration in the position of the umbilical or common iliac artery could change the orientation of the migrating kidneys thus leading to contact and fusion. [5] The reported incidence of crossed renal ectopia is 1:2000 to 1:7000 autopsies. The incidence of unfused crossed renal ectopia however has been reported to be 1 in 75,000 autopsies, an incidence 10-times lower than that of fused crossed renal ectopia. [6] The crossed ectopic kidney is classified into four types: (1) crossed renal ectopia with fusion, (2) crossed renal ectopia without fusion, (3) solitary crossed renal ectopia and (4) bilaterally crossed renal ectopia. [7] Incidentally, diagnosed patients constitute 20-30% of the cases [Figure 1]. [8] | Figure 1: Intravenous pyelogram showing unfused crossed renal ectopia with left ureter crossing midline.
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The embryologic etiology of crossed ectopic kidneys is unclear. Some have suggested that the developing kidney crosses to the opposite side. [9] Our patient with ectopia had segmental dysplasia and the kidney was non-functioning in spite of good cortical thickness of around 1.5 cm. Dysplasia in crossed fused ectopic kidneys has been reported rarely. [10]
CT is a superior tool to US for topographical anatomic details [Figure 2], [Figure 3], [Figure 4], [Figure 5] and [Figure 6]; however, an ectopic kidney may be difficult to identify in scans where intravenous radio-contrast injections were not used. [11] | Figure 6: CT scan showing horseshoe kidney with fused lower pole over the aorta.
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During Tc-99m DMSA scintigraphy has been used to differentiate between fused and unfused forms [11] as well as providing information about perfusion and level of function. [12] We reported these cases to show that some anomalies can only be discovered incidentally while being evaluated for something else.
 References | |  |
| 1. | Brunwald E, Fauci AS, Kasper DL, Hauser SL, Longo DL, Jameson JL. Polycystic kidney disease. In: Brunwald E, Fauci AS, Kasper DL, Hauser SL, Longo DL, Jameson JL, Eds. Harrison's Principles of Internal Medicine. 15th ed. New York City, U.S: McGraw Hill; 2001;1598-600 
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| 2. | Dees JE. Clinical Importance of congenital anomalies of upper urinary tract. J Urol 1941; 46:659-66.
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| 3. | Lowsley OS. Surgery of horseshoe Kidney. J Urol 1952;56:565-78.
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| 4. | Moore KL, Persaund TV. The urogenital system. In: The developing human clinically oriented embryology (7th ed.). Philadelphia: Saunders; 2003;293-5.
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| 5. | Domenech-Mateu JM, Gonzales-Compta X. Horseshoe kidney: A new theory on its embryogenesis based on the study of a 16-mm human embryo. Anat Rec 1988;222:408-17.
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| 6. | Felzenberg J, Nasrallah PF. Crossed renal ectopia without fusion associated with hydronephrosis in an infant. Urology 1991;38:450-2.
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| 7. | McDonald JH, McClellan DS. Crossed renal ectopia. Am J Surg 1957;93:995-9.
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| 8. | Mansberg VJ, Rossleigh MA, Farnsworth RH, Van Rooijen M. Unfused crossed renal ectopia with ectopic left ureter inserting into a prostatic utricle diverticulum. AJR Am J Roentgenol 1999;172:455-6.
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| 9. | Purpon I. Crossed renal ectopy with solitary kidney. A review of the literature. J Urol 1963; 90:13-5.
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| 10. | Rosenberg HF, Snyder HM, Duckett J. Abdominal mass in newborn. Multicystic dysplasia of crossed fused renal ectopia - ultrasonic demonstration. J Urol 1984;131:1160-1.
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| 11. | Hwang CM, Miller FH, Dalton DP, Hartz WH. Accidental ureteral ligation during an inguinal hernia repair of patient with crossed fused renal ectopia. Clin Imaging 2002;26:306-8.
[PUBMED] [FULLTEXT] |
| 12. | Jolles PR, Yassa NA, Shah H, Purnell GL. Crossed renal ectopia. Correlative imaging. Clin Nucl Med 1992;17:306-7.
[PUBMED] |
Correspondence Address:
Saurabh Garge
Department of Surgery, M.Y. Hospital, Indore
India
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6] |
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