Bilateral duplex collecting system in horse shoe kidney: an unusual association.

A 17 years unmarried female presented to Gastroenterology Department of our hospital for nonspecific symptoms of epigastric pain. The Ultrasonographic examination of the patient revealed triple kidney with horseshoe anomaly. She was then referred to us for further evaluation. We further proceed with Intravenous Urography (IVU) which demonstrated a bilateral duplex system in a asymmetrical horseshoe kidney (L shaped fusion). Left side kidney was vertically placed while the right side kidney was horizontally placed. One of the moieties was on the right side of vertebral column while the other moiety was overlying the vertebra and isthmus was on the left side of vertebra (Figure-1). A contrast enhanced computed tomography (CECT) scan confirmed the diagnosis of bilateral duplex system in horseshoe kidney (Figure-2). As the patient had non-specific, unrelated symptoms, patient was give symptomatic treatment for the same and was advised regular follow-up. Duplicated collecting systems (also known as duplex collecting systems) can be defined as renal units containing two pyelocaliceal systems that are associated with a single ureter or with double ureters. The prevalence of Partial duplication is 0.6%, while complete duplication of ureters occurs in 0.2% of live births (1). When a single ureteral bud bifurcates before the ampulla bifurcates, a duplex kidney with a bifid renal pelvis or bifid ureter results (2). Congenital anomalies of the kidneys include a group of so-called fusion anomalies, in which both kidneys are fused together in early embryonic life. Fusion anomalies of the kidneys can generally be placed into 2 categories: [1] horseshoe kidney and its variants and [2] crossed fused ectopia. Horseshoe kidney is probably the most common fusion anomaly. The term horseshoe kidney refers to the appearance of the fused kidney, which results from fusion at one pole. Horseshoe kidney is the most common renal fusion anomaly, the incidence being about 1