Ectopic kidney with varied vasculature: demonstrated by CT angiography

Unilateral non-rotated left kidney with vascular and ureter variations in a cadaver: a unique case report with embryological and educational aspects

The kidneys and ureters are retroperitoneal structures in the upper part of the paravertebral gutters, tilted against the structures on the sides of the lowest two thoracic and upper three lumbar vertebrae, so that their anterior and posterior surfaces face antero-laterally and postero-medially, respectively. Congenital anomalies of the urinary tract are often the underlying cause of renal pathologies; 40% of these pathological conditions are due to variations in location, shape, and size of the kidney(s), calyces, ureter, or bladder. This case report describes the presence of a unilateral non-rotated left kidney with vascular and ureter variations found during routine cadaveric dissection for medical graduates. Alterations in rotation of the kidney and its relation to structures at the hilum have great clinical significance when conducting surgical procedures like partial nephrectomy, nephron sparing surgery, and renal transplantation.

Safe Completion of Laparoscopic Anterior Resection in a Patient With a Solitary Pelvic Kidney: A Case Report

Pelvic kidney, an ectopic renal mass caused by developmental failure, is a rare condition. Here, we report a case of laparoscopic anterior resection in a patient with a solitary pelvic kidney. A 76-year-old man was diagnosed as having rectosigmoid colon cancer. Preoperative computed tomography revealed a left ectopic kidney in his pelvis. Computed tomographic angiography and retrograde pyelography were performed preoperatively to identify the renal vessels and the ureter. To keep the surgical plane intact for complete mesocolic excision, a complete laparoscopic anterior resection was safely performed without open conversion, and there was no injury to the pelvic kidney. The patient was discharged on postoperative day eight without any complication. No deterioration of renal function was observed after surgery. This report describes a case of laparoscopic anterior resection that was safely performed without conversion to open surgery in a patient with a pelvic ectopic kidney.

Malrotation of an iliac ectopic kidney with pyelo-ureteral duplication: An incidental three-in-one congenital anomaly

Renal ectopia is a rare congenital anomaly that mostly occurs in the pelvic area. An ectopic kidney is usually associated with other anomalies such as a malrotation. We report the case of a 15-year-old male who consulted after a blunt abdominal trauma. A left iliac renal ectopia was incidentally discovered. This ectopic kidney was associated with a malrotation, and a pyelo-ureteral duplication. Iliac renal ectopia should be dissociated from other abdominal renal ectopias, and its association with other renal malformations should be further investigated.

Eventration of right diaphragm with an intrathoracic ectopic kidney: A case report

Introduction

Congenital diaphragmatic eventration is characterized by the elevation of the diaphragm, causing a protrusion of the intraabdominal viscera into the affected hemithorax and resulting in respiratory distress. Diaphragmatic eventration with an intrathoracic ectopic kidney is a very rare disorder with the incidence of 0.25% of all ectopias.

Presentation of case

A 16-day-old male presented with chief complaint of respiratory distress. His plain chest X-ray showed intestinal gases in the right diaphragm and elevation of the right diaphragm. Intraoperative findings revealed elevation of the right diaphragmatic dome and visceral displacement, including the ileum, transverse colon, and right lobe of the liver. Subsequently, hemidiaphragm plication was conducted. Two weeks after surgery, the patient suffered from respiratory distress again. Computed tomography (CT) scanning revealed right diaphragmatic elevation and an ectopic kidney inside the right hemithorax. During the second operation, there were no longer elevation of the right diaphragmatic dome nor any other organ displacement. Moreover, we decided to let the intrathoracic kidney remain in place. The outcome was good during the postoperative period and six months after surgery.

Discussion

Eventration of diaphragm with an intrathoracic ectopic kidney should be considered as a differential diagnosis in neonate patients with respiratory distress accompanied by a thoracic mass.

Conclusion

Congenital diaphragmatic eventration with an intrathoracic ectopic kidney is a very rare disorder, requiring a personalized surgical repair to achieve a good outcome. CT scanning may help confirm the diagnosis, particularly to define the dome elevation and the intrathoracic organ precisely.

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CT-scan should be performed to establish the diagnosis of eventration of diaphragm and to find an incidental, very rare intrathoracic finding, such as an ectopic kidney.

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Diaphragmatic eventration with an intrathoracic ectopic kidney is a very rare disorder, requiring personalized surgical repair to achieve a good outcome.

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Ectopic kidney might be left intrathoracic without any complications and not require any surgical treatment.

Chronic kidney disease and upper tract concerns after congenital and acquired urinary tract abnormalities: considerations for transition of care in teens and young adults

PURPOSE

To emphasize the burden that chronic kidney disease (CKD) and its complications place on overall health and well-being over the lifetime in individuals with congenital and acquired urinary tract abnormalities.

METHODS

Topic-based literature review was performed and professional opinion was obtained to describe the scope of medical challenges faced by both teens and adults and their health care providers in the context of congenital and acquired urinary tract abnormalities.

