1. ABSTRACT ID: IRIA - 1229 Unilateral supernumerary kidney

2. Learning objectives  Supernumerary kidney is the rarest of all renal anomalies; fewer than 100 cases have been reported in the literature over the years.  Most commonly located on the left side of the abdomen.  Because of their infrequent occurrence and reporting, they frequently cause diagnostic challenges.  We report a case in a 15-year-old male patient of unilateral supernumerary kidney on the right side of the abdomen.

3. Background  A supernumerary kidney is a very rare additional kidney with renal function, own blood supply, organ capsule and pyelocaliceal system. Next to the supernumerary kidney, there are two normal kidneys.  The supernumerary kidney shares the ureter and ostium with a normal ipsilateral kidney in 50 % cases.  It results from the aberrant division of the nephrogenic cord into two metanephric blastemas; two kidneys then form in association with a partially or completely duplicated ureteral bud.

4. Background  Supernumerary kidneys may be associated with urogenital malformations like horseshoe kidney, ectopic ureteral opening, double collecting system, aortic coarctation and duplication of the penis.  Pathologic conditions reported to affect supernumerary kidneys include hydronephrosis, pyonephrosis, pyelonephritis, cysts, calculi, carcinoma, papillary cystadenoma, and Wilms’ tumour.  In our case, no such anomalies were diagnosed.  Long-term follow up is recommended for asymptomatic cases of supernumerary kidney because of high rate of occurrence of complications and malignant change.

5. Findings and procedure details  A 15-year-old male patient who presented with history of fever and was referred to the radiodiagnosis department of our hospital for ultrasound abdomen.  General examination revealed no abnormality.  Past medical history revealed there were repeated attacks of urinary tract infections. There was no family history of renal disease or any other major illness.  Routine haematological and biochemical investigations were within normal limits.

6. Ultrasound abdomen Cranial kidneyCaudal kidney

7. Cranial kidney seen moving along the caudal kidney during respiration. ULTRASOUND

8. CT – Plain and Contrast  Plain CT scan of the abdomen showed two separate kidneys on the right side which was confirmed in the intravenous-contrast enhanced CT.  The cranially located right kidney measured 7.3 x4 cm and is normally oriented.  The caudally located right kidney is malrotated and measured 7.5 x 4.0 cm.  The left kidney measured 10.2 x 5.1 cm.

9. CT AXIAL SECTION – PLAIN STUDY Cranial kidney Caudal kidney

10. CT AXIAL SECTION- CECT Cranial kidney Caudal kidney

11. CT CORONAL SECTION SHOWING CRANIAL AND CAUDAL KIDNEYS Plain Post Contrast

12. CT SAGITTAL SECTION Plain Post Contrast

13. Coronal 3D volume rendering image showing two separate right kidneys

14. Renal artery supply for both kidneys Cranial kidney - arising from aorta at level of L1 Caudal kidney - anterior aspect of L3- L4 levels

15. Both the cranial and caudal kidneys have separate draining into the IVC Cranial kidneyCaudal kidney

16. Axial,coronal and sagittal post contrast CT images showing two separate ureters on the right side traced upto the L5 level

17. Coronal 3D volume rendering shows two separate ureters from the cranial and caudal kidneys

18. Conclusion  Supernumerary kidney is a very rare congenital renal anomaly and may be associated with different urogenital malformations.  The potentially high rate of complication, including malignancy make diagnosis important.  Because of their infrequent occurrence and asymptomatic nature, diagnosis may be challenging.

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