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Saudi Journal of Kidney Diseases and Transplantation
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Year : 2006  |  Volume : 17  |  Issue : 4  |  Page : 577-578
Transplantation of a Lump or Cake Kidney: A Case Report


Shiraz Organ Transplantation Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran

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How to cite this article:
Salahi H, Salehipour M, Bahador A, Davari H, Nikeghbalian S, Kazemi K, Malek-Hosseini SA. Transplantation of a Lump or Cake Kidney: A Case Report. Saudi J Kidney Dis Transpl 2006;17:577-8

How to cite this URL:
Salahi H, Salehipour M, Bahador A, Davari H, Nikeghbalian S, Kazemi K, Malek-Hosseini SA. Transplantation of a Lump or Cake Kidney: A Case Report. Saudi J Kidney Dis Transpl [serial online] 2006 [cited 2021 Jul 25];17:577-8. Available from: https://www.sjkdt.org/text.asp?2006/17/4/577/32500

   Introduction Top


Renal transplantation is the optimal treat­ment for patients with end-stage renal disease (ESRD). Although the number of patients with ESRD awaiting kidney transplantation is rapidly increasing, the donor pool remains relatively stable. Due to this discrepancy, kidneys with congenital anomalies should be considered as an additional source of organs for transplantation.

We herewith report a case of successful transplantation of a lump or cake kidney from a cadaveric donor. The aim of reporting this case is to increase awareness about trans­planting such kidneys.


   Case Report Top


A 29-year-old man was declared as having brain-death following intracranial hemorrhage and considered a potential organ donor. The donor's renal function was normal with a serum creatinine of 0.9 mg/dl and the urine output was good. Abdominal exploration for organ retrieval revealed a lump or cake kidney located in the left pelvic cavity. In addition, the kidney had four arteries, origin­ating from the aorta and common iliac artery, and one main renal vein draining into the external iliac vein, also there were two small accessory veins. The kidney, in addition, had two ureters that separately entered the urinary bladder without crossing [Figure - 1].

The kidney was removed en block with preservation of all vessels and was transplanted. The first two arteries of the upper pole were sewn together and then anastomosed end­to-side to the aorta. One artery supplying the mid pole was anastomosed to the external iliac artery and the fourth artery, to the internal iliac artery.

The main renal vein was anastomosed to the external iliac vein. The accessory veins were ligated. The ureters were implanted into the urinary bladder separately using the modified lich-Gregoir technique [Figure - 2].

Post-transplantation, the patient developed adequate urine output and her serum crea­tinine gradually decreased and at discharge, it was 0.5 mg/dl. The recipient continued to do well when last seen three months after surgery.


   Discussion Top


Structurally anomalous kidneys were pre­viously considered unsuitable for transplant­ation but due to the increasing shortage of organ donors, kidneys with atypical anatomy are currently being considered for transplant­ation. The lump or cake kidney is a relatively rare form of fusion. [1] In this anomaly, the entire renal substance is fused into one mass which is located in the pelvic cavity, and has two ureters which enter the urinary bladder separately.[2] The lump kidney is not nece­ssarily associated with renal dysfunction or progressive deterioration of renal function but does require exclusion of other associated anomalies. Also, long-term follow-up for detecting complications such as obstruction, infection or calculi is required. [3]

The anomalous kidneys often have complex vascular and ureteral anatomy in addition. The number as well as the position of the renal arteries and veins can vary greatly. They require meticulous attention during organ harvest­ing; transplantation of such kidneys is more difficult than normal kidneys.

In conclusion, anatomically anomalous kidneys can be used for transplantation provided they are functioning normally meticulous attention is paid to technical details during surgery.

 
   References Top

1.Bauer SB. Anomalies of the upper urinary tract; In Walsh PC, Retik AB, vaughan ED, wein AJ (eds): campbell's urology. Philadelphia, 2002;3:1885-1924.  Back to cited text no. 1    
2.Glenn JF. Fused pelvic kidney. J Urol 1958; 80: 7-9.  Back to cited text no. 2  [PUBMED]  
3.Martinez-Lazaro R, cortes-Blanco A. Cake kidney drained by single ureter: MAG 3 renogram for diagnosis and function follow­up. Nephrol Dial Transplant 2000;15:1700-1.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]

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Correspondence Address:
Heshmatollah Salahi
Shiraz Organ Transplantation Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz
Iran
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PMID: 17186697

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    Figures

  [Figure - 1], [Figure - 2]



 

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    Introduction
    Case Report
    Discussion
    References
    Article Figures
 

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