Opšta Medicina (Jan 2018)
Ren arcuatus: Manifestations
Abstract
Introduction: Ren arcuatus is a congenital kidney malformation with irregular kidney form, consisting of connected lower kidney parts, forming a structure horseshoe like. Case report: A 42 years old patient pays a visit to a doctor because he experienced pain in kidney region. He was previously treated for frequent urinary tract infections and kidney stones. An ultrasound of his abdomen and urinary tract was performed. Ultrasound examination showed a stone of 18mm in the right kidney and there were several smaller stones, up to 6.5mm in the left kidney. Patient was forwarded to Urology clinic, where IVP (Intravenous pylography) was done, as well as lithotripsy-ESWL of the right kidney. The definite diagnosis was established then - Ren arcuatus. During the following appointment at Urology clinic, Clinical center of Serbia, repeated lithotripsy - ESWL for the right kidney was recommended. He was admitted to the Urology clinic on March 24th, 2014 for the planned lithotripsy-ESWL, but it was given up and urgent Lithoclast was performed on the right side. Lithoclast was scheduled for March, 25th and stone push back into the right kidney was performed, with JJ stent insertion in the same kidney. At the follow up appointment, at Urology clinic, it was recommened to remove JJ stent, in the regional health center. The attempt to remove the stent in the regional health center was unsuccesful because the stent was disruptered (only 6 cm of calcified stent was removed). So, the patient was dispatched to Urology clinic, where he was hospitalized from September 15th to November 6th, 2014, where lithotripsy - ESWL on his right kidney was performed four times. During his hospital stay, stent extraction was attemped three times unsuccesfully. After that the patient was operated and percutaneous nephrolithotomy - PCNL was performed on the right kidney and JJ stent was removed. During 2015 and 2016 frequent urinary tracr infections occurred. 'Super bug' Proteus miriabilis (ESBL+, producing beta lactamase) was isolated. Conclusion: Due to congenital malformation Ren arcuatus there are more frequent urinary obstructions, hydronephrosis and urinary tract infections, as well as kidney stone formation. This kidney malformation represents significant health hazard for a patient. Proper attention should be payed and frequent follow up appointments should be scheduled in order to prevent complications.
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