A pelvic kidney is a rare congenital condition where one or both kidneys are located in the pelvis rather than their usual position in the lower back. This occurs due to a failure of the kidney to ascend to its normal position during fetal development. Although often asymptomatic, it can sometimes lead to complications such as urinary tract infections or obstruction.

Regular monitoring and medical care are important to manage any potential issues associated with this condition.

What is pelvic kidney?

A pelvic kidney is a type of congenital kidney abnormality where one or both kidneys fail to migrate to their typical position in the lower back during fetal development. Instead, they remain in the pelvic region, near the bladder. This condition is present from birth, but it may not always cause symptoms or be discovered until later in life, often through imaging studies done for unrelated reasons.

People with a pelvic kidney might be at higher risk for certain issues, such as urinary tract infections or obstructions, but many lead normal lives without significant complications. Regular monitoring and medical care are recommended to ensure the kidneys are functioning properly and to address any issues that may arise.

Why some people have pelvic kidney?

Pelvic kidneys occur due to a disruption in the normal development of the kidneys during fetal growth. Typically, the kidneys begin in the pelvic region and then ascend to their usual position in the lower back as the fetus develops. In cases of pelvic kidney, this ascent is incomplete or fails to occur.

The exact cause of this abnormal migration is not always clear, but it can be influenced by genetic factors or environmental conditions. In some cases, it might be part of a broader set of congenital abnormalities. While most cases occur sporadically, a family history of kidney abnormalities may increase the likelihood of this condition.

Complications of pelvic kidney

Pelvic kidneys can be associated with several potential complications, although many individuals with this condition may not experience significant issues. Some of the potential complications include:

• Urinary Tract Infections (UTIs): The abnormal position of the kidney can affect urine flow and drainage, increasing the risk of infections.
• Obstruction: The pelvic kidney might cause or be affected by obstructions in the urinary tract, leading to pain, swelling, or impaired kidney function.
• Hydronephrosis: This is a condition where urine builds up in the kidney due to obstruction, causing it to swell.
• Kidney Stones: Individuals with a pelvic kidney may have an increased risk of developing kidney stones.
• Injury or Trauma: A kidney located in the pelvis might be more vulnerable to injury from trauma or accidents due to its atypical location.
• Increased Risk of Cancer: While rare, there may be a slightly increased risk of developing kidney cancer in individuals with a pelvic kidney.

Pelvic kidney and pregnancy

If someone is pregnant or planning to become pregnant and has a pelvic kidney, it’s best to consult with a urologist for personalized advice and care. Here’s how a pelvic kidney may impact pregnancy:

Risks and Considerations:

• Anatomical Challenges: A pelvic kidney can be at a higher risk of developing hydronephrosis (swelling of the kidney due to urine buildup) because the uterus enlarges during pregnancy and may compress the ureters or the kidney itself.
• Urinary Tract Infections (UTIs): The abnormal position of the kidney can increase the risk of UTIs, which are already more common during pregnancy. Regular monitoring is essential.
• Labor and Delivery: In some cases, the presence of a pelvic kidney may complicate vaginal delivery due to its position, potentially necessitating a Cesarean section. However, this depends on the kidney’s exact location and any associated complications.

Management:

• Regular Monitoring: Pregnant women with a pelvic kidney should be closely monitored by a healthcare provider, including regular ultrasounds to check for hydronephrosis and kidney function tests.
• Urology and Obstetrics Consultation: Consultation with both a urologist and an obstetrician may be recommended to develop a plan for managing the pregnancy and delivery.
• Hydration and Infection Prevention: Staying well-hydrated and promptly treating any infections are important preventive measures.

Contraindications:

• A pelvic kidney itself is not a contraindication to pregnancy, but careful management is essential to address any potential complications.
• It’s crucial to have a thorough evaluation before conception and to plan for any necessary interventions during pregnancy.

