Bilateral Ectopic Kidneys Presenting as Lower Abdominal Pain

Background: Bilateral Ectopic Kidney is uncommon and usually diagnosed during a routine medical checkup. It could be misdiagnosed as an abdominopelvic mass. In-depth knowledge of its presentation will aid in its management. A poor anatomical relation of the kidneys with other abdominopelvic organs could lead to renal complications and surgical errors. This is of gynaecological importance and worthy of discussion for a lady of her reproductive age. Case presentation: A 20-year-old nulliparous lady of African descent presented with a long-standing history of dull lower abdominal pain. The pain has been intermittent and occasionally associated with a sensation of movement in the lower abdomen. She has a regular and normal menstrual cycle and has no lower urinary tract symptoms. Physical examination was unremarkable with intact secondary sexual characteristics. The abdomen was soft, non-tender and without any organomegaly. Abdominal ultrasonography, renal pyelogram and urinalysis were carried out after her consent was sought in accordance with the institution’s protocol. Urine analysis was normal and culture was negative. However further imaging revealed a bilateral pelvic ectopic kidney. Conclusion: Most of the cases reported are usually unilateral ectopic kidneys. It is, therefore, our belief that this information will be useful to medical practitioners such as surgeons, urologists, radiologists and gynaecologists. Such a diagnosis will enable clinicians to follow up with the client and preserve the renal function whiles preventing iatrogenic injuries during surgical procedures.

Improved Quantification of Glomerular Filtration Rate and Differential Renal Function of Ectopic Kidneys in a Dual Head Gamma Camera

Introduction: Tc-99m Di-ethylene Tri-amine Penta Acetic Acid (DTPA) renogram is an accepted method to measure Glomerular Filtration Rate (GFR) of the kidneys. The depth and position of ectopic kidneys may vary. This may lead to variation in tissue attenuation and error in the computed GFR and Differential Renal Function (DRF) of each kidney. Objective: The present study was undertaken in patients with ectopic kidneys to improve the accuracy of GFR and DRF calculation in a renogram with single injection of Tc-99m DTPA on a dual head gamma camera. Materials and Method: The study was conducted on 55 patients with ectopic kidneys. Images were acquired on a dual head gamma camera simultaneously in anterior and posterior views. Both anterior and posterior image datasets were used to compute the GFR of the ectopic kidney by Gates method. Depth correction of the ectopic kidney was done using the lateral view image. Total GFR was calculated as the sum of the anterior dataset ectopic kidney GFR and the posterior dataset normal kidney GFR. DRF was calculated again, by using the anterior dataset GFR of the ectopic kidney and posterior dataset for normal kidneys. The total GFR calculated by our method was compared to the patient’s eGFR (based on serum creatinine, age and sex). Result: The GFR calculated by anterior data set in the ectopic kidney was significantly higher than that calculated by posterior dataset (p 0.001). Similarly, the differential GFR of the ectopic kidney was higher when the anterior dataset was used (p 0.001). The ectopic kidney GFR of 34 (61.8%) of the 55 patients was greater than 35 ml/min, whereas in 21 patients (38.2%), it was less than 35 ml/min. The total GFR calculated by using both anterior and posterior data set was compared with the eGFR;the correlation coefficient was 0.74 in patients with ectopic kidney GFR of >35 ml/min and 0.83 in those with Conclusion: The GFR of ectopic kidney as calculated from the anterior data set was significantly higher in comparison to the GFR calculated from the posterior data set (p 0.001). Using the anterior dataset GFR, the DRF values for the ectopic kidneys was also significantly higher (p 0.001). This method improves the accuracy of the GFR and DRF values and helps to differentiate a normally functioning ectopic kidney from a poorly functioning one. Compared to the total GFR as calculated by the present method, the eGFR showed a better correlation in patients with ectopic kidney

Laparoscopic treatment of bilateral duplex kidney and ectopic ureter: A case report

BACKGROUND Duplication of the renal pelvis is a common congenital malformation of the urinary system.About one-third of cases are complete unilateral duplication of the renal pelvis,while bilateral duplication is extremely rare.Herein,we described a single case of bilateral renal duplication with double ureteral orifice ectopic vaginal fistula treated with laparoscopy.CASE SUMMARY A 6-year-old girl suffering from long-term vaginal leakage was admitted on June 10,2018.She was diagnosed with complete duplication of both kidneys and ureters and ectopic opening of both ureters combined with ureterovaginal fistula.The patient received laparoscopic ectopic ureteral bladder replantation and was followed up for 2 years.No renal function damage and vaginal leakage were found.CONCLUSION Laparoscopic bladder-ureter reimplantation could effectively determine the location and number of ectopic ureters by imaging and cystoscopy.

