Supernumerary kidneys — a third kidney present from birth — are documented in fewer than 100 cases worldwide each year, making them among the rarest congenital anomalies in medical literature.
A 31-year-old man in Wardha, India arrived at a medical center with five days of lower-right back pain, a burning sensation during urination, and a fever exceeding 102.2 degrees Fahrenheit (39 degrees Celsius). His urine was cloudy, his abdomen was tender on the right side, but his heart rate, blood pressure, and respiration were all within normal range. The working assumption was a urinary tract infection.
Blood work confirmed elevated leukocyte levels, and a urine culture identified Klebsiella pneumoniae, a bacterium commonly associated with UTIs. That confirmed an active infection. What the infection alone could not have revealed was what an ultrasound and CT scan found next: a third kidney, fused to the man’s right kidney in a horseshoe configuration.
According to the case report, this particular presentation — a supernumerary kidney fused in a horseshoe shape with an existing kidney — has appeared only five times in the scientific literature, making it a case within a rare case.
A supernumerary kidney is a congenital anomaly believed to originate during fetal development through abnormal cell division in the cord that eventually forms the kidneys. The condition does not always impair kidney function and frequently goes undetected throughout a patient’s life. In this instance, it was a urinary infection that brought the anomaly to light — a pattern the report notes is not unusual, as third kidneys are sometimes discovered incidentally during treatment for unrelated conditions.
The imaging also showed that both the left and right kidneys were swollen and contained calculus — mineral crystal deposits that form when urine becomes overly concentrated. Small stones often pass without intervention, but when they accumulate untreated, they create conditions favorable to infection. The left kidney carried the more serious burden: calculus had built up inside the left ureter, the tube connecting that kidney to the bladder, compounding the infection risk on that side.
Doctors addressed this by inserting a stent into the left ureter to restore drainage, then administering intravenous piperacillin and tazobactam three times daily alongside levofloxacin every other day. Within 48 hours, the patient’s condition had improved sufficiently for discharge. He was instructed to return within one month to have the stent removed and to receive ongoing management for the calculus buildup.
He left the hospital knowing something about his own anatomy that 31 years of life had given no indication of.
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