236

J Anat. Soc. India 51(2) 236-238 (2002)

Ectopic Kidney and associated anomalies : A Case Report

Belsare S.M; Chimmalgi M., Vaidya S.A. & Sant S.M.
Department of Anatomy, B.J. Medical College, Pune, India.
Abstract. A case of ectopic kidney of left side was found during routine dissection in the department of Anatomy. It was associated
with multiple visceral and vascular variations. Visceral variations were in the form of mechanical displacement of sigmoid colon and
mesocolon to the right side, compensatory hypertrophy of the right kidney, consequential absence of renal impression on the spleen,
enlarged uterus and displaced ovary. Thus it involved multiple systems. Vascular variations included multiple renal vessels on both the
sides, variations in abdominal aorta and inferior venacava, variations in the gonadal vessels, etc. An attempt has been made to
systematically document these variation and give possible explanations for the same on the basis of ontogeny.
Although the ectopic kidneys are often nonfunctional, cases of lithiasis or formation of renosigmoid fistulae have been reported in
relation to pelvic kidney. In such cases nephrectomy forms the choice of treatment, an effort to save the kidney being made only if the
kidney is found to be functioning normally.
Key words :
aortic bifurcation

Ectopic Kidney, inferior venacava (IVC), subcardinal vein, renosigmoid fistulae, lithiasis, inferior phrenic arteries,

Introduction :

kidney was passing downwards, forwards and to the

left.

Urinary tract anomalies form a long and

exhaustive list. Congential anomalies of urinary tract
are often the underlying causes of pathologies.
According to Guiterrez, 40% of pathologic conditions
of the urinary system are due to these variations.
Variations may be in the number, position, shape
and size or in rotation of kidney(s), calyces, ureter(s)
or bladder. Usually these anomalies are associated
with anomaleis of vertebral column, lower
gastrointestinal tract, genital tract or spinal cord and
meninges.
Ectopic kidney has a reported frequency of
1:500 to 1:110; ectopic thoracic kidney 1:13000;
solitary kidney 1:1000; solitary pelvic kidney
1:22000; one normal and one pelvic kidney 1:3000;
and crossed renal ectopia 1:7000 (Bergman et al).
We are reporting a case of ectopic kidney with
associated anomalies found during the routine
dissection in the department of Anatomy.
Observations :
A case of unilateral ectopic kidney was found
during routine dissection in a female cadaver of
Indian origin (fig. 1). Right kidney was normal in
position. Left kidney was situated anterior to the
bodies of L5, S1 and S2 vertebrae. It was oval in
shape and measured 14 cm vertically, 10 cm
transversely and 4.5 cm in its thickness. Its dorsal
surface was smooth; ventral surface was marked
with hilum and was lobulated. Long axis of the left

Upper pole of the kidney was close to the

midline, related to the left common iliac vessels
superiorly. Lower pole, situated in the true pelvis
was tilted to the left approaching the left lateral
pelvic wall. Right margin was related to sigmoid
mesocolon and colon, which were pushed to the
right ilac fossa. Left margin was related to left
common iliac vessels, left internal iliac vessels and
left ovarian vessels from above downwards. Dorsal
surface was related to bodies of 5th lumbar, 1st and
2nd sacral vertebrae. Ventral surface was related
largely to the coils of intestines and in its lower part
to the uterus and to the left ovary.
Ventral surface was characteristically marked
by a large hilum, occupied by the renal pelvis. The
ureter coursed around the body of uterus and
crossing over the uterine artery it opened into the
urinary bladder. From the right superior quadrant of
the hilum, main renal vein emerged; ascending in
front of the kidney and right common ilac vessels, it
drained into ventral aspect of inferior vena cava.
A pair of renal vessels emerged from left
upper quadrant of the hilum. Artery was a ventral
branch of the abdominal aorta arising 1 cm proximal
to the aortic bifurcation. Accompanying vein was a
tributary of left common iliac vein. Close to the
lower pole, another set of renal vessels emerged
from the ventral surface (not seen in the picture)
and these were branch/tributary of internal iliac
vessels.
J. Anat. Soc. India 51(2) 236-238 (2002)

Belsare S.M. et al

Other associated anomalies seen were :

(a)

Enlarged right kidney with two renal veins both draining into IVC and two renal arteries.
The renal arteries were lateral branches of
abdominal aorta, one was retrocaval and
another was passing in front of IVC.

