Right to Left Crossed Fused Renal Ectopia: An Incidental Finding in Cadaveric Dissection

Abstract

Development of the kidney begins in the sacral region during the 4th week of gestation. As the development progresses, kidneys ascend to reach their adult position in the upper portion of the posterior abdominal wall. During the complex process of ascension, several different congenital anomalies have been shown to develop.Congenital urinary tract and renal malformations are not uncommon. One such anomaly is the fusion of the kidneys during the early embryonic period called crossed fused renal ectopia (CFRE). CFRE is a rare type of congenital malformation where both kidneys are situated on one side of the midline. In about 90% of cases, the crossed ectopic kidney is fused with the normally placed contralateral kidney. Prevalence of CFRE is estimated to be 1:1300 to 1:7500 (Turkvatan et al 2009, Bauer SB 2002). This anomaly is usually detected as incidental finding as it is often asymptomatic.We present a case of a crossed fused renal ectopia (CFRE), discovered by freshman medical students during a cadaveric dissection in a gross anatomy course at the University of Arkansas for Medical Sciences (UAMS). The body donor was a middle‐aged Caucasian female whose death was attributed to natural causes. In this case, the right kidney was positioned inferiorly and transversely fused with the lower pole of the left kidney, resulting in a single fused L‐shaped kidney (MC Donald and MC Clellan, 1957) at the gross level. The renal vascular supply was also unusual. The left renal artery arose from the normal position as a lateral branch of the abdominal aorta. Whereas, the right ectopic kidney was supplied by three arterial branches: a branch from the anterior aspect of the abdominal aorta, a second branch from the left common iliac artery and a third branch from the point of bifurcation of the abdominal aorta. In addition, the inferior mesenteric artery arose from the abdominal aorta at a much higher level than normal. It was at the level of the L1/L2 intervertebral disc. The ureteric openings in the bladder were more inferior than usual. Several small cysts were found on the kidney surface and microscopic examination of a biopsy samples from the ectopic right kidney revealed nephrosclerosis.CFRE with vascular anomalies can be clinically confusing as it would give rise to symptoms in the lower abdomen rather than in the loin. As such, surgeons who encounter this during abdominal procedures need to be aware of the multiple aberrant arteries that can make vascular control a challenge.Support or Funding InformationSupportTwo UAMS Departments: a) Neurobiology and Developmental Sciences, b) PathologyThis abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.