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Inferior crossed fused ectopia incidentally detected in a 32-year-old man. a Oblique coronal, b sagittal and c cinematic rendered CECT images show ectopic location and fusion of the right kidney to the inferior pole of the orthotopic left kidney without axial rotation (both the renal hila facing anteromedially). d On the maximum intensity projection urographic phase image, the right ureter is observed to cross the midline and drain into the urinary bladder on the right side
Source publication
Renal fusion anomalies are common congenital anomalies of the urogenital tract and have their genesis in the early embryonic period. They are classified into partial fusion anomalies (e.g., crossed fused ectopia, and horseshoe kidney) and complete fusion anomalies (e.g., fused pelvic kidney). Horseshoe kidney is the most common renal fusion anomaly...
Citations
... Some studies have pointed out that complex renal calculi are often accompanied by abnormalities in the structure of the renal collecting system and the course of renal blood vessels, which vary greatly from patient to patient, and the puncture point and puncture channel set by PCNL are different for each patient, which should be different from person to person (9,10). Other studies have pointed out that complex kidney stones are often accompanied by abnormal renal anatomy, especially in horseshoe kidney patients, due to renal fusion, malrotation and abnormal vascular supply, conventional ultrasound and fluoroscopy are difficult to locate (11). Therefore, the preliminary evaluation of routine renal CT examination before PCNL for patients with complex renal calculi combined with intraoperative ultrasound and fluoroscopy cannot meet the actual needs of patients, and the clinical application has certain limitations. ...
Background: To investigate the effect of percutaneous nephrolithotomy (PCNL) guided by holographic image technology on stress response and renal injury factors in patients with complex renal calculi. Methods: A retrospective analysis was conducted on the clinical data of 70 patients admitted to our hospital between August 2022 and June 2023 who had complex kidney stones. The patients were divided into two groups, namely, group A and group B, based on whether they received guidance from preoperative holographic imaging technology. Group A consisted of forty patients who underwent PCNL after undergoing renal CT examination prior to surgery, while Group B included thirty patients who underwent PCNL guided by holographic imaging technology. Various indexes, including operative factors, stress response, inflammatory response, renal injury factors, renal function, complication rate, and the rate of achieving complete stone clearance in a single procedure, were compared between the two groups. Results: In group B, the puncture time and operation time of the target calyces were shorter compared to group A, additionally, the intraoperative blood loss in group B was lower than that in group A (P<0.05). 24 h after surgery, group B exhibited higher levels of superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) compared to group A, additionally, the level of malondialdehyde (MDA) in group B was lower than that in group A (P<0.05). 24 h after surgery, group B exhibited lower levels of tumor necrosis factor α (TNF-α), interleukin-6 (IL-6), IL-1, and hypersensitive C-reactive protein (hs-CRP) compared to group A (P<0.05). Furthermore, group B showed lower levels of neutrophil gelatinase-associated lipid carrier protein (NGAL), inducible protein-8-like molecule 2 (TIPE2), and β2-microglobulin (β2-MG) than group A at the 7-day mark (P<0.05). 24 h after the operation, There was no statistically significant difference observed in the levels of SCr, BUN, between group A and group Bgroup B(P > 0.05); however, exhibited lower levels of CysC compared to group A (P < 0.05). Additionally, there were no significant differences in postoperative complications between group B and group A (P>0.05). Furthermore, one month after surgery, the one-time stone clearance rate in group B was significantly higher than that in group A (P<0.05). Conclusion: PCNL under the guidance of hologram technology can shorten the time of puncture target calyce and operation, reduce the amount of intraoperative blood loss, effectively reduce the postoperative stress reaction and inflammatory reaction of patients, reduce the level of renal injury factors, improve renal function, and increase the one-time stone clearance rate.
... Renal fusion is a rare condition in veterinary medicine but is a relatively common congenital malformation of the urinary tract in humans. [1][2][3] The three main types described in the literature are horseshoe kidneys, crossed fused renal ectopia (CFRE) and fused pelvic kidney (pancake kidney). 1 Renal fusion is often asymptomatic but has been reported in association with other congenital malformations and may predispose to several complications, such as recurrent urinary tract infections or calculi. 2 Horseshoe kidney is the most common renal fusion anomaly in humans, accounting for 90% of cases. 3 It refers to partially fused kidneys on either side of the vertebral column. ...
... [1][2][3] The three main types described in the literature are horseshoe kidneys, crossed fused renal ectopia (CFRE) and fused pelvic kidney (pancake kidney). 1 Renal fusion is often asymptomatic but has been reported in association with other congenital malformations and may predispose to several complications, such as recurrent urinary tract infections or calculi. 2 Horseshoe kidney is the most common renal fusion anomaly in humans, accounting for 90% of cases. 3 It refers to partially fused kidneys on either side of the vertebral column. ...
