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Isthmus undivided bilateral nephrectomy in a patient with polycystic horseshoe kidney.

Yao XL, Jin BY, Wang YM, Wang YM - Chin. Med. J. (2015)

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, The First Affiliated Hospital of Medical College, Zhejiang University, Hangzhou, Zhejiang 310003, China.

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Horseshoe kidney is a type of renal fusion by the lower poles anomaly during embryogenesis... She complained of recurrent fever and hematuria and was admitted to hospital for bilateral nephrectomy in controlling severe kidney infection and preparation for renal transplantation... She felt recurrent attacks of bilateral loin pains without rigors and vomiting and medications did not improve the situation... Horseshoe kidney is the most common type of renal fusion with the incidence of 1 in 400–1 in 800... Great attention was paid in our procedures to prevent heavy bleeding when isolating the isthmus from the inferior vena cava abdominal aorta lying under the isthmus... There are two advantages of isthmus undivided bilateral nephrectomy of a polycystic horseshoe kidney versus cutting isthmus... On one hand, the isthmus is usually thick with rich blood supply, keeping the isthmus intact could dramatically reduce the risk of bleeding and save operation time... On the other hand, the cysts of the kidney are often accompanied by infection... Our approach prevented the infected fluid entering into the peritoneal cavity, which could cause severe infection after operation... Additionally, more CO2 would be absorbed in laparoscopic procedure that could increase the risk of acidosis especially for the patient with end stage renal failure, maybe our method was better in this special situation.

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Computed tomography scan of the patient showing renal fusion and massive cysts.
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Figure 1: Computed tomography scan of the patient showing renal fusion and massive cysts.

Mentions: A 59-year-old woman with end-stage renal failure secondary to polycystic kidneys had been on peritoneal dialysis for 15 months. She complained of recurrent fever and hematuria and was admitted to hospital for bilateral nephrectomy in controlling severe kidney infection and preparation for renal transplantation. She felt recurrent attacks of bilateral loin pains without rigors and vomiting and medications did not improve the situation. Her laboratory findings were as follows: white cell count 9.0 × 109/L, hemoglobin 69 g/L, platelets 317 × 109/L, serum urea 11.1 mmol/L, serum creatinine 694 μmol/L. Abdominal ultrasonography and computed tomography (CT) scan presented enlarged bilateral polycystic kidney fusing across the midline without stone and tumor as shown in Figure 1. The contrast CT scan needed to take a lot of contrast agent by injection that was harmful to the renal function, so there was no three-dimensional or reconstructed picture shown here.


Isthmus undivided bilateral nephrectomy in a patient with polycystic horseshoe kidney.

Yao XL, Jin BY, Wang YM, Wang YM - Chin. Med. J. (2015)

Computed tomography scan of the patient showing renal fusion and massive cysts.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4834786&req=5

Figure 1: Computed tomography scan of the patient showing renal fusion and massive cysts.
Mentions: A 59-year-old woman with end-stage renal failure secondary to polycystic kidneys had been on peritoneal dialysis for 15 months. She complained of recurrent fever and hematuria and was admitted to hospital for bilateral nephrectomy in controlling severe kidney infection and preparation for renal transplantation. She felt recurrent attacks of bilateral loin pains without rigors and vomiting and medications did not improve the situation. Her laboratory findings were as follows: white cell count 9.0 × 109/L, hemoglobin 69 g/L, platelets 317 × 109/L, serum urea 11.1 mmol/L, serum creatinine 694 μmol/L. Abdominal ultrasonography and computed tomography (CT) scan presented enlarged bilateral polycystic kidney fusing across the midline without stone and tumor as shown in Figure 1. The contrast CT scan needed to take a lot of contrast agent by injection that was harmful to the renal function, so there was no three-dimensional or reconstructed picture shown here.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, The First Affiliated Hospital of Medical College, Zhejiang University, Hangzhou, Zhejiang 310003, China.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Horseshoe kidney is a type of renal fusion by the lower poles anomaly during embryogenesis... She complained of recurrent fever and hematuria and was admitted to hospital for bilateral nephrectomy in controlling severe kidney infection and preparation for renal transplantation... She felt recurrent attacks of bilateral loin pains without rigors and vomiting and medications did not improve the situation... Horseshoe kidney is the most common type of renal fusion with the incidence of 1 in 400–1 in 800... Great attention was paid in our procedures to prevent heavy bleeding when isolating the isthmus from the inferior vena cava abdominal aorta lying under the isthmus... There are two advantages of isthmus undivided bilateral nephrectomy of a polycystic horseshoe kidney versus cutting isthmus... On one hand, the isthmus is usually thick with rich blood supply, keeping the isthmus intact could dramatically reduce the risk of bleeding and save operation time... On the other hand, the cysts of the kidney are often accompanied by infection... Our approach prevented the infected fluid entering into the peritoneal cavity, which could cause severe infection after operation... Additionally, more CO2 would be absorbed in laparoscopic procedure that could increase the risk of acidosis especially for the patient with end stage renal failure, maybe our method was better in this special situation.

Show MeSH
Related in: MedlinePlus