Pelvic Ectopic Kidney: What is It, Causes, Symptoms, Diagnosis and Treatment

Pelvic ectopic kidney refers to a congenital condition where one or both of the kidneys fail to ascend to their normal position in the abdomen during fetal development and instead remain in the pelvic area. Typically, kidneys develop in the pelvic area during early fetal development and gradually ascend to their normal position in the abdomen by the ninth week of gestation. However, in cases of pelvic ectopic kidney, this ascent fails to occur completely or at all.

This condition can manifest in various ways, depending on the degree of ascent and the orientation of the kidney within the pelvis. In some cases, the ectopic kidney may function normally, while in others, it may be associated with complications such as urinary tract infections, obstruction of urine flow, or increased risk of kidney stones.

Diagnosis of pelvic ectopic kidney is typically made through imaging studies such as ultrasound, MRI, or CT scans. Treatment options depend on the specific complications present and may include medications to manage symptoms, surgical intervention to correct urinary tract obstructions or other issues, or close monitoring in cases where the ectopic kidney is functioning normally without complications.

Overall, while pelvic ectopic kidney is a congenital anomaly that can present challenges and potential complications, proper diagnosis and management can help individuals lead healthy and fulfilling lives.

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What is “pelvic ectopic kidney”?

A pelvic ectopic kidney is a congenital condition where one or both kidneys fail to ascend to their normal position in the abdomen during fetal development and instead remain in the pelvic area. Typically, kidneys develop in the pelvic area during early fetal development and gradually ascend to their normal position in the abdomen by the ninth week of gestation. However, in cases of PEK, this ascent fails to occur completely or at all.

Mechanisms and causes of pelvic ectopic kidney

The mechanisms and causes of PEK are not entirely understood, but they are thought to involve disruptions in the normal processes of kidney development during fetal development. Several factors may contribute to the development of pelvic ectopic kidney:

Genetic Factors: Genetic mutations or variations may play a role in the development of PEK. These mutations can affect the genes responsible for kidney development, leading to abnormalities in the migration of the kidneys from the pelvic area to their normal position in the abdomen.
Embryological Factors: The development of the kidneys involves a complex series of events during embryonic development. Any disruptions or abnormalities in these processes can result in PEK. For example, issues with the formation or migration of the ureteric bud, which gives rise to the ureter and renal pelvis, may lead to ectopic kidney placement.
Environmental Factors: Certain environmental factors or exposures during pregnancy may increase the risk of pelvic ectopic kidney. These factors could include maternal infections, exposure to toxins, or maternal conditions such as diabetes or hypertension, which can affect fetal development.
Teratogens: Exposure to certain teratogenic substances during pregnancy may interfere with normal kidney development and increase the risk of pelvic ectopic kidney. Teratogens are substances that can cause birth defects or abnormalities in fetal development.
Multifactorial Causes: In many cases, pelvic ectopic kidney likely results from a combination of genetic, environmental, and embryological factors. The exact interplay of these factors can vary from one individual to another.

Overall, PEK is a complex condition with multifactorial causes. While some risk factors may be identified, the precise mechanisms underlying its development often remain unclear. Further research into the genetics and embryology of kidney development is needed to better understand the pathogenesis of pelvic ectopic kidney.

Symptoms

The symptoms of pelvic ectopic kidney can vary depending on factors such as the position of the ectopic kidney, its function, and whether any complications are present. In some cases, PEK may not cause any symptoms and may be incidentally discovered during imaging studies for unrelated reasons. However, when symptoms do occur, they may include:

Abdominal or Pelvic Pain: Some individuals with PEK may experience intermittent or chronic abdominal or pelvic pain. This pain may be dull or sharp and may vary in intensity.
Urinary Symptoms: PEK can sometimes lead to urinary symptoms such as frequent urination, urgency, or difficulty urinating. This may be due to compression of the bladder or urethra by the ectopic kidney.
Urinary Tract Infections (UTIs): Individuals with PEK may be at increased risk of developing urinary tract infections. This is because abnormalities in kidney position or urinary tract anatomy can interfere with the normal flow of urine and increase the likelihood of bacterial colonization and infection.
Hematuria: Blood in the urine (hematuria) may occur in some cases of pelvic ectopic kidney. This may be due to irritation or inflammation of the urinary tract caused by the abnormal kidney position or associated complications such as kidney stones.
Hydronephrosis: Pelvic ectopic kidney may be associated with hydronephrosis, a condition characterized by the dilation or swelling of the kidney due to obstruction of urine flow. Hydronephrosis can cause symptoms such as flank pain, urinary tract infections, and changes in urinary habits.
Complications: In some cases, PEK may lead to complications such as kidney stones, urinary obstruction, or urinary reflux (the backward flow of urine from the bladder into the kidneys). These complications can cause additional symptoms such as severe pain, fever, and recurrent UTIs.

It’s important to note that not everyone with pelvic ectopic kidney will experience symptoms, and the condition may only be discovered incidentally during imaging studies or medical examinations. If you experience any concerning symptoms suggestive of PEK or urinary tract issues, it’s essential to consult a healthcare professional for proper evaluation and management.

