Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/1677-5449.200156
Jornal Vascular Brasileiro
Review Article

Unilateral non-rotated left kidney with vascular and ureter variations in a cadaver: a unique case report with embryological and educational aspects

Rim esquerdo unilateral sem rotação com variações vasculares e de ureter em cadáver: relato de caso com aspectos embriológicos e educacionais

Kusum Gandhi; Judith Jaison; Eti Mantri

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Abstract

Abstract: The kidneys and ureters are retroperitoneal structures in the upper part of the paravertebral gutters, tilted against the structures on the sides of the lowest two thoracic and upper three lumbar vertebrae, so that their anterior and posterior surfaces face antero-laterally and postero-medially, respectively. Congenital anomalies of the urinary tract are often the underlying cause of renal pathologies; 40% of these pathological conditions are due to variations in location, shape, and size of the kidney(s), calyces, ureter, or bladder. This case report describes the presence of a unilateral non-rotated left kidney with vascular and ureter variations found during routine cadaveric dissection for medical graduates. Alterations in rotation of the kidney and its relation to structures at the hilum have great clinical significance when conducting surgical procedures like partial nephrectomy, nephron sparing surgery, and renal transplantation.

Keywords

kidney, non-rotation, ureter, renal arteries, partial nephrectomy

Resumo

Resumo: Os rins e o ureter são estruturas retroperitoneais localizadas na parte superior do sulco paravertebral, inclinados contra as estruturas laterais das duas vértebras torácicas inferiores e das três vértebras lombares superiores. Assim, as superfícies anteriores e posteriores estão nas porções anterolateral e posteromedial, respectivamente. As anomalias congênitas do trato urinário frequentemente são causas subjacentes de patologias renais, e 40% delas ocorrem devido a variações no local, formato e tamanho dos rins, cálices, ureter ou bexiga. Este relato de caso descreve a presença de rim esquerdo unilateral sem rotação com variações vasculares e de ureter encontradas durante uma dissecção de cadáver rotineira com graduandos de Medicina. As alterações na rotação do rim e a sua relação com as estruturas no hilo têm grande importância clínica durante procedimentos cirúrgicos como a nefrectomia parcial, a cirurgia poupadora de néfrons e o transplante renal.
 

Palavras-chave

rim, sem rotação, ureter, artérias renais, nefrectomia parcial

References

1 Romanes GJ. Thorax and Abdomen. In: Cunningham DJ, Romanes GJ, editors. Cunningham’s Manual of Practical Anatomy. Oxford: Oxford University Press; 1986.

2 Standering S. Gray’s anatomy: the anatomical basis of clinical practice. 40th ed. Elsevier Publications. 2020.

3 Adamakis I, Pournaras C, Katafigiotis I, et al. Radical cystectomy and lymphadenectomy to two patients with pelvic kidney: surgical pitfalls and considerations. Case Rep Med. 2013;841806. http://dx.doi.org/10.1155/2013/841806. PMid:24307907.

4 Benz-Bohm G. Anomalies of kidney rotation, position and fusion. In: Fotter R, editor. Pediatric Uroradiology. Medical Radiology (diagnostic imaging). Berlin: Springer; 2008. http://dx.doi.org/10.1007/978-3-540-33005-9_4.

5 Kara E, Oztürk NC, Ozgür A, Yıldız A, Oztürk H. Ectopic kidney with varied vasculature: demonstrated by CT angiography. Surg Radiol Anat. 2011;33(1):81-4. http://dx.doi.org/10.1007/s00276-010-0684-7. PMid:20556387.

6 Kelly CR, Landman J. Normal and abnormal development. In: Kelly CR, Landman J, editors. The netter collection of medical illustrations—urinary system, 2nd ed. Amsterdam: Elsevier Saunders; 2012.

7 Lim TJ, Choi SK, You HW, et al. Renal cell carcinoma in a right malrotated kidney. Korean J Urol. 2011;52(11):792-4. http://dx.doi.org/10.4111/kju.2011.52.11.792. PMid:22195271.

8 Muttarak M, Sriburi T. Congenital renal anomalies detected in adulthood. Biomed Imaging Interv J. 2012;8(1):e7. PMid:22970063.

