Pelvic kidney

A pelvic kidney is the most common type of renal ectopia and occurs in 1 700 live births.1Caiulo V.A. Caiulo S. Gargasole C. et al.Ultrasound mass screening for congenital anomalies urinary tract.Pediatr Nephrol. 2012; 27: 949-953Crossref PubMed Scopus (50) Google Scholar Pelvic kidneys are usually smaller than expected gestational age have an aberrant blood supply. Most these malrotated on their vertical axis, with hilum facing anteriorly instead medially toward spine. one located below aortic bifurcation presacral area. The location results from failure ascent early embryonic development. discovered when empty fossa prompts a thorough search absent kidney. Demonstration within pelvis can be challenging because bowel acoustic shadowing iliac wings.2Meizner I. Yitzhak M. Levi A. Barki Y. Barnhard Glezerman Fetal kidney: challenge prenatal diagnosis?.Ultrasound Obstet Gynecol. 1995; 5: 391-393Crossref (23) Furthermore, small size, diagonal or horizontal orientation, make visualization more challenging. Frequently, dilation collecting system cystic dysplasia further confound ultrasonographic diagnosis distortion normal anatomy. However, reniform structure between vessels coronal view adjacent to bladder suggests location, even if appearance somewhat atypical (Figure 1). Color Doppler tracing supply distal aorta, bifurcation, vessel may provide supportive evidence presence Not infrequently, follow-up examination helpful visualizing ectopic kidney, as echogenicity changes age. Occasionally, absence overlooked loops mistaken close inspection transverse parasagittal views will reveal slit-like lack hypoechoic medullary pyramids converging hilum. Other clues loss boomerang shape adrenal gland, which appear flattened, elongated, “lying down” plane 2), inability demonstrate artery using color Doppler.3Hoffman C.K. Filly R.A. Callen P.W. sign: sonographic indicator agenesis fetuses neonates.J Ultrasound Med. 1992; 11: 533-536Crossref (44) Scholar,4Majmudar Cohen H.L. “Lying-Down” there exceptions rule Among 2017; 36: 2599-2603Crossref (3) contralateral bladder, genitalia should carefully assessed well. Rarely, both pelvis. Nearly 50% affected by hypoplasia, dysplasia, hydronephrosis.5Batukan Yuksel Prenatal postnatal outcome kidneys.Prenat Diagn. 2011; 31: 356-359Crossref (4) conditions rarely correlate adverse prognosis fetus.5Batukan Although vesicoureteral reflux identified 80% during childhood, it resolves over time conservative management.5Batukan Scholar,6Arena F. Arena Paolata Campenni Zuccarello B. Romeo G. Is complete urological evaluation necessary all newborns asymptomatic ectopia?.Int J Urol. 2007; 14: 491-495Crossref (28) Dysplasia affects 4% cases.7Guarino N. Tadini Camardi P. Silvestro L. Lace R. Bianchi incidence associated abnormalities children ectopia.J 2004; 172: 1757-1759Crossref (87) Contralateral hydronephrosis requiring surgical intervention, such that caused ureteropelvic junction (UPJ) obstruction, uncommon, occurring 5% cases.6Arena Coexisting single umbilical cardiac intracranial been reported.5Batukan Hypospadias cryptorchidism males genital affecting females seem slightly increased pediatric series.5Batukan Scholar, 6Arena 7Guarino masses, including teratoma, neuroblastoma, supernumerary ovarian mesenteric cysts, considered. An 47% cases 42% cases, pelvis.8Chow J.S. Benson C.B. Lebowitz R.L. clinical significance sonography.J 2005; 24: 1049-1054Crossref (18) In some missing fused unusual other (eg, diaphragmatic hernia) present.8Chow Chromosomal rare isolated If no noted ultrasound family history unremarkable, genetic beyond standard aneuploidy typically recommended. additional nongenitourinary present, amniocentesis chromosomal microarray analysis (CMA) offered. Syndromic conditions, VACTERL (vertebral defects, anal atresia, tracheoesophageal fistula, anomalies, limb abnormalities) CHARGE (coloboma, heart atresia choanae [choanal atresia], growth restriction, ear anomalies), considered multiple anomalies.9Sahay Congenital tract (CAKUT).Clinical Queries: Nephrology. 2013; 2: 156-165Abstract Full Text PDF Scholar,10Wellesley D. Howe D.T. syndromes.Prenat 2001; 21: 992-1003Crossref (22) consanguinity, specific condition, gene panel testing exome sequencing sometimes useful CMA does not detect single-gene (Mendelian) disorders. pursued, appropriate pretest posttest counseling provider experienced complexities genomic After counseling, cell-free DNA option patients who decline diagnostic evaluation, particularly suspected. detailed anatomic survey focusing genitourinary cardiovascular systems performed exclude anomalies. fetal echocardiogram anomaly third trimester pregnancy assess late development warranted, consultation urology nephrology specialists review childhood follow-up. finding affect timing mode delivery, based usual obstetrical indications. favorable although function reduced.11van den Bosch C.M. van Wijk J.A. Beckers G.M. der Horst H.J. Schreuder M.F. Bökenkamp Urological nephrological findings 2010; 183: 1574-1578Crossref (36) Generally, involving either improves Surgical intervention UPJ obstruction) needed hypertension, until young adulthood recommended.11van infections nephrolithiasis reported adults.12Singer Simmons M.Z. Maldjian P.D. Spectrum presenting adulthood.Clin Imaging. 2008; 32: 183-191Abstract (14) relies high index suspicion recognizing fossa. Direct requires focused gray scale due challenges posed bones and, occasionally, appearance. Amniocentesis warranted only additional, extragenitourinary malformations present. Obstetrical management altered, generally good.