Combined approach for non-functioning moiety of crossed fused kidney

摘要

Abstract Aim We report the combined approach for the treatment of non-functioning moiety of a mal-rotated crossed fused kidney.Methods A 2 year-old boy presented with recurrent UTI and haematuria in the context of an anorectal malformation and a crossed fused ectopic right kidney with gross ureteric dilatation. Ultrasound, MRI and CT angiogram showed a complex renal unit in the right flank comprising of two moieties. The “posterior” non-functioning moiety gave rise to a markedly dilated refluxing ureter. The “anterior” larger moiety with more normal renal tissue had a non-dilated ureter. The CT revealed complex vascular pattern proving an excision of the moiety to be quite risky to the normal moiety. Selective embolization of the non-functioning moiety was performed by Interventional Radiology with 250-micron particles through an anti-reflux catheter and three detachable coils. 2 days later, he underwent an uneventful laparoscopic ureterectomy.Results There was a mild increase in serum creatinine post-embolization which returned to baseline after ureterectomy. Postoperative ultrasound with Doppler showed that the vascularity was preserved in the functioning residual anterior moiety. At 12 months follow-up he remains asymptomatic with no further haematuria or UTI.Conclusion Clinically indicated approach to removal of renal moieties in complex fusion anomalies requires a multimodal strategy. This is especially important when the intention is nephron sparing and should include appropriate post-embolization syndrome management.