Complications of pelvic ectopic kidney

Pelvic ectopic kidney can be associated with various complications, which may arise due to the abnormal position and anatomy of the kidney or other related factors. Some of the common complications of pelvic ectopic kidney include:

Urinary Tract Infections (UTIs): Individuals with PEK may be at increased risk of developing urinary tract infections. This increased risk is due to abnormalities in kidney position or urinary tract anatomy, which can interfere with the normal flow of urine and increase the likelihood of bacterial colonization and infection.
Urinary Obstruction: Pelvic ectopic kidney may lead to urinary obstruction, which can occur due to anatomical abnormalities or the development of kidney stones. Urinary obstruction can cause symptoms such as flank pain, urinary frequency, urgency, and difficulty urinating.
Hydronephrosis: Hydronephrosis refers to the dilation or swelling of the kidney due to obstruction of urine flow. Pelvic ectopic kidney can be associated with hydronephrosis, which can lead to symptoms such as flank pain, urinary tract infections, and changes in urinary habits.
Renal Calculi (Kidney Stones): Individuals with PEK may be at increased risk of developing kidney stones. An abnormal kidney position and urinary tract anatomy can predispose to the formation of kidney stones, which can cause symptoms such as severe pain, hematuria (blood in the urine), and urinary obstruction.
Urinary Reflux: Urinary reflux is the backward flow of urine from the bladder into the kidneys. Pelvic ectopic kidney can be associated with urinary reflux, which can increase the risk of urinary tract infections and kidney damage over time.
Renal Dysfunction: In some cases, pelvic ectopic kidney may be associated with impaired kidney function or chronic kidney disease. This can occur due to complications such as urinary obstruction, recurrent infections, or other factors affecting kidney health.
Complications During Pregnancy: Pelvic ectopic kidney may pose challenges during pregnancy, as the abnormal kidney position can increase the risk of urinary tract infections, hydronephrosis, and other complications. Close monitoring and management may be necessary to ensure the health and well-being of both the mother and baby.

It’s important to note that not everyone with pelvic ectopic kidney will experience complications, and the severity and frequency of complications can vary widely among individuals. Proper diagnosis, monitoring, and management by a healthcare provider are essential for identifying and addressing any potential complications associated with pelvic ectopic kidney.

Diagnosis

The diagnosis of PEK typically involves a combination of medical history, physical examination, and imaging studies. Here are the main steps involved in diagnosing pelvic ectopic kidney:

Medical History and Physical Examination: The healthcare provider will begin by taking a detailed medical history, including any symptoms you may be experiencing. They will also perform a physical examination to assess for signs of abdominal or pelvic abnormalities.
Imaging Studies: Imaging studies are crucial for confirming the diagnosis of pelvic ectopic kidney and evaluating its position and anatomy. The following imaging modalities may be used:

Ultrasound: Ultrasound imaging is often the first-line modality for evaluating pelvic ectopic kidney. It can provide detailed images of the kidneys, ureters, and bladder and can identify abnormalities such as ectopic kidney position, hydronephrosis, or urinary tract obstruction.

CT Scan (Computed Tomography): CT scanning provides detailed cross-sectional images of the abdomen and pelvis and can help visualize the exact position and orientation of the ectopic kidney. It is particularly useful for assessing associated complications such as kidney stones or urinary tract obstruction.

MRI (Magnetic Resonance Imaging): MRI can also be used to visualize pelvic ectopic kidney and assess its anatomy and associated complications. It provides excellent soft tissue contrast and does not involve radiation, making it a preferred option in certain situations, such as in pregnant individuals.

Voiding Cystourethrogram (VCUG): In some cases, a voiding cystourethrogram may be performed to evaluate for urinary reflux (the backward flow of urine from the bladder into the kidneys). This test involves injecting contrast dye into the bladder and imaging the urinary tract during urination.
Laboratory Tests: Laboratory tests such as urinalysis may be performed to assess for signs of urinary tract infection, kidney function, or the presence of blood in the urine.
Additional Studies: Depending on the specific clinical presentation and findings, additional studies such as renal scintigraphy (nuclear medicine imaging) or cystoscopy (direct visualization of the bladder and urethra) may be considered.

Once a diagnosis of pelvic ectopic kidney is confirmed, further evaluation may be needed to assess for associated complications and determine the most appropriate management plan. This may involve consultations with specialists such as urologists or nephrologists.

