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CASE REPORT
Year : 2015  |  Volume : 18  |  Issue : 2  |  Page : 89-90

Ectopic pelvic kidney in a neonate in Gusau, Zamfara, North Western Nigeria


1 Department of Paediatrics, Yariman Bakura Specialist Hospital, Gusau, Zamfara State, Nigeria
2 Department of Medicine, Yariman Bakura Specialist Hospital, Gusau, Zamfara State, Nigeria

Date of Web Publication14-Jul-2015

Correspondence Address:
Dr. Bilkisu Garba Ilah
Department of Paediatrics, Yariman Bakura Specialist Hospital, PMB 1010, Gusau, Zamfara State
Nigeria
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DOI: 10.4103/1118-8561.160812

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  Abstract 

Ectopic kidney occurs as a result of cessation in migration of kidneys to their usual position in the lumbar region. Several cases have been reported worldwide, however only one case of ectopic kidney in infant has been reported in North Western Nigeria which was not a pelvic kidney. We present an incidental case of unilateral ectopic pelvic kidney managed in our facility. A 28-day-old male infant presented with a week history of crying while defecating and fever. He had normal abdominal findings. Abdominal ultra sound scan revealed a unilateral left ectopic pelvic kidney with no associated abnormalities. Full blood count showed elevated white blood cell count predominately neutrophils. He was managed as a case of neonatal sepsis with antibiotics. A thorough antenatal ultrasonography and early neonatal ultrasound are required for early diagnosis. Asymptomatic and noncomplicated cases are managed conservatively.

Keywords: Ectopic, kidney, neonate, Nigeria, pelvic


How to cite this article:
Ilah BG, Sakajiki AM, Aghadueki S, Bassey E, Kolawole T, Adeniji AO. Ectopic pelvic kidney in a neonate in Gusau, Zamfara, North Western Nigeria. Sahel Med J 2015;18:89-90

How to cite this URL:
Ilah BG, Sakajiki AM, Aghadueki S, Bassey E, Kolawole T, Adeniji AO. Ectopic pelvic kidney in a neonate in Gusau, Zamfara, North Western Nigeria. Sahel Med J [serial online] 2015 [cited 2021 Sep 27];18:89-90. Available from: https://www.smjonline.org/text.asp?2015/18/2/89/160812


  Introduction Top


During fetal development, the fetal kidneys first appear as buds inside the pelvis. In the course of development, the kidneys ascend to their usual position in the lumbar region. [1]

Sometimes, one of the kidneys remains in the pelvis or stops ascending before it reaches its usual position in the lumbar region. [1] In other cases, the kidney ascends higher than the usual position. Rarely does a child have bilateral ectopic kidneys. [1]


  Case Report Top


Y.D. a 28-day-old male neonate presented with a week history of crying while defecating. Stool is loose, not mucoid, initially not bloody which later became bloody. There was associated abdominal swelling; however, no vomiting or refusal to suck. There was associated history of high grade fever, intermittent and transiently relieved by paracetamol, but no crying on micturition nor reduction in urinary frequency or volume.

General physical examination was normal apart from pyrexia. Abdominal examination was essentially normal. Digital rectal examination revealed good anal hygiene, normal anal sphincteric tone and an empty rectum. Gloved finger was stained with scanty, nonbloody stool. Other systemic examinations were normal.

Full blood count showed a packed cell volume of 38%, white blood cell count of 13.5 × 10 9 , predominatly neutrophils of 55%.

Blood culture did not yield any growth.

Serum electrolytes were normal.

Stool microscopy, culture and sensitivity-pus cells were seen and culture yielded  Escherichia More Details coli; sensitive to ofloxacin, genticin, ciprofloxacin, cefixime and ceftazidine. Abdominopelvic ultra sound scan showed left ectopic kidney in the pelvic region, just superior to the bladder. It measured 39 mm in bipolar length. There was preserved corticomedullary differentiation and no calculus or renal mass seen.

He was managed as a case of late onset neonatal sepsis and ectopic left kidney with antibiotics. He was discharged after 1-week, and is followed-up at the nephrology clinic.


