The n e w e ng l a n d j o u r na l of m e dic i n e

Images in Clinical Medicine

Chana A. Sacks, M.D., Editor

Three Kidneys

Jose O. Medina-Pestana, M.D., Ph.D.

Renato D. Foresto, M.D.
Hospital do Rim
São Paulo, Brazil
rdforesto@gmail.com

A
38-year-old man presented to the outpatient clinic with severe low back pain. As part of
the evaluation, computed tomography (CT) was performed. The scan incidentally showed the presence of
three kidneys: a normal-appearing left kidney and two fused kidneys in the pelvis. The ureter from the left
pelvic kidney joined the ureter from the other left kidney just above its entrance into the bladder. The ureter from
the right pelvic kidney entered the bladder on the right side. The CT scan also showed a herniated disk between L4
and L5. Renal function was normal, with a creatinine level of 0.9 mg per deciliter (80 µmol per liter) (normal range,
0.6 to 1.0 mg per deciliter [53 to 88 µmol per liter]). This uncommon congenital abnormality was thought to be the
consequence of aberrant processes during embryogenesis. The duplicate left kidney may have resulted from a pre-
mature division of the left ureteral bud. In addition, the right and lower left developing kidneys fused and did not
ascend during development. Affected persons are commonly asymptomatic, and as in this case, the condition may
not become known until imaging is performed for another reason. The patient’s back pain was attributed to the
lumbar disk herniation, and he was treated with an oral analgesic agent.
DOI: 10.1056/NEJMicm1910376
Copyright © 2020 Massachusetts Medical Society.
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