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Renal Cases

Discussion in 'Spot Diagnosis' started by Egyptian Doctor, Nov 10, 2012.

  1. Egyptian Doctor

    Egyptian Doctor Moderator Verified Doctor

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    What is your medical diagnosis ?

    Renal Cases.jpg
     

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  2. neo_star

    neo_star Moderator

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    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
     

  3. bb100

    bb100 Bronze Member

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    horseshoe kidney
     

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  4. neo_star

    neo_star Moderator

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    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 ?

    (-:
     

    Last edited: Nov 11, 2012
  5. Gospodin Seki

    Gospodin Seki Moderator Staff Member

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    Indeed,it's Horseshoe kidney
     

  6. dr.angela

    dr.angela Bronze Member

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    horseshoe kidney
     

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