Treatment of pelvic ectopic kidney

The treatment of pelvic ectopic kidney depends on various factors, including the presence of symptoms, associated complications, and the overall health and preferences of the individual. Treatment options may range from conservative management to surgical intervention. Here are the main approaches to managing pelvic ectopic kidney:

Observation and Monitoring: In cases where pelvic ectopic kidney is asymptomatic and not causing any complications, a conservative approach of observation and monitoring may be appropriate. Regular follow-up visits with a healthcare provider may be recommended to monitor kidney function, assess for the development of complications, and ensure that the condition remains stable over time.
Symptomatic Management: If PEK is causing symptoms such as pain or urinary tract infections, symptomatic management may be necessary. This may involve the use of pain medications to alleviate discomfort or antibiotics to treat urinary tract infections. Lifestyle modifications, such as increasing fluid intake and maintaining good urinary hygiene, may also help manage symptoms and reduce the risk of complications.
Treatment of Complications: Complications associated with PEK, such as urinary tract obstruction, kidney stones, or urinary reflux, may require specific treatments. Depending on the nature and severity of the complication, treatment options may include medications, minimally invasive procedures, or surgical intervention to alleviate obstruction, remove kidney stones, or correct urinary reflux.
Surgical Intervention: In some cases, surgical intervention may be necessary to address complications or correct anatomical abnormalities associated with pelvic ectopic kidney. Surgical procedures may include nephrectomy (removal of the ectopic kidney), nephropexy (surgical fixation of the kidney in its abnormal position), or reconstructive surgery to correct urinary tract abnormalities.
Management of Renal Function: Individuals with pelvic ectopic kidney may require ongoing monitoring of kidney function to assess for any decline in renal function over time. This may involve periodic blood tests to measure kidney function (such as serum creatinine and glomerular filtration rate) and imaging studies to assess for changes in kidney size or structure.
Patient Education and Support: Patient education is an essential component of managing PEK. Healthcare providers should provide information about the condition, its potential complications, and strategies for symptom management and prevention. Additionally, providing support and resources for individuals with pelvic ectopic kidney and their families can help improve their overall quality of life.

The specific treatment approach for pelvic ectopic kidney should be individualized based on the unique circumstances and needs of each patient. It’s important for individuals with pelvic ectopic kidney to work closely with a healthcare team, including urologists, nephrologists, and other specialists, to develop a comprehensive management plan tailored to their specific situation.

Treatment of pelvic ectopic kidney

The treatment of PEK depends on various factors, including the presence of symptoms, associated complications, and the overall health and preferences of the individual. Treatment options may range from conservative management to surgical intervention. Here are some approaches to treating pelvic ectopic kidney:

Observation and Monitoring: If the PEK is asymptomatic and not causing any complications, a conservative approach of observation and monitoring may be appropriate. Regular follow-up visits with a healthcare provider may be recommended to monitor kidney function, assess for the development of complications, and ensure that the condition remains stable over time.
Symptomatic Management: If PEK is causing symptoms such as pain or urinary tract infections, symptomatic management may be necessary. This may involve the use of pain medications to alleviate discomfort or antibiotics to treat urinary tract infections. Lifestyle modifications, such as increasing fluid intake and maintaining good urinary hygiene, may also help manage symptoms and reduce the risk of complications.
Treatment of Complications: Complications associated with pelvic ectopic kidney, such as urinary tract obstruction, kidney stones, or urinary reflux, may require specific treatments. Depending on the nature and severity of the complication, treatment options may include medications, minimally invasive procedures, or surgical intervention to alleviate obstruction, remove kidney stones, or correct urinary reflux.
Surgical Intervention: In some cases, surgical intervention may be necessary to address complications or correct anatomical abnormalities associated with PEK. Surgical procedures may include nephrectomy (removal of the ectopic kidney), nephropexy (surgical fixation of the kidney in its abnormal position), or reconstructive surgery to correct urinary tract abnormalities.
Management of Renal Function: Individuals with pelvic ectopic kidney may require ongoing monitoring of kidney function to assess for any decline in renal function over time. This may involve periodic blood tests to measure kidney function (such as serum creatinine and glomerular filtration rate) and imaging studies to assess for changes in kidney size or structure.
Patient Education and Support: Patient education is an essential component of managing PEK. Healthcare providers should provide information about the condition, its potential complications, and strategies for symptom management and prevention. Additionally, providing support and resources for individuals with pelvic ectopic kidney and their families can help improve their overall quality of life.

The specific treatment approach for pelvic ectopic kidney should be individualized based on the unique circumstances and needs of each patient. It’s important for individuals with PEK kidney to work closely with a healthcare team, including urologists, nephrologists, and other specialists, to develop a comprehensive management plan tailored to their specific situation.

Summary

Pelvic ectopic kidney is a congenital condition where one or both kidneys fail to ascend to their normal position in the abdomen during fetal development and instead remain in the pelvic area. This abnormal positioning can lead to various complications, including urinary tract infections, urinary obstruction, kidney stones, hydronephrosis, and urinary reflux.

Diagnosis of PEK typically involves medical history, physical examination, and imaging studies such as ultrasound, CT scans, or MRI. Treatment options vary depending on the presence of symptoms and complications. Conservative management, including observation and symptomatic treatment, may be sufficient in asymptomatic cases. However, complications may require medications, minimally invasive procedures, or surgical intervention to alleviate symptoms and prevent further damage.

Regular monitoring of kidney function and close follow-up with a healthcare provider are essential for individuals with pelvic ectopic kidney to ensure early detection and management of any complications. Overall, while PEK presents challenges, proper diagnosis and management can help individuals lead healthy and fulfilling lives.

Prof. Dr. Emin ÖZBEK

Urologist

Istanbul- TURKEY