... 3 A fused pelvic kidney is the least common type of renal fusion described in human medicine, consisting of a complete renal fusion at the level of the pelvic cavity and two short orthotopic ureters. 1,4,5 There are several published classifications of CFRE in humans: 6 lump kidney is classified as extensive renal fusion that forms an irregular mass/lump; disc kidney displays fusion along the medial concave surface of both kidneys; inferior ectopia is when the ectopic kidney is fused to the inferior pole of the orthotopic kidney; superior ectopia is when the ectopic kidney is fused to the superior pole of the orthotopic kidney; sigmoid or S-shaped kidney is when the ectopic kidney is axially rotated and inferior to the orthotopic kidney; and L-shape kidney is characterized by the ectopic kidney being transversely oriented and the upper pole of the ectopic kidney being fused to the lower pole of the orthotopic kidney. 6,7 Inferior crossed fusion is reported to be the most common type in humans. ...
Case series summary
A retrospective multicenter case series of renal fusion anomalies in cats was investigated. The aim of this study was to describe the imaging characteristics (radiography, ultrasonography and CT) of renal ectopia and fusion in cats. A total of 13 feline patients (median age 9 years) were included in this multicentric retrospective study. Ultrasound was available in 12/13 cases, radiographs in 4/13 cases and CT in 3/13 cases. Of the 13 cases, seven were left to right fusions, four were right to left fusions, one was on the midline and one was in the pelvic inlet. Adopting a human classification system, there were five lump kidneys, four disc kidneys, one horseshoe kidney, one caudal ectopia, one L-shaped kidney and one pelvic kidney. In 2/13 cases, additional congenital malformations were noted, including an azygous continuation of the caudal vena cava and a peritoneal-pericardial diaphragmatic hernia.
Relevance and novel information
This study provides further description of the imaging findings in feline patients with fused renal ectopia. The morphologic characteristics of the fused kidneys in cats appear similar to what is published in the human literature. Renal fusion might be an incidental finding in cats, but further investigations are necessary to determine their clinical relevance.
... La FRP o riñón panqueque, por su morfología, es un tipo de ectopia renal fusionada, representa menos del 2 % de las anomalías de fusión y suele confundirse con un riñón en herradura, mucho más frecuente (90 %). [4][5][6][7][8][9][10][11] Ambos riñones están ubicados en zona lumbar baja o pelvis, fusionados longitudinalmente, sin septo que los diferencie; el sistema excretor es anterior drenado por dos uréteres que no se entrecruzan y desembocan normalmente en vejiga. Mucho más rara aún es la presencia de un solo uréter. ...
... [6][7][8] Pueden estar asociados con alteraciones de la vía urinaria: obstrucción, reflujo, duplicaciones, desembocadura anormal de uréter. 4 El diagnóstico es habitualmente accidental cuando se evalúan otras patologías congénitas q u e s e p u e d e n a s o c i a r ( t e s t i c u l a r e s , uterovaginales, cardíacas, anorrectales, óseas lumbosacras). 4-7 Suelen ser asintomáticos, pero, por su ubicación y anormal anatomía, pueden presentar complicaciones: infección, litiasis, lesión por trauma, neoplasia, quistes, lesión renal aguda. ...
... 4-7 Suelen ser asintomáticos, pero, por su ubicación y anormal anatomía, pueden presentar complicaciones: infección, litiasis, lesión por trauma, neoplasia, quistes, lesión renal aguda. 4 Histológicamente pueden presentar glomérulos inmaduros, túbulos alargados, quistes, zonas de infarto. 9 Sin embargo, esto no implica un pronóstico malo para la función renal; hasta el momento no se ha descrito algún caso de deterioro crónico por esta patología. ...
Background:
Crossed fused renal ectopia (CFRE) is an extremely rare congenital anomaly of the urinary tract that is prone to stone formation. The surgical treatment of CFRE with stones is challenging due to anatomical abnormalities.
Materials and methods:
Right kidney stones were treated by flexible ureteroscopic lithotripsy (FURSL) and left kidney stones were treated by robotic surgery.
Results:
The authors present an unreported case of bilateral renal stones in a patient with CFRE, which was successfully treated by robotic pyelolithotomy combined with FURSL. The procedure was manoeuverable, and the stone-free rate was satisfactory.
Conclusions:
CFRE with stones (S-shaped kidney) present a surgical challenge due to anatomical abnormalities and a high stone burden. The authors recommend robotic pyelolithotomy with or without FURSL as a viable treatment option for stones with similar anatomical abnormalities.