(b)

Sigmoid colon and mesocolon was shifted to

the right side.

(c)

Uterus was enlarged to 12-14 weeks' size and

was firm in consistency. On section, it showed
caseation.

(d)

Left ovary was in recto-uterine or rather

nephro-uterine pouch.

(e)

Left overian vessels drained into left common

iliac vessels.

(f)

Right ovarian vein drained into lower right

renal vein.

(g)

Left suprarenal vein drained into IVC directly.

(h)

Inferior phrenic arteries were arising by a

common trunk as the first ventral branch of
abdominal aorta.

(i)

As a consequence of ectopic kidney, spleen

showed no renal impression.

Discussion :
Cases of ectopic kidney, unilateral or bilateral
have been reported in the literature regularly (Moore
& Parsaud, 1999; Hollinshead, 1971; Benjamin &
Tobin, 1951; Baurys, 1951; Gray and Skandalakis
1972 etc.) Incidence of ectopic kidney reported in
literature is 1:500 to 1:110. Incidence of one normal
and one pelvic kidney is 1:800 to 1:3000 (Gray and
Skadalakis 1972). In our case the kidney was not
entirely pelvic, its upper pole being at the level of
L5. This position is due to halt in its ascent during
the development. It was interesting to note a series
of other anomalies associated with it. As a
consequence to left kidney being ectopic, spleen did
not show the renal impression. Sigmoid colon along
with mesocolon was pushed to the right side as the
ectopic kidney occupied its normal site. For the
same reason, ovary was found in the recto uterine
(nephrouterine) pouch. Possibly because of ectopic
kidney being nonfunctional or less functional, right
J. Anat. Soc. India 51(2) 236-238 (2002)

237

kidney was enlarged as a compensatory

mechanism. In addition to these, uterus was
enlarged to 12 to 14 weeks' size and this variation
seems to have no relation to the existence of
ectopic kidney. Left ureter was crossing over the
uterine artery instead of passing under it.
In ectopia, the vascularization pattern remains
frozen at whatever development stage the ascent
ceases (Gray & Skandalakis 1972). Un-ascended
kidney seen by us showed multiple vessels - two
arteries and three veins. It is to be expected
because the ascending kidney receives blood supply
from neighbouring vessels. In this case, as the
ascent of left kidney has been arrested at the level
of junction between the common iliacs with aorta/
inferior venacava, it is being supplied by these
vessels. In order to accommodate the changes in
blood supply to the ectopic kidney, both abdominal
aorta and IVC showed certain variations.
Abdominal aorta had five ventral branches. In
addition to the normal three branches it had the
common trunk of inferior phrenics as its first ventral
branch. Left renal artery was the last ventral branch
given just before aortic bifurcation. It was interesting
to note that even though right renal arteries (two)
were lateral branches, left renal was a ventral
branch. Left gonadal artery was arising from left
common iliac instead of from aorta. Three veins
drained left kidney. The main vein drained into IVC
on its ventral aspect; the vein accompanying the
main renal artery drained into left common iliacs
and the vein emerging from the lower pole drained
into the left internal iliac vein. Hence, IVC received
left renal vein as its first tributary on its ventral
aspect. Other changes seen in IVC were the left
suprarenal vein draining into it directly. In this case,
the left suprarenal vein must have developed from
incorporating a segment of left subcardinal vein and
the intersubcardinal anastomosis, which would be
part of left renal vein in the normal course.
Gonadal veins also deviated from the normal
on both the sides; the right drained into the lower
right renal vein and the left drained into left common
iliac vein. In the early fetal life the lower renal vein
must have drained into the right subcardinal vein.
Subsequently this part of the subcardinal may have
been incorporated into the right lower renal vein.