  Discussion Top


Ectopic kidney is a congenital defect in which a kidney is located below, above or on the opposite side of its usual position at the lumbar region. [2] Ectopic kidney is thought to occur in approximately 1 in 1000 live births but only about 1 in 10 of these cases is ever diagnosed. [2] Some of these cases are discovered incidentally, when a child or adult is having ultrasonography for medical condition unrelated to renal ectopia. [2]

According to Bergman et al. incidence of ectopic kidney is 1:100-1:500, ectopic thoracic kidney 1:13,000, solitary kidney 1:1000, solitary pelvic kidney 1:2200, one normal and one pelvic kidney 1:3000 and one crossed renal ectopia 1:700. [2]

Ectopic pelvic kidney can occur on either side, male to female variation has also been reported. [3] Muthiah et al. [3] reported on four cases of ectopic kidneys. Three of the ectopic kidneys were seen in female and remaining one in male. All were found in the pelvic region, of which three were seen on the left and remaining on the right. Three cases had compensatory enlargement of the contralateral kidney while only one had urinary tract infection (UTI).

Ectopic kidney may be asymptomatic and in few cases symptomatic. [4] In a study by Lusch et al., only 6% of children with pelvic ectopic kidney were symptomatic with recurrent UTI, abdominal pain, hypertension and hydronephrosis. [4]

Asghar and Wazir in 2008 studied the prevalence of renal ectopia in patients with abdominal complaints. [5] They found that 0.2% of 12,000 patients of various age groups investigated for the causes of abdominal pain had renal ectopia. In their study, 7 had right sided ectopic kidney, 5 had left sided ectopic pelvic kidney, others had variable presentation. [5] In another report, an ectopic kidney may cause abdominal discomfort or urinary symptoms. [6] Possible complications of an ectopic kidney include vesicoureteric reflux, UTI, renal stones and renal damage. However, trauma to the kidney may also complicate an ectopic kidney because of the malposition of the kidney. [6]

Despite reported cases of ectopic kidney, only one has been diagnosed in neonate in Northern Nigeria hence the need to report our case. [7]


  Conclusion Top


This is the second ectopic kidney reported in neonates; and the first ectopic pelvic kidney in neonates reported in North Western Nigeria. Ectopic kidney is however not a common condition, a thorough antenatal ultrasonography and early neonatal ultrasound are required for early diagnosis. Asymptomatic and noncomplicated cases are managed conservatively.

 
  References Top

1.
Moore KL, Persaud TV. Urogenital system. In: The Developing Human. Clinical Embryology. 8 th ed. Philadephia: WB Sauder; 2008. p. 24-456.  Back to cited text no. 1
    
2.
Bergman RA, Afifi AK, Myauchi R. In: Illustrated Encyclopedia of Human Anatomic Variation. OPUSA IV: Organ System Urinary System: Kidney, Ureters, Bladder and Urethra; 2014. Available from: http://www.virtualhospital.com. [Last cited on 2014 May 12].  Back to cited text no. 2
    
3.
Muthiah M, Arun K, Bilo D, Adithys M. A case series study of ectopic kidneys. Indian J Med Case Rep 2013;2:52-6.  Back to cited text no. 3
    
4.
Lusch A, Koen M, Becker T, Engelhardt PF, Riccabona M. Pelvic kidney in childhood. Specific features, concomitant pathologies and useful diagnostic investigations. Urologe A 2007;46:132-6.  Back to cited text no. 4
    
5.
Asghar M, Wazir F. Prevelence of renal ectopia by diagnostic imaging. Gomal J Med Sci 2008;6:2-5.  Back to cited text no. 5
    
6.
Samaila IS, Shuaib KA. Case report: Ectopic kidney case report and contemporary literature review in North Eastern Nigeria. Bjul 2010;12:2042-997.  Back to cited text no. 6
    
7.
Yakkubu AM, Abdurrahman MB, Garg SK. Abdominal swelling in the newborn: In Zaria, Northern Nigeria. J Trop Pediatr 1987;33:116-9.  Back to cited text no. 7
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   Abstract
  Introduction
  Case Report
  Discussion
  Conclusion
   References

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