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REFERENCES
1. Yarmohammadi A, Mohamadzadeh Rezaei M, Feizzadeh B, Ahmadnia H.Retrocaval ureter: a study of 13 cases. Urol J. 2006:175-8
2. Minniti S,Visentini S, Procacci C, Minniti S, Visentini S, Procacci C.Congenital anomalies of the venae cavae: embryological origin, imagingfeatures and report of three new variants. Eur Radiol. 2002: 2040-2055.
3. Perimenis P, Gyftopoulos K, Athanasopoulos A, Pastromas V, Barbalias G.Retrocaval ureter and associated abnormalities. Int Urol Nephrol. 2001:19-22.
4. Cardoza F, Shambhulinga CK, Rajeevan AT. Retrocaval ureter and contralateral renal agenesis – a case report and review of literature.Int braz j urol. 2016:842-844.
A very rare case of right retrocaval ureterwith contralateral renal agenesis
METHODS
A 35 years old male patient of Indian origin with noprevious medical history was further investigated due tothe diagnosis of acutisation of a symptomatic nonpreviously investigated hypertension (210/160 mmHg).Laboratory tests revealed a severe kidney failure with aplasmatic creatinine at 420 umol/l and BUN at 19.3mmol/l. Abdominal ultrasound showed ahyperechogenic right kidney with dilated excretorycavities and a distal ureter which could not be detected.Additionally there was an atrophic left kidney. CT scanand MRI-scan confirmed the dilatation of the right renalexcretory cavities with a spiroidal ureter crossingposteriorly of the inferior vena cava. Renal scintigraphy(MAG3) demonstrated that the kidney function wasexclusively maintained by the right kidney, with arelatively preserved parenchymal tracer uptake on theright but without any signal on the left side. The patientunderwent emergency right sided double-J procedure,and later on elective uretherolisis andpyelouretheroanastomosis, with the goal of retardationof progression to a terminal kidney failure.Intraoperative biopsies of the right kidney revealed amicroscopic aspect of terminal kidney probably due to asevere hypertensive nephropathy.
DISCUSSION
Despite a rapid medical work-up, diagnosis andsurgery, it was not possible to improve the kidneyfunction in this young patient. Hypertension in youngpatients may be the only clinical evidence of anunderlying kidney dysfunction. After diagnosis of severehypertension in younger patients a forced imagingwork-up is mandatory in order to detect the pathologyearly and to manage these patients accordingly.Existing guidelines recommend further investigations inyounger patients with severe hypertension, especially ifthere are no family history and no cardiovascular riskfactors.
BACKGROUND
A retrocaval ureter is a rare congenital anomalyaffecting 1 in 1000 newborns1. It is the result of adefault in the embryological development of the inferiorvena cava.2 Additional congenital anomalies arepresent in up to 21% of such cases.3 A retrocaval ureterwith contralateral renal agenesis is a very rare entitywhich has been reported only once up to now.4 Wedescribe and illustrate such a rare case especially whatconcerns diagnosis, imaging and evolution.
RESULTS
Despite these therapeutic procedures no improvementof the kidney function was obtained. The patient is stillfollowed by both our nephrology and urology teams andoptions, such as a preemptive renal transplantation, areconsidered.
Joao Costa dos Santos 1, Michael Chilcott 1, Meryll Cassat 2,
Farshid Fateri 4 , Christine Theodoloz 3, Bernhard Egger 4
1 Department of Surgery, HFR Riaz2 Clinic of Nephrology HFR Fribourg3 Department of Radiology HFR Riaz
4 Department of Surgery, HFR Fribourg – Cantonal Hospital
Image 1 and 2- CT scan and MRI findings. It is possible to see thecompression of the ureter by inferior cava vein (Image 1) and thediminished flow in the right ureter. In both images we can see bothdilation of right renal excretory cavities and the absence of left kidney