RESULTS

Challenges include accurate assessment of glomerular filtration rate; engaging for consistent surveillance of blood pressure, proteinuria, and medical complications of CKD that increase the risk of progression to end-stage renal disease and affect general health; achieving early referral to nephrology for better outcomes; managing renal complications within the unique limitations of lower urinary tract function; treating upper tract urolithiasis in the atypical urinary tract; and preparing for successful renal transplant.

CONCLUSION

In individuals with congenital or acquired abnormalities of the urinary tract, there is an inherent risk of CKD with its associated morbidity and increased mortality risk. Interplay between the upper and lower urinary tract impacts CKD progression. Collaborative management between urology and nephrology is highly recommended to address the unique challenges for each individual over the lifetime.

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

PURPOSE

The purpose of this study is to investigate the origin of the vascular structures in ectopic kidneys with multidetector computed tomography (CT).

METHODS

The abdominal CT images of 96 cases with 106 ectopic kidneys were retrospectively reviewed. The ectopic kidney location, type of ectopia, and the origins of renal arteries and veins of the ectopic kidneys were evaluated. The origins of the renal arteries and veins were classified as suprarenal aorta/inferior vena cava (IVC), normal origin, infrarenal aorta/IVC, aortic/IVC bifurcation, common iliac artery/vein, iliac bifurcation, internal iliac artery/vein, and external iliac artery/vein. Finally, the ectopic kidneys were classified according to the most common combinations of artery and vein origins.

RESULTS

The renal artery originated from the suprarenal aorta in 1 case, normal origin in 13 cases, the infrarenal aorta in 36 cases, aortic bifurcation in 50 cases, the common iliac artery in 17 cases, and the iliac artery bifurcation in 2 cases. The renal vein was of normal origin in 19 cases, originated from the infrarenal IVC in 44 cases, IVC bifurcation in 36 cases, the common iliac vein in 23 cases, the internal iliac vein in 1 case, and the external iliac vein in 1 case. We classified the artery and vein origins of the ectopic kidneys into 7 most common types and other less common types. A significant correlation was found between the level of the ectopic kidneys and the origin of the arteries and veins (P < 0.001).

CONCLUSIONS

Our study shows that the majority of ectopic kidneys have various origins of arterial and venous supply. We described the most common vascular origins of ectopic kidneys. Prior knowledge of these vascular variations may have important implications in preventing iatrogenic hemorrhage during surgery of patients with ectopic kidney.

Bilateral Malrotation and a Congenital Pelvic Kidney with Varied Vasculature and Altered Hilar Anatomy

Variations of structure and position of the kidney along with variations of renal vessels are most frequently reported. Rotational variations form a rare entity that are not cited in most embryology textbooks. During an educational cadaveric dissection of a 42-year-old male, a complex picture of bilateral anatomical variants was encountered. Malrotation of both kidneys and a left lobulated ectopic kidney along with open hilum was observed. The left kidney showed a pelvic position in front of sacral promontory with three renal arteries retaining its embryological aortoiliac branches and two renal veins draining into right common iliac vein. These variations have an embryological base. Pelvic kidney with rotational variation though comparatively rare assumes great importance in view of present-day surgical procedures like laparoscopic radical nephrectomy, percutaneous nephrectomy, and renal transplantation.

MDCT findings of right circumaortic renal vein with ectopic kidney

Anomalies of renal vasculature combined with ectopic kidneys were found on a multi-detector CT scan. Knowledge of renal vascular variation is very important for surgical exploration, radiologic intervention and staging for urologic cancer. We present an extremely rare case of a right circumaortic renal vein combined with a right ectopic kidney. The right kidney was located at the level between the third and fifth lumbar vertebra. The right circumaortic renal vein crossed the aorta and returned to the inferior vena cava behind the aorta.

Coping with genetic diversity: the contribution of pathogen and human genomics to modern vaccinology

Vaccine development faces major difficulties partly because of genetic variation in both infectious organisms and humans. This causes antigenic variation in infectious agents and a high interindividual variability in the human response to the vaccine. The exponential growth of genome sequence information has induced a shift from conventional culture-based to genome-based vaccinology, and allows the tackling of challenges in vaccine development due to pathogen genetic variability. Additionally, recent advances in immunogenetics and genomics should help in the understanding of the influence of genetic factors on the interindividual and interpopulation variations in immune responses to vaccines, and could be useful for developing new vaccine strategies. Accumulating results provide evidence for the existence of a number of genes involved in protective immune responses that are induced either by natural infections or vaccines. Variation in immune responses could be viewed as the result of a perturbation of gene networks; this should help in understanding how a particular polymorphism or a combination thereof could affect protective immune responses. Here we will present: i) the first genome-based vaccines that served as proof of concept, and that provided new critical insights into vaccine development strategies; ii) an overview of genetic predisposition in infectious diseases and genetic control in responses to vaccines; iii) population genetic differences that are a rationale behind group-targeted vaccines; iv) an outlook for genetic control in infectious diseases, with special emphasis on the concept of molecular networks that will provide a structure to the huge amount of genomic data.