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{{SK}} Ectopic kidney
{{SK}} Ectopic kidney


==Overview==
== [[Renal ectopia overview|Overview]] ==


Renal ectopia describes a [[kidney]] that is not located in its usual position. It results from the kidney failing to ascend from its origin in the true pelvis or from a superiorly ascended kidney located in the thorax.
== [[Renal ectopia historical perspective|Historical Perspective]] ==


==Pathophysiology==
== [[Renal ectopia classification|Classification]] ==


* Normal ascent of the kidneys is required for formation of the extraperitoneal perirenal fascial planes.
== [[Renal ectopia pathophysiology|Pathophysiology]] ==
* Ectopia (or renal agenesis) results in failure of development of fascial layers in the flanks on the side not occupied by renal tissue.
* Lack of restraining fascia leads to possible malposition of bowel into the extraperitoneal fat of the empty renal fossa and relaxation of mesenteric supports for bowel loops in this region.


===Crossed-fused renal ectopia===
== [[Renal ectopia causes|Causes]] ==


* Crossed ectopy = kidney located on the opposite side of the midline from its ureter. <ref>Dunnick, N.R., Sandler, C.M., Newhouse, J.H., and Amis, E.S. Textbook of uroradiology, 3rd Edition. Lippincott Williams and Wilkins, 2001.</ref> <ref>Dyer, R.B., Chen, M.Y., and Zagoria, R.J. Classic signs in uroradiology. Radiographics, 2004; 24:S247-S280.</ref> <ref>Gay, S.B., Armistead, J.P. Weber, M.E., and Williamson, B.R.J. Left infrarenal region: anatomic variants, pathologic conditions, and diagnostic pitfalls. Radiographics 1991; 11: 549-570.</ref> <ref>Meyers, M.A., Whalen, J.P., Evans, J.A. and Viamonte, M. Malposition and displacement of the bowel in renal agenesis and ectopia: new observations. AJR, 1972; 117,2: 323-333.</ref>
== [[Renal ectopia differential diagnosis|Differentiating Renal ectopia from other Diseases]] ==
* In 90% of crossed ectopy, there is at least partial fusion of the kidneys (the remainder demonstrate two discrete kidneys on the same side, crossed-unfused ectopy)
* Due to improper renal ascent in embryogenesis (4<sup>th</sup>-8<sup>th</sup> week of fetal life - normally, the kidney reaches its appropriate position at L2 level at the end of the 2<sup>nd</sup> month)
* Fusion of the kidneys within the pelvis leads to crossed-fused renal ectopia.
* Abnormally situated umbilical artery prevents normal cephalic migration. Another theory is that the ureteric bud crosses to the opposite side and induces nephron formation in the contralateral metanephric blastema.


==Epidemiology and Demographics==
== [[Renal ectopia epidemiology and demographics|Epidemiology and Demographics]] ==
* Incidence: 1 out of 1,000 births.
* 2:1 male to female ratio
* A single renal mass with two collecting systems is located on one side of the abdomen.
* Left-to-right ectopy three times more common.


==Complications==
== [[Renal ectopia risk factors|Risk Factors]] ==
* In a crossed fused renal ectopic kidney, complications such as [[nephrolithiasis]], infection, and [[hydronephrosis]] approaches 50%.


==Diagnosis==
== [[Renal ectopia natural history, complications and prognosis|Natural History, Complications and Prognosis]] ==
===Imaging===
* Readily detected on conventional urography.
* CT and US very useful.
* On US, identified by characteristic anterior or posterior "notch" between the two fused kidneys.
* Anterograde or retrograde ureterogram most often demonstrates normal bladder trigone without ureteral ectopy.
* Blood supply usually anomalous.
* Angiography recommended before surgical intervention.
* Findings on CT or barium contrast studies of the bowel should be interpreted in light of bowel laxity in the region of the empty renal fossa (discussed above). In particular, distinction must be made from internal hernia.


====CT Scan====
== Diagnosis ==
'''Patient #1: CT images demonstrate a pelvic kidney'''


[http://www.radswiki.net Images courtesy of RadsWiki]
[[Renal ectopia history and symptoms|History and Symptoms]] | [[Renal ectopia physical examination|Physical Examination]] | [[Renal ectopia laboratory findings|Laboratory Findings]] | [[Renal ectopia x ray|X Ray]] | [[Renal ectopia CT|CT]] | [[Renal ectopia ultrasound|Ultrasound]] | [[Renal ectopia other imaging findings|Other Imaging Findings]] | [[Renal ectopia other diagnostic studies|Other Diagnostic Studies]]


<gallery>
== Treatment ==
Image:Ectopic kidney 001.jpg
Image:Ectopic kidney 002.jpg
Image:Ectopic kidney 003.jpg
</gallery>


[[Renal ectopia medical therapy|Medical Therapy]] | [[Renal ectopia surgery|Surgery]] | [[Renal ectopia primary prevention|Primary Prevention]] | [[Renal ectopia secondary prevention|Secondary Prevention]] | [[Renal ectopia cost-effectiveness of therapy| Cost-Effectiveness of Therapy]] | [[Renal ectopia future or investigational therapies|Future or Investigational Therapies]]


'''Patient #1: CT images demonstrate cross-fused renal ectopia'''
==Case Studies==
 
[[Renal ectopia case study one|Case #1]]
[http://www.radswiki.net Images courtesy of RadsWiki]
 
<gallery>
Image:Crossed-fused-ectopia-101.jpg|Kidney 1
Image:Crossed-fused-ectopia-102.jpg|
Image:Crossed-fused-ectopia-103.jpg|Kidney 2
</gallery>
 
'''Patient #2: Renal scan images demonstrate cross-fused renal ectopia'''
 
[http://www.radswiki.net Images courtesy of RadsWiki]
 
<gallery>
Image:Crossed-fused-ectopia-001.jpg
Image:Crossed-fused-ectopia-002.jpg
Image:Crossed-fused-ectopia-003.jpg
</gallery>
 
==References==
{{Reflist|2}}


{{Congenital malformations of genital organs and urinary system}}
{{Congenital malformations of genital organs and urinary system}}


[[Category:Nephrology]]
[[Category:Nephrology]]
 
[[Category:Disease]]
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Revision as of 16:01, 27 September 2012

Renal ectopia
Renal scan image demonstrates cross-fused renal ectopia.
Image courtesy of RadsWiki
ICD-10 Q63.2
ICD-9 753.3

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: : Cafer Zorkun M.D., PhD.

Synonyms and keywords: Ectopic kidney

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Renal ectopia from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms | Physical Examination | Laboratory Findings | X Ray | CT | Ultrasound | Other Imaging Findings | Other Diagnostic Studies

Treatment

Medical Therapy | Surgery | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

Case Studies

Case #1

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