Malrotated Kidney - An Overview

Introduction

A malrotation kidney is a medical condition resulting from a developmental defect during fetal development, which causes an abnormal kidney position. Normally, the kidneys are in the retroperitoneal space with the right one being slightly lower. However, in malrotation, the kidney is rotated abnormally and may be located in various areas of the abdomen. Though this condition is not rare, it often has no symptoms but can cause complications such as kidney stones or urinary tract infections. This article will cover the causes, symptoms, diagnosis, and treatment options for a malrotation kidney.

What Is a Malrotated Kidney?

A congenital abnormality known as malrotation of the kidney involves the kidney being situated in an atypical anatomical position. Typically, the kidney's convex surface faces outward. Still, in the case of malrotation, the kidney may be positioned abnormally, such as rotating around its axis, twisted, or located in the pelvis or midline. This condition is considered rare.

What Are the Causes of Malrotated Kidney?

Malrotation of the kidney refers to a condition where it fails to rotate correctly during its fetal development, resulting in it assuming an unusual position within the abdomen. While this condition generally does not produce any noticeable symptoms, it may be accidentally detected during imaging scans conducted for unrelated purposes. The possible factors that contribute to the development of malrotation in kidneys are as under:

• Congenital Abnormality: The primary cause of malrotation of the kidney is a congenital abnormality. This means the abnormality is present at birth and may result from genetic or developmental issues during fetal development.

• Genetic Factors: Certain genetic factors may contribute to the development of malrotation of the kidney. For instance, there could be a genetic predisposition to abnormalities in kidney development during fetal development.

• Abnormal Fetal Positioning: The position of the fetus in the womb may also impact the development of the kidneys. If the fetus is in an unusual position, it can disrupt the rotation of the kidneys during development.

• Intrauterine Growth Restriction: Intrauterine growth restriction (IUGR) occurs when the fetus does not grow normally during pregnancy. This can lead to a range of developmental abnormalities, including malrotation of the kidneys.

• Abnormal Fetal Development: Malrotation of the kidney may be linked to other developmental abnormalities, such as digestive system or organ abnormalities.

• Trauma: Trauma to the abdomen or lower back can also cause malrotation of the kidney, typically due to direct injury to the kidney or surrounding tissues.

• Surgery: Surgery on the abdomen or lower back may also cause malrotation of the kidney, usually due to scarring or adhesions that occur post-surgery.

What Are the Symptoms of a Malrotated Kidney?

Here are some of the symptoms that may indicate a malrotated kidney:

• Abdominal Pain: One of the most common symptoms of malrotation of the kidney is abdominal pain, which can range from mild to severe, depending on the degree of torsion or twisting of the blood vessels.

• Urinary Tract Infections (UTIs): Individuals with malrotation kidneys are more prone to urinary tract infections due to the abnormal flow of urine, which can lead to the formation of kidney stones and bacterial infections.

• Blood in the Urine: Malrotation of the kidney can cause hematuria or blood in the urine. This symptom is caused by the twisting of the blood vessels, which can lead to bleeding.

• Nausea and Vomiting: Malrotation of the kidney may cause nausea and vomiting due to the increased pressure on the gastrointestinal tract.

• Hypertension: In some cases, malrotation of the kidney can lead to high blood pressure due to the abnormal positioning of the renal artery.

• Difficulty in Breathing: A malrotation kidney can cause respiratory distress if it pushes up against the diaphragm, making breathing difficult.

• Renal Failure: In severe cases, a malrotation kidney may cause renal failure, which can be life-threatening.

• Regular Check-ups and Imaging Tests: It is important to note that some individuals with malrotation kidneys may not experience any symptoms. Therefore, regular check-ups and imaging tests may be necessary to detect and monitor the condition.

How to Diagnose a Malrotated Kidney?

The following are the steps for diagnosing a malrotation kidney:

I. Medical History and Physical Examination

• The initial step in diagnosing a malrotation kidney is to review the patient's medical history and perform a physical examination. This step can help to identify any symptoms related to the condition, such as pain or urinary tract infections.

II. Imaging Tests

• Imaging tests play a significant role in confirming the diagnosis of a malrotation kidney. These tests may include ultrasound, CT scan, and MRI. An ultrasound is a non-invasive test that produces images of the kidney, showing its position, shape, and any abnormalities. A CT scan uses X-rays to produce detailed images of the kidney, showing its orientation and any other abnormalities. MRI uses a magnetic field and radio waves to produce detailed images of the kidney, showing its position, orientation, and any other abnormalities.

III. Renal Function Tests

• Renal function tests may also be conducted to evaluate the kidneys' overall functioning. These tests may include blood and urine tests to measure the levels of various substances in the blood and urine.

IV. Referral to a Specialist

• If a malrotated kidney is suspected, the patient may be referred to a specialist such as a urologist or a nephrologist, who can provide further evaluation and recommend the appropriate treatment.

What Is the Treatment of Malrotated Kidney?

Malrotation of the kidney is a congenital abnormality where the kidney does not rotate into its normal position during development. This can lead to various complications and require different treatment approaches.

• Observation: In mild cases, observation may be the only necessary treatment, with regular kidney function and symptoms monitoring to ensure the malrotation is not causing any problems.

• Antibiotics: In case of urinary tract infections, antibiotics may be prescribed to treat and prevent their recurrence. The patient may also be advised to increase water intake to flush out bacteria from the urinary tract.

• Surgery: Severe cases may require surgery to correct the malrotation and prevent complications such as kidney stones or blockages. The type of surgery used will depend on the severity of the malrotation and the patient's overall health.

• Pain Management: Patients experiencing pain or discomfort due to malrotation may be prescribed pain medication or other pain management strategies.

• Lifestyle Changes: Lifestyle changes may be advised to reduce the risk of complications, such as increasing water intake, avoiding certain foods that can increase the risk of kidney stones, and maintaining a healthy weight.

• Follow-up Care: Regular follow-up care is essential for patients with malrotation of the kidney, including monitoring kidney function and symptoms, performing regular imaging tests to check the kidney's position, and adjusting treatment as needed.

Conclusion

Malrotated Kidney is a rare condition caused by abnormal positioning of the kidney. It may not show symptoms and usually does not require treatment, but can lead to complications such as kidney stones and infections. Monitoring and diagnosis are important to prevent complications, and treatment may involve surgery. Regular check-ups with a healthcare professional are advised.