Ectopic Autosomal Dominant Polycystic Kidney Disease (ADPKD)—An Extremely Rare Radiological Finding

ADPKD is an inherited systemic disorder that predominantly affects the kidney, but may affect other organs including liver, pancreas, brain, and arterial blood vessel. APKPD occurs worldwide affecting about 1 in 500 - 1000 people. Hypertension is the most common manifestation of ADPKD and the major contributor to renal disease progression. A definite diagnosis of ADPKD relies on image testing. Renal ultrasound is commonly used because of its cost effectiveness.

Endovascular Repair for Abdominal Aortic Aneurysm with an Ectopic Pelvic Kidney: Case Report and Procedural Consideration of the Aberrant Renal Artery

A 91-year-old female presented with a pulsatile abdominal mass. Her past medical history included hypertension and hyperlipidemia. A 6.9 cm infrarenal abdominal aortic aneurysm, with a left ectopic pelvic kidney and two aberrant renal arteries, one each from the left and right common iliac arteries was found on computed tomography. Because of the high risk of rupture, surgery was recommended and an endovascular aneurysm repair was performed. The antegrade flow of the aberrant renal artery from the left common iliac artery was preserved. The right aberrant renal artery was covered with stent graft. The patient’s serum creatinine level remained unchanged throughout the postoperative course, with an uneventful postoperative recovery.

Ectopic Spleen Mimicking Kidney Activity Post-Nephrectomy

Ectopic spleen may simulate kidney activity on renal scintigraphic imaging. Accurate diagnosis requires correlation with the patient’s history and anatomic imaging studies. We report a case where the spleen migrated to the left renal fossa and mimicked the left kidney after a left nephrectomy.

Bilateral thoracic kidneys combined with inferior vena cava located behind the anterior abdominal wall: A case report and review of literature

Ectopic thoracic kidneys are the rarest form of renal ectopia.Moreover,congenital abnormality of a primary anterior inferior vena cava(IVC)located behind the anterior abdominal wall is extremely rare.To date,only one such case has been reported.Herein,we report a rare case of a 55-year-old Chinese male with bilateral thoracic kidneys combined with an anterior IVC,a malformed liver,and a large-round-folds navel.The classification,clinical characteristics,and management options of a thoracic kidney was also summarized by literature review.To our best knowledge,the simultaneous detection of such multiple complex abnormalities has not been reported.

Management of staghorn stones in special situations

Staghorn stones have always been a challenge for urologists,especially in some special situations,such as horseshoe kidney,ectopic kidney,paediatric kidney,and solitary kidney.The treatment of these staghorn stones must be aggressive because they can lead to renal function loss and serious complications.The gold-standard management for staghorn stones is surgical treatment with the aim of clearing the stones and preserving renal function.Treatment methods for staghorn stones have developed rapidly,such as extracorporeal shock wave lithotripsy,retrograde intrarenal surgery,percutaneous nephrolithotomy and laparoscopy and open surgery.Whether the standard procedures for staghorn stones can also apply to these stones in special situations is still not agreed upon.The decision should be made individually according to the circumstances of the patient.In this review,we evaluates the previous studies and comments on the management of staghorn stones under special situations in the hope of guiding the optimal choice for urologists.

膀胱憩室合并感染误诊为盆腔异位肾脓肿1例

患者女，24岁，主因“停经68天，下腹痛、血尿1周余”入院。查体：左下腹压痛，无反跳痛。实验室检查：尿红细胞8～10／HP，尿白细胞25／μl；妊娠试验（＋）。首次经腹超声：双子宫畸形，右侧宫内孕，单活胎，

Kidney Stones Are Prevalent in Individuals with Pseudoxanthoma Elasticum, a Genetic Ectopic Mineralization Disorder

Objective:Pseudoxanthoma elasticum(PXE)is a rare genetic disorder caused by loss-of-function mutations in the ABCC6 gene.While PXE is characterized by ectopic mineralization of connective tissues clinically affecting the skin,eyes,and cardiovascular system,kidney stones were reported in some individuals with PXE.The aim of this study is to determine whether kidney stones are an incidental finding or a frequent manifestation of PXE.Methods:We first investigated the genetic basis of two siblings diagnosed with PXE.The younger patient presented with recurrent kidney stones since 8 years old.Secondly,to address whether kidney stones are associated with PXE,the prevalence of kidney stones in a survey cohort of 563 respondents with PXE was compared to that of a general U.S.population survey,National Health and Nutrition Examination Survey,with 28,629 participants.Results:Genetic analysis in both patients identified compound heterozygous mutations in ABCC6,c.2787+1G>T,and c.3774_3775insC.The analysis of participants 20 years old and older revealed that 23.4%of PXE patients had previously had a kidney stone,a significant increase compared to 9.2%in the general population(P<0.01).In addition,17.8%of PXE patients reported their first kidney stone episode before age of 18 years old.Conclusions:PXE correlates with an increased risk of developing kidney stones with considerable morbidity and health-care cost.