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Author Spotlight: Developing a Bedside Protocol for Kidney and Genitourinary Ultrasonography
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[Malrotated kidney causing prenatal giant hydronephrosis].

R E Massicot1, S Ferracci2, A-P Uzel3

  • 1Laboratoire d'anatomie médico-chirurgicale appliquée, CHU de Pointe-à-Pitre, route de Chauvel, 97159 Pointe-à-Pitre, Guadeloupe.

Morphologie : Bulletin De L'Association Des Anatomistes
|September 17, 2017
PubMed
Summary
This summary is machine-generated.

A rare case of giant prenatal hydronephrosis in a neonate was caused by a malrotated kidney obstructing the ureteropelvic junction. Surgical correction by repositioning the kidney resolved the obstruction and hydronephrosis.

Keywords:
HydronephrosisPrenatal diagnosisRenal malrotation

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Area of Science:

  • Pediatric Surgery
  • Urology
  • Developmental Biology

Background:

  • Giant prenatal hydronephrosis is a significant congenital condition requiring prompt diagnosis and management.
  • Malrotation of the kidney is an uncommon anomaly that can lead to urinary tract obstruction.
  • Understanding upper urinary tract morphogenesis is crucial for diagnosing rare causes of obstruction.

Observation:

  • A neonate presented with a malrotated right kidney, exhibiting a 180° hyper-rotation from its fetal position.
  • The renal hilum was oriented posteriorly, and the inferior renal pole acted as a 'violin bridge' compressing the ureteropelvic junction.
  • This extrinsic compression, not vascular in origin, caused severe, giant hydronephrosis.

Findings:

  • Surgical intervention involved simply uncrossing the ureteropelvic junction from the inferior renal pole.
  • This maneuver effectively relieved the extrinsic ureteral obstruction.
  • The giant hydronephrosis resolved postoperatively, indicating the success of the corrective procedure.

Implications:

  • This case highlights a rare cause of extrinsic ureteropelvic junction obstruction due to renal malrotation.
  • It underscores the importance of considering anatomical variations in the differential diagnosis of prenatal hydronephrosis.
  • The findings contribute to the understanding of upper urinary tract development and congenital obstructive uropathies.