Ectopic Kidney

238

The gonadal vein developing from the caudal part of

the subcardinals therefore must have formed the
tributary of the right lower renal vein. The left side
gonadal vessels were branch/tributary of left
common iliac vessels. Ascent of kidney preceedes
descent of gonads, which reach pelvic brim by 28th
week of intra-uterine life. The left kidney at the
pelvic brim must have allowed formation of multiple
vascular channels at that level. When the ovary
descended to this level these channels must have
established secondary communications with the
ovarian
vessels.
Subsequently,
these
communications must have persisted as definitive
ovarian vessels - thus explaining their drainage into
common iliacs and the original vessels from aorta
and IVC must have disappeared.

2.

Baurys W. (1951): Fused pelvic kidneys. Journal of Urology.

65: 781-783.

3.

Benjamin J.A. and Tobin C.E. (1951): Abnormalities of

kidneys, ureters and perinephric fascia - Anatomic and
clinical study Journal of Urology. 65: 715-733.

4.

Bergman R.A., Afifi A.K. and Miyauchi R In: Illustrated

Encyclopedia of human anatomic variation. opus IV: Organ
system: Urinary system: Kidneys, ureters, bladders and
urethra @ www/virtual hospital.com.

5.

Gray S.E. and Skandalakis J.E. Embryology for surgeons The embryological basis for the treatment of congenital
defects. W.B. Saudners Co. Philadelphia. London. Toronto
pp. 472-474 (1972).

6.

Hollinshead H.W. Anatomy for surgeons - The thorax,

abdomen, and pelvis. In: Kidneys, ureters and suprarenal
glands. 2nd Edn; Vol II. Harper and Row Publishers,
Newyork. Evanston. San-fransisco. London. pp 548-550
(1971).

7.

Moore, K.L. and Persaud T.V.N. The developing human Clinically oriented embrylogy. In: Urological system 6th Edn;
W.B. Saunders Co. Philadelphia pp 312 (1999).

Unilateral ectopic kidney is commoner than

bilateral. It is also found that congenital pelvic
kidney is commoner on left side than on the right. In
our case, the ectopia was unilateral and on the left
side in accordance with the findings of others. The
frequency is quoted to be higher in males than in
females. In our case it was found in a female
cadaver.
Kidneys in ectopic (pelvic) position are
dysplastic and often non-functional. They may go
undetected in life and get noticed only after death
either in autopsy or during dissection. Often they are
diagnosed for presence of a pelvic mass or on
pyelogram. Ectopic or congenital unascended
kidney has to be carefully differentiated from
(acquired) nephroptosis where the length of the
ureter is normal. Symptoms due to ectopic kidney
may vary from none to pain; hydronephrosis,
pyelonephritis, renosigmoid fistulae or lithiasis (Gray
and Skandalasi 1972). In case of females, the pelvic
kidney may result in obstetric complications (Banner
1965).
Treatment is mainly based on the functional
capacity of the kidney; nephrectomy being done on
non-functional kidneys and corrective procedures
forming the mainline of treatment for the functional
kidneys.
References :
1.

Banner E.A. (1965): The ectopic kidney in obstetrics and

gynaecology. Surgery, Gynaecology and Obstetrics. 121: 3236.
J. Anat. Soc. India 51(2) 236-238 (2002)

Opp. 236

Ectopic Kidney

Fig. 1
Photograph of a dissected specimen showing (a) Left kidney
(b) Left main renal v. (c) Left renal a. (d) IVC (e) Aorta (f)
Right kidney (g) uterus (h) left ovary (i) left ovarian vessels (j)
right ovarian vessels (k) left pelvis and ureter