Aneurisma de aorta abdominal sintomático associado a rim em ferradura / Symptomatic abdominal aortic aneurysm in a patient with a horseshoe kidney

Resumo O rim em ferradura é a anomalia congênita renal mais comum, ocorrendo em 0,15 a 0,25% de nascidos vivos. A associação de rim em ferradura com aneurisma de aorta abdominal é rara, estando presente em apenas 0,12% dos pacientes submetidos a tratamento dos aneurismas de aorta abdominal. Este desafio terapêutico consiste em um caso de um paciente portador de um aneurisma de aorta abdominal sintomático associado a rim em ferradura. A irrigação do rim em ferradura dava-se por meio de quatro artérias, sendo que duas delas emergiam diretamente do saco aneurismático. O caso foi solucionado por meio de cirurgia aberta, em caráter de urgência, com acesso transperitoneal, interposição de enxerto de Dacron bifurcado aorto bi-ilíaco e reimplante das duas artérias renais anômalas no corpo principal do Dacron. O paciente teve boa evolução pós-operatória, recebendo alta da unidade de tratamento intensivo no 3º dia e alta hospitalar no 8º dia, mantendo níveis normais de creatinina sérica.

Abstract Horseshoe kidney is the most common congenital renal anomaly, occurring in 0.15-0.25% of newborns. The association of a horseshoe kidney with an abdominal aortic aneurysm is rare. Only 0.12% of patients requiring abdominal aortic repair have a horseshoe kidney. This therapeutic challenge constitutes a patient presenting with a symptomatic abdominal aortic aneurysm and a horseshoe kidney. The horseshoe kidney was supplied by 4 renal arteries, 2 of which emerged from the aneurysmal sac. The patient underwent urgent open repair, with transperitoneal exposure, interposition of a bifurcated aorto-bi-iliac Dacron graft and re-implantation of the 2 anomalous renal arteries on the Dacron main body. Postoperatively, the patient was discharged from the intensive care unit on day 3, and discharged home on day 8, maintaining normal serum creatinine.

Rim em Panqueca ­ Um Achado Incomum / Pancake Kidney ­ An Unusual Finding

Introdução: o rim em panqueca foi descrito pela primeira vez por Looney e Dodd (1926), mas apresenta outras nomenclaturas como "bolo", "disco", "rosca" e "rim em escudo", porque produz uma massa em forma de anel ou em forma de rosca. É uma ectopia renal congênita fundida muito rara. Objetivo: relatar um caso raro de rim em panqueca associado a apendicite. Materiais e Métodos: revisão do prontuário, registro fotográfico dos métodos diagnósticos e revisão da literatura. Resultados: jovem de 15 anos de idade, do sexo masculino, com dor em cólica no hipogástrio há dois dias com vômitos há um dia. A tomografia computadorizada demonstrou apendicite e uma massa lobulada fundida situada na cavidade pélvica que se estende de L2 a L4 com ureteres inserindo-se separadamente na bexiga urinária, caracterizando rim em panqueca. Conclusão: relatamos um caso de rim em panqueca, entidade muito rara e pouco relatada na literatura médica, muitas vezes insuspeitada na avaliação clínica inicial, porém que pode causar complicações, tais como a litíase renal e a hipertensão arterial.

Introduction: pancake kidney was first described by Looney and Dodd, but presents other nomenclatures such as "cake", "disk", "doughnut" and "shield kidney" because it produces a ring-shaped or doughnut-shaped mass. It is a very rare fused congenital renal ectopia. Objective: to report a rare case of pancake kidney associated with appendicitis. Materials and Methods: We carried out a review of medical records, photographic record of diagnostic methods and review from the literature. Results: 15 year old male patient with colic pain in the hypogastrium two days ago with vomiting a day ago. Computed tomography scan showed appendicitis and a fused lobulated mass located in the pelvic cavity extending from L2 to L4 with ureters inserting separately into the urinary bladder, characterizing pancake kidney. Conclusion: pancake kidney is an entity very rare and little reported in the medical literature, often unsuspected in the initial clinical evaluation, but that can lead to complications such as renal lithiasis and arterial hypertension.

