A Rare Case of Bilateral Kidney Malrotation Presenting with Nephrotic Range Proteinuria in a 31 Year Old Female Patient

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A Rare Case of Bilateral Kidney Malrotation Presenting with Nephrotic Range Proteinuria in a 31 Year Old Female Patient

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Co-author 1

Maia Celeste Arbatin mcarbatin@gmail.com Chong Hua Hospital Cebu Internal Medicine, Nephrology Cebu City Philippines *

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Introduction

Renal malrotation is a rare congenital condition which refers to a variation in anatomical position of the kidneys to anomalous orientation of the renal hilum. In one autopsy, a prevalence of ~1 in 2000 was reported. It is usually unilateral and is more common in males. This paper will highlight a remarkable case of bilateral renal malrotation in a young female who presented with nephrotic range proteinuria

Methods

Results

The case study presented here is that of a 31 year old Filipino female who had episodes of recurrent UTI in the past 15 years, in which no single imaging investigation was done until she presented with complicated pyelonephritis and acute kidney injury at a provincial hospital where computed tomography scan of the abdomen showed bilateral malrotated kidneys. Consult at our institution was done where the patient presented with azotemia, hematuria and nephrotic range proteinuria. Kidney biopsy was attempted but was deemed technically difficult due to the malrotation and thinning of the cortex in one kidney. The patient was then managed as a probable case of secondary glomerulonephritis and chronic pyelonephritis secondary to bilateral malrotated kidneys. Supportive management was done with an ACE inhibitor, healthy diet and lifestyle. Figure 1. Computerized tomography (CT) of the abdomen showing bilateral malrotated kidneys. Single arrow shows the right nonrotated kidney. Double arrows show the reversely rotated left kidney

Conclusion

This case adds to the limited literature on bilateral renal malrotation and its possible short and long term complications.

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