Ectopic Thoracic Kidney and End-Stage Renal Disease in a 38-Year-Old Nigerian

This patient is a 38-year-old housewife who presented with a one-month history of difficulty, in breathing, chest pain and bilateral leg swelling and had a blood pressure of 260/150？mmHg, features of malignant hypertension and hypertensive heart disease. Chest CT scan revealed a chest location of the left kidney. She also had elevated serum urea and creatinine and proteinuria (++). The right kidney was normally located with loss of corticomedullary differentiation. She is on maintenance haemodialysis and is being worked up for possible left nephrectomy. 1. Introduction Renal ectopias are relatively common congenital anomalies believed to occur in about 1/1000 live births, though only about 10% are usually detected [1]. Ectopic thoracic kidneys, on the other hand, are very rare anomalies and constitute less than 5% of renal ectopias [2–4]. In Nigeria, only one case has been documented [5]. Many of the cases of intrathoracic kidneys reported have been asymptomatic and only discovered during routine medical checks or having mild respiratory symptoms. Here we report a case of a 38-year-old Nigerian female with a left intrathoracic ectopic kidney and markedly elevated blood pressure leading to renal failure. 2. Case Presentation This patient is a 38-year-old housewife who was referred from the general out-patient clinic on account of a one-month history of recurrent difficulty in breathing, associated with chest pain, recurrent headaches, blurring of vision, and dizziness with blood pressure of 260/150？mmHg. There was a history of orthopnoea and paroxysmal nocturnal dyspnoea. She had no associated cough but had a mild centrally located chest pain. There was a history of bilateral leg swelling which has been progressively worsening and associated with diminution in urine volume. She was diagnosed as hypertensive five years before presentation but had not been compliant with antihypertensive medications. There was no known family history of hypertension. Examination showed a young woman in respiratory distress, pale, afebrile (temperature 36.8°C), bilateral pitting leg oedema up to the knee with no sacral oedema. Waist circumference was 78？cm, hip circumference 80？cm, and a body mass index (BMI) 23.8？kg/m2. Her respiratory rate was 50 cycles/minute with reduced breath sounds in the left lower lung zones and bibasal fine crepitations. The pulse rate was 118 beats/minute, normal volume and regular. There was clinical evidence of arterial wall thickening. Blood pressure was 220/120？mmHg with a fourth heart sound and loud aortic component of the second heart