Open Surgical Repair of Abdominal Aortic Aneurysm Coexisting with Horseshoe Kidney

Horseshoe kidney (HSK) is the most common congenital abnormality of the urologic system encountered during abdominal aortic aneurysm (AAA) surgery. Here, the authors report a case of AAA coexisting with HSK that was successfully treated by open surgery. Two accessory renal arteries of 2.5 mm and 3.1 mm were reimplanted. One of the implanted arteries later occluded and infarct of the isthmus developed, but there was no impairment of renal function. The authors discuss the complexity of the surgical treatment of AAA coexisting with HSK, and place focus on which accessory renal arteries should be reconstructed.

Renal Cell Carcinoma in a Horseshoe Kidney and Preoperative Superselective Renal Artery Embolization: A Case Report

Only rarely is renal cell carcinoma encountered in a horseshoe kidney. This is a case report on renal cell carcinoma in a horseshoe kidney, in which superselective renal artery embolization was performed preoperatively. CT and digital subtraction angiography revealed a horseshoe kidney with a 3-cm tumor in the left side. Superselective renal artery embolization of the tumor was performed as a prerequisite procedure for the organ-preserving surgery of simple enucleation. Preoperative superselective renal artery embolization can be an effective tool to facilitate organ-preserving surgery in a horseshoe kidney.

Expression of EGF mRNA in renal parenchyma of congenital hydronephrosis in children / 中华泌尿外科杂志

Objective To detect the expression of EGF mRNA in renal parenchyma in congenital hydronephrosis in children and to evaluate the role of EGF in causing chronic renal damage. Methods The expression of EGF mRNA in renal parenchyma, renal pelvis and PUJ tissues from congenital hydronephrosis in children was studied by means of RT PCR. Results The expression of EGF in the aff ected renal parenchyma and PUJ tissues decreased.It also decreased in the affected pelvis but the difference was not significant. The decrease of EGF expression was the most obvious in the affected renal parenchyma. Conclusions EGF expression decreased in renal parenchyma in congenital hydronephrosis and the decrease might be related to the chronic renal damage and renal atrophy caused by hydronephrosis.

Peripelvic and Perirenal Lymphangiectasia and Bilateral Renal Vein Thrombosis: A Case Report

We report the computed tomography (CT) and magnetic resonance imaging (MRI) findings in a patient with peripelvic and perirenal lymphangiectasia associated with bilateral renal vein thrombosis. CT scanning revealed multiple hypodense masses in the bilateral peripelvic and perirenal space, and on MR images, these masses had a multiple cystic appearance, with low signal intensity on T1-weighted and high signal intensity on T2-weighted images. CT, MR, and renal angiography failed to visualize bilateral renal veins, though serpigi-nous collateral veins were seen in the perirenal spaces.

Fused Cake Kidney Combined with Hypoplastic Thumb: A Case Report

During embryologic development, many renal anomalies, including fusion and ectopia, can occur. Among them, fused cake kidney is a rare developmental anomaly. We report a case in which this condition was combined with hypoplastic thumb. Ultrasonographic, scintigraphic, CT and MRI findings of this rare condition are presented.

Focal Xanthogranulomatous Pyelonephritis: Reports of 2 Cases

Xanthogranulomatous pyelonephritis is a chronic inflammatory condition which in most cases involves either an entire non-duplicated kidney or a moiety of a duplicated kidney. These cases present with quite characteristic radiologic findings including an enlarged non functioning kidney and renal stones. However, when the condition involves only a part of a non-duplicated kidney and especially where there is an absence of the specific findings described above, differentiation from cystic neoplasm may be difficult. We report the radiologic findings of twosuch cases of focal xanthogranulomatous pyelonephritis.