ANOMALIES OF THE KIDNEYS Anomalies of the kidneys include complete absence of one or both kidneys, disturbances in the frontal development, or else deviations from the normal position Alsberg).
Absence of the kidney, is generally accompanied by other serious deformities (Zaufal). Hochsinger has described congenital absence of the whole urinary system. combined with total lack of liquor amnii. In this ease the suprarenal glands were present, and the sexual organs perfectly normal. A serious deforniity of this kind raises the question of how far the kidney is necessary to life during the fcktal stage. Scheib's 013,:.rrvation of a female foetus seven months olcl, proved that intra uterine development of a fmtris is possilde notwithstanding the absence of both kidneys. The foetus seen by him lived for ten minutes after delivery in spite of the serious deformity.
Unilateral defect of the kidney, according to Klebs, generally occurs in the left kidney. On the whole, most renal deformities occur on the left side, a fact which this author explains by declaring that the spiral rotation of the body is an important causal factor. According to Ballowitz, one-sided defect of the kidney is often combined v,-ith anom alies of the Mtillerian ducts, and hyperplasia of the kidney is often accompanied by disturbances of the other parts of the genito-urinary apparatus anatomically essential. Hyperplasia of one kidney is generally conditioned upon hypoplasia of the other. Persistenee of the fcetal lobulation, the "reniculi " not to be regarded as a deformity; it will not infrequently be found even in adults.
31olli-format'.on of the kidney, is of the utmost rarity. The finding of two kidneys upon one side has been described by Ellebs. Somewhat more frequent is the horseshoe kidney, resulting from fusion of the two kidneys either at the upper or the lower pole, or more rarely at the hilum. The horseshoe kidney is as: a rule abnormal in location.
Changes in the situation of the kidneys may be either congenital or acquired. Dystopia affects in most cases the left kidney, whose position may vary from the lowest part of the small pelvis to the fourth lumbar vertebra. Lobulation of such congenitally misplaced kidneys is as a
rule, strongly accentuated. Contrary to the conclition found in acquired dislocations, the ureter is not twisted. The blood supply is often derived from several renal vessels of abnormal origin. According to Zenker, the common dystopia is simply a lower position of the left kindey, with dis placement towards the middle line. The direction of the hiluin is to the front and upward:, The suprarenal gland is in its usual location.
A case of crossed dystopia of the kidney with change of situation of the sexual organs, has been described by Schumacher.
Dystopia of the kidney is percept ible as a tumor, and the anomaly has some clinical importance owing to the fact that it may be confounded with other tumors of the false pelvis, with undeseended testicles with swollen glands, with fecal conemtions, etc. Moreover, the differential diagnosis fro,» intussnsception anti appendicitis has in many cases to be considered. Uncle/. these conditions palpation may bee.ome of decisive importance to establish the diagnosis. The anomaly may be attended in older children by pains localized near the ilium and radiating into the extremities, or it may cause frequent micturition. In certain circumstances, pressure of the ureter against the ilium may be fol lowed by t formation of a " water-bag kidney " (hydronephrosis. Schott), the practical importance of which has been pointed out by Billroth.
The formation of a purulent sac in the mislocatecl kidney has also been described. R is said that this will predispose to fixation of the sigmoid flexure. The assertion that congenitally dislocated kidneys are not movable is not exactly true. since in isolated eases abnormal mobility of dystopic kidneys has been observed (Gruber). But it is trite that abnormal mobility is not a siel, of eongenital dislocation of the kidney, as has been stated by Knopfelmacher.