Evaluating the origin of vascular structures in ectopic kidneys with multidetector computed tomography

Prenatal diagnosis of ectopic kidney: Evaluation of characteristics, additional anomalies and urinary complications

OBJECTIVE

To assess the characteristics, additional structural anomalies and postnatal urinary outcome of the cases diagnosed with fetal ectopic kidneys in the prenatal period.

STUDY DESIGN

Cases having fetal ectopic kidneys, detected from a total of 14,617 pregnant women examined by routine detailed (Group 1) or indicated (Group 2) obstetric ultrasonography (USG) in a tertiary perinatology unit were analyzed. The prevalence of the cases, time of the diagnosis, sidedness of the affected kidney, anatomical location, origins of blood supply, additional urinary or extraurinary anomalies, and urinary complications during the postnatal follow-up period were investigated.

RESULTS

We have detected 33 fetuses with ectopic kidneys in our cohort. The prevalence of fetal ectopic kidney was 0.22 %, with a median (min.-max.) diagnosis time of 21.3 (17.6-34) weeks. In the group in whom indicated USG was performed, the time of diagnosis was later compared to routine detailed USG (p = 0.04) group. There was no difference in terms of gender [male, (n = 14), female (n = 19), p = 0.38] and the sidedness of the ectopic kidneys (p = 0.38). The location of ectopic kidneys was most frequent in the iliac fossa (n = 20, 60.6 %) and in the lateral pelvic areas (n = 13, 39.3 %). The blood supply origin of ectopic kidneys was the common iliac artery in 22 (66.6 %), whereas the aorta in 11 cases (33.3 %). There was an additional urinary anomaly in 8 cases (24 %), an extraurinary structural anomaly, most commonly cardiac, and/or a soft marker for aneuploidy were presented in 16 cases (48 %). The most common urinary complication in the postpartum period was vesicoureteral reflux (n = 5).

CONCLUSION

Ectopic kidney in the prenatal period is a rare structural anomaly that can equally affect both genders and both kidneys. Prenatal diagnosis is important for the diagnosis of additional anomalies and follow-up of postnatal complications.

Ectopic vascularization of the right kidney arising from contralateral common iliac artery

BACKGROUND

Variant renal arteries have been reported in 20~30% of the entire population. The anatomic variations among advanced patients should be investigated when performing surgery or interventional procedures on the kidney. Most variant renal arteries originated from various level of the abdominal aorta. Very rarely, this case shows renal artery originated from the contralateral common iliac artery with other accessory arteries.

CASE PRESENTATION

MDCT angiography revealed several anatomical variants of the right kidney. There were four right renal arteries. The main renal artery originated from the left proximal common iliac artery and other renal artery originated from the aortic bifurcation. The other two renal arteries arose from the abdominal aorta, lower thoracic T12 level and lower lumbar L4 level. The right kidney was located at the level of the third to fifth lumbar vertebra. And renal pelvis of the right kidney was laterally rotated.

CONCLUSION

This case documented a rare anatomic variant, involving multiple accessory renal arteries, including the main artery originating from the contralateral iliac artery, caused by a specific renal embryological condition. These variants should be analysed to effectively perform surgical and interventional procedures.