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Saudi Journal of Kidney Diseases and Transplantation
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LETTER TO THE EDITOR Table of Contents   
Year : 2010  |  Volume : 21  |  Issue : 6  |  Page : 1149-1150
Reverse rotation of kidney with spina bifida in an adult

Department of Surgery, Santosh Medical College and Hospital, Ghaziabad, UP, India

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Date of Web Publication4-Nov-2010

How to cite this article:
Thakur SK, Gupta S, Gupta SR, Jha S. Reverse rotation of kidney with spina bifida in an adult. Saudi J Kidney Dis Transpl 2010;21:1149-50

How to cite this URL:
Thakur SK, Gupta S, Gupta SR, Jha S. Reverse rotation of kidney with spina bifida in an adult. Saudi J Kidney Dis Transpl [serial online] 2010 [cited 2022 Jun 27];21:1149-50. Available from: https://www.sjkdt.org/text.asp?2010/21/6/1149/72313
To the Editor,

Rotational anomalies of kidney are a rare con­genital entity. Isolated malrotation of kidney is even more rare. [1] The adult kidney, as it assumes its normal position, orients itself such that ca­lyces point laterally and pelvis faces medially. When this alignment is not exact, it is known as malrotation. Most often, malrotation is found in conjunction with another renal anomaly such as ectopia with or without fusion or with horse­shoe kidney. We present here a 36-year-old male with bilateral flank pain and dysuria for 3 days. He had a history of fever on and off since the last 7 months. An ultrasound showed a cal­culus of 2 Χ 1 cm in the lower calyx of left kid­ney and bilateral mild hydronephrotic changes. X-ray KUB showed a radio opaque shadow of size 2 Χ 1 cm in the left renal area [Figure 1] and spina bifida occulta of L5 vertebra (marked by arrow in both the figures). Urine microscopy showed plenty of pus cells (20-30 hpf) and urine culture did not show any growth as he was already on ofloxacine and ornidazole com­bination since the last 2 days as per the advice of a local doctor. Blood urea and serum crea­tinine were normal. Surprisingly, intravenous pyelogram showed left kidney with complete malrotation, the renal pelvis was facing late­rally and all the calyces were facing medially [Figure 2]. The radio opaque shadow seen in plain X-ray was found to be a renal stone and it was lying in the lower calyx. The kidneys were in normal anatomical positions. The pelvis of both the kidneys were dilated and ureters could not be visualized, probably due to PUJ obstruction. Due to some family problems, the patient wanted some time before under­going further investigations. We had planned CT angiography for kidney, and depending on the findings, were intending to do PCNL and bila­teral double J stenting. However, the patient has not turned up as yet.
Figure 1 :Plain X-ray KUB showing calculus in left renal area and spina bifida of 5th lumbar vertebra marked by an arrow.

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Figure 2 :IVU showing reverse rotation of left kidney with hydronephrotic changes on both the sides. The ureters are not visualized. Spina bifida of 5th lumbar vertebra has been marked by an arrow.

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Several features of isolated malrotation have been described in the literature. The kidney may be discoid, elongated, oval or triangular in shape. A dense amount of fibrous tissue en­cases the hilar area distorting and fixing the pelvis. [2] This may be the reason for bilateral dilatation of renal pelvis and nonvisibility of ureters on both the sides in IVU as observed in this case. The vascular anomaly may add to it. Anomalies of rotation include ureteric pelvis that face ventrally, ventromedially, laterally or dorsally. A ventral facing pelvis indicates ab­sence of so called rotation, whereas dorsal and lateral varieties are said to be caused by hypo­rotation and reverse rotation. The cause of mal­rotation is more likely to be asymmetrical growth. [3] The association of malrotation of kid­ney and anomalies of renal vessels has fre­quently been quoted. [2],[4],[5] The malrotation of kid­ney does not produce any specific symptom. The diagnosis of lateral rotation of kidney is confirmed by excretory IVU, ultrasonography or retrograde pyelogram. [2] In this case, the ul­trasonologist had failed to detect the malrota­tation. It may be confused with horseshoe kid­ney but careful inspection for an isthmus and observation of the lower pole renal outline should help to distinguish the two entities.

Further investigations like CT scan, MRI, angio­graphy are needed only to plan the treatment of associated conditions like stone in this case. The spina bifida in this case is a coincidental finding.

   Acknowledgement Top

We are thankful to Dr. V.K. Arora, Director, Santosh University, for his kind permission to publish this case.

   References Top

1.Ingole IV, Ghosh SK. Laterally rotated kidney: A rare congenital anomaly. J Anat Soc India 2005;54(1):19-21.  Back to cited text no. 1
2.Bauer SB. Anomalies of kidney and ureteropelvic junction. In: Campbell-Walsh Urology. 9 th ed. Philadelphia. W.B. Saunders Company 2007.chap 113, 3291-2.  Back to cited text no. 2
3.O'Rahilly RR, Muller F. Human Embryology and Teratology. 3rd ed. New York. Wiley, 2001. 305.  Back to cited text no. 3
4.Das S, Amar A. Ureteropelvic junction obstruction with associated renal anomalies. J Urol 1984;131(5):872-8.  Back to cited text no. 4
5.Wong WY, Liu PF, Hsu HS, Lai MK. Lateral Malrotation of the Kidney with uncoupled vasculature. J Urol . 2001;12(3):139-41.  Back to cited text no. 5

Correspondence Address:
Sudhir Kumar Thakur
Department of Surgery, Santosh Medical College and Hospital, Ghaziabad, UP
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Source of Support: None, Conflict of Interest: None

PMID: 21060195

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