Horseshoe kidney - a congenital abnormality

Horseshoe kidney is a congenital disorder. It consists of two distinct functioning kidneys on each side of the midline, connected at the lower poles by an isthmus of functioning renal parenchyma or fibrous tissue that crosses the midline of the body. This is the most common renal fusion disorder.

  • How common is it?
  • It occurs between 1: 400 and 1: 800 births. It is more common in men with a male / female around 2:1. Although no inherited association has been established, it may rarely occur in more than one offspring in a family.
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  • Where is a horseshoe kidney located?
  • The horseshoe kidney is located at a lower abdomen than normally.
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  • What are the symptoms?
  • One third of people remain asymptomatic and they are diagnosed by chance after an ultrasound check up. Symptoms are related to the presence of stone and / or urinary tract infection.
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    • Is horseshoe kidney associated with the appearance of urinary tract infections?
    • Yes, it is associated with increased urinary tract infection incidents, usually due to a termination of the urine stream when there is a ureteropelvic junction stenosis that is evident as a ureteropelvic enlargement. Urine infections may also be responsible for the frequent coexistence of vesicoureteral reflux. If there is no urine termination, the frequency of urinary tract infections and lithiasis does not differ from other people. 
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    • Does the horseshoe kidney associate with chronic kidney failure?
    • As far as renal function is concerned, there is no predisposition for renal failure nor it is related to complications in the pregnancy of women with horseshoe kidney.
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    • How is horseshoe kidney diagnosed?
    • With the use of ultrasound. However, CT scan without or with the use of contrast media is considered an ideal solution. MRI scan as well as angiography can reveal the vascular system that is usually difficult to be displayed in the horseshoe kidney. Kidney scintigraphy can be of a great help when there is distension to uncover whether there is obstruction or stenosis and to clarify if the isthmus is functional. In the case of urinary tract infections in children, it may be necessary to have a voiding cystourethrogram for the blockage of vesicoureteral reflux.
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    • What does horseshoe kidney treatment entail?
    • There is no therapeutic approach unless a problem such as a urinary tract infection or lithiasis occurs. If the imaging test reveals a ureteropelvic junction stenosis, surgical intervention with pyeloplasty is suggested preferably with laparoscopic surgery.
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    • Mesogeios Dialysis Centers Group Scientific Team 
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    • Bibliography
    • 1: Kirkpatrick JJ, Leslie SW. Horseshoe Kidney. 2017 May 21. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2017 Jun-. Available from http://www.ncbi.nlm.nih.gov/books/NBK431105/PubMed PMID: 28613757.
    • 2: Taghavi K, Kirkpatrick J, Mirjalili SA. The horseshoe kidney: Surgical anatomy and embryology. J Pediatr Urol. 2016 Oct;12(5):275-280. doi: 10.1016/j.jpurol.2016.04.033. Epub 2016 May 31. Review. PubMed PMID: 27324557.
    • 3: Raison N, Doeuk N, Malthouse T, Kasivisvanathan V, Lam W, Challacombe B. Challenging situations in partial nephrectomy. Int J Surg. 2016 Dec;36(Pt C):568-573. doi: 10.1016/j.ijsu.2016.05.070. Epub 2016 Jun 2. Review. PubMed PMID: 27262880.
    • 4: Caccetta F, Caroppo M, Musio F, Mudoni A, Accogli A, Zacheo MD, Burzo D, Bramato D, Carluccio G, Nuzzo V. [Horseshoe kidney: not a simple fusion anomaly]. G Ital Nefrol. 2015 