Symptoms of pelvic kidney

Many people with a pelvic kidney experience no symptoms and the condition is discovered incidentally during imaging for unrelated issues. However, when symptoms do occur, they might include:

• Abdominal Pain: Discomfort or pain in the lower abdomen or pelvis due to the abnormal position of the kidney or associated complications.
• Flank Pain: Pain on the side of the body where the kidney is located, though it may be less common compared to pain from a kidney in its usual position.
• Urinary Tract Infections (UTIs): Symptoms may include frequent urination, pain or burning during urination, and cloudy or foul-smelling urine.
• Difficulty in Urination: Issues with urination, such as a weak stream or the feeling of incomplete bladder emptying, can occur if the kidney’s position affects urine flow.
• Swelling: Swelling in the lower abdomen or pelvis, particularly if there is an associated obstruction or infection.
• Hematuria: Blood in the urine, which can be a sign of a urinary tract infection, kidney stones, or other issues.

Dignosis of pelvic kidney

Diagnosing a pelvic kidney typically involves imaging studies and sometimes additional tests to evaluate kidney function and structure. The process may include:

• Ultrasound: Often the first test used to detect the presence and location of the kidney. It provides a clear image of the kidney’s position and can reveal any associated complications.
• CT Scan (Computed Tomography): A CT scan provides detailed cross-sectional images of the kidneys and surrounding structures, helping to confirm the diagnosis and assess any complications like obstruction or hydronephrosis.
• MRI (Magnetic Resonance Imaging): MRI may be used if further detailed imaging is needed, especially if there are concerns about other anatomical structures.
• Intravenous Pyelogram (IVP): An X-ray examination where a contrast dye is injected into a vein, which then travels to the kidneys, ureters, and bladder. This test helps visualize the urinary tract and assess kidney function.
• Renal Scintigraphy: A nuclear medicine scan that evaluates kidney function and can help detect issues such as obstruction or decreased function.
• Urinalysis: A urine test to check for signs of infection, blood, or other abnormalities that might indicate a problem with kidney function.

Treatment indications

The treatment for a pelvic kidney depends on whether the condition is causing symptoms or complications:

• Asymptomatic Cases: If the pelvic kidney is not causing any symptoms or complications, no specific treatment may be necessary. Regular monitoring may be recommended to ensure there are no changes or emerging issues.

• Symptomatic Cases: If the pelvic kidney causes symptoms such as pain, infections, or urinary obstructions, treatment will be required to address these issues.
• Complications: If complications such as obstruction, hydronephrosis, or kidney stones are present, treatment will focus on managing these problems.

Treatment of pelvic kidney

Here’s a general overview of treatment indications and options:

Treatment Options

• Medications:
  • Antibiotics: For treating urinary tract infections.
  • Pain Relievers: To manage pain associated with complications like kidney stones or infections.
• Lifestyle and Dietary Changes:
  • Hydration: Increased fluid intake can help prevent kidney stones and support urinary tract health.
  • Diet: Dietary adjustments might be recommended to manage or prevent complications like kidney stones.
• Surgical Interventions:
  • Stone Removal: If kidney stones are causing significant problems, procedures like extracorporeal shock wave lithotripsy (ESWL), ureteroscopy, or percutaneous nephrolithotomy may be used.
  • Corrective Surgery: In rare cases where the pelvic kidney causes severe obstruction or other significant issues, surgical procedures may be necessary to correct the position or manage complications.
• Regular Monitoring:
  • Imaging Studies: Periodic ultrasounds or other imaging studies may be required to monitor the kidney’s condition and ensure there are no developing issues.
  • Kidney Function Tests: To assess how well the kidney is functioning and detect any problems early.

Summary

A pelvic kidney is a congenital condition where one or both kidneys remain in the pelvic area rather than ascending to their usual position in the lower back. While often asymptomatic, it can lead to complications such as urinary tract infections, obstruction, or kidney stones. Diagnosis is typically made through imaging studies like ultrasound or CT scans. Treatment depends on symptoms and complications, ranging from monitoring and medications to surgical interventions if necessary. Regular follow-up is important to manage any potential issues.

Prof. Dr. Emin ÖZBEK

Urologist

Istanbul- TURKIYE