9 Seseke F. Clinical aspects of Paediatric Urology. In: Becker W, Meller J, Zappel H, Leenen A, Seseke F, editors. Imaging in Paediatric Urology. Heidelberg: Springer-Verlag; 2003. http://dx.doi.org/10.1007/978-3-642-55785-9_1.

10 Shapiro E, Bauer S, Chow J. Anomalies of the upper urinary tract. In: Wein A, Kavoussi L, Novick A, Partin A, Peters C, editors. Campbell-Walsh Urology. 10th edn. Philadelphia: Elsevier Saunders; 2011.

11 Gulas E, Wysiadecki G, Cecot T, et al. Accessory (multiple) renal arteries - differences in frequency according to population, visualizing techniques and stage of morphological development. Vascular. 2016;24(5):531-7. http://dx.doi.org/10.1177/1708538116631223. PMid:26945775.

12 Bergman R, Tompson S, Aff A, Saadeh F. Compendium of Human Anatomic Variation: Text, Atlas, and World Literature. Munich: Urban & Scharzenberg, Inc.; 1988.

13 Koc Z, Ulusan S, Oguzkurt L, Tokmak N. Venous variants and anomalies on routine abdominal multi-detector row CT. Eur J Radiol. 2007;61(2):267-78. http://dx.doi.org/10.1016/j.ejrad.2006.09.008. PMid:17049792.

14 Atwell JD, Cook PL, Howell CJ, Hyde I, Parker BC. Familial incidence of bifid and double ureters. Arch Dis Child. 1974;49(5):390-3. http://dx.doi.org/10.1136/adc.49.5.390. PMid:4834020.

15 Whitaker J, Danks DM. A study of the inheritance of duplication of the kidneys and ureters. J Urol. 1966;95(2):176-8. http://dx.doi.org/10.1016/S0022-5347(17)63429-3. PMid:5903033.

16 Alberts VP, Minnee RC, Pant KAD, et al. Duplicated ureters and renal transplantation: a case-control study and review of the literature. Transplant Proc. 2013;45(9):3239-44. http://dx.doi.org/10.1016/j.transproceed.2013.06.012. PMid:24182792.

17 Pollak R, Prusak BF, Mozes MF. Anatomic abnormalities of cadaver kidneys procured for purposes of transplantation. Am Surg. 1986;52(5):233-5. PMid:3518559.

18 Dunnwald M, Pizzimenti MA. A case study of Malrotated Kidneys with asymmetric multiple renal arteries, variant venous drainage, and unilateral ureteral duplication. Case Rep Vasc Med. 2019;2019:1893137. http://dx.doi.org/10.1155/2019/1893137. PMid:31011461.

19 Barakat AJ, Drougas JG. Occurrence of congenital abnormalities of kidney and urinary tract in 13,775 autopsies. Urology. 1991;38(4):347-50. http://dx.doi.org/10.1016/0090-4295(91)80150-6. PMid:1755145.

20 Daneman A, Alton DJ. Radiographic manifestations of renal anomalies. Radiol Clin North Am. 1991;29(2):351-63. PMid:1998056.

21 Satyapal KS, Haffejee AA, Singh B, Ramsaroop L, Robbs JV, Kalideen JM. Additional renal arteries: incidence and morphometry. Surg Radiol Anat. 2001;23(1):33-8. http://dx.doi.org/10.1007/s00276-001-0033-y. PMid:11370140.

22 Willan PL, Humpherson JR. Concepts of variation and normality in morphology: important issues at risk of neglect in modern undergraduate medical courses. Clin Anat. 1999;12(3):186-90. http://dx.doi.org/10.1002/(SICI)1098-2353(1999)12:3<186::AID-CA7>3.0.CO;2-6. PMid:10340459.

23 Sadler TW. Urogenital system. In: Langman J, editor. Langman’s medical embryology. 12th ed. USA: Lippinott Williams & Wilkins; 2012.

24 Moore KL, Persaud TVN. The cardiovascular system. In: Moore KL, Persaud TVN, editors. The developing human: clinically oriented Embryology. 7th ed. Philadelphia: Saunders; 2003.

25 Schoenwolf GC, Bleyl SB, Brauer PR, FrancisWest PH. Larsen’s human Embryology. 4th ed. Philadelphia: Churchhill Livingstone; 2009. Development of the vasculature. p. 385-432.
 


Submitted date:
08/21/2020

Accepted date:
10/05/2020

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">
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