Bilateral staghorn calculus ( although more pronounced on one side ) with hydronephrosis. Will not be amenable to any percut. procedures and lithotripsy is out of the question. Any delay in proceeding to surgery will increase filtration pressures in the better kidney ....leading to FSGS ( focal segmental glomerulosclerosis ) and rapidly extending to the entire kidney ( global )....life long dialysis or kidney transplant :s If treated in time...she may be able to manage with her better kidney at least for a decade. As this is secondary to a hygiene problem...advice regarding the same needs to be given. Most imp advice - always wash the urethra first b4 washing the anus (after passing feces) as that is usually the source of infection of an otherwise sterile urogenital tract ! Even if the diagnosis is something else...I hope this info will be useful
Nice challenge by Egyptian doctor ! I agree with bb100 ! It is horseshoe kidney ! There is a tissue bridge across the mid-line and abnormal orientation of the renal axis (. Hydronephrosis seems to be secondary to this abnormal orientation. Also I see some malrotation of the left kidney - the hilum is directed antero - laterally ( reverse rotation ), further evidenced by the concavity of the major calyces facing medially ( instead of laterally ). My revised diagnosis So this is Horseshoe + Malrotated ( reverse rotation ) kidney ...giving rise to subtle kinking of the ureter ( not visible in this radiograph )...leading to hydronephrosis. Those in doubt (about the rotation aspect ) can compare with a normal radiograph (Y) Also the inferior mesentric has got in the way of the ascend (at the site of fusion - preventing further ascend), in which case the fused mass may lie in front of the aorta and the IVC. I wonder if that would cause any additional problems for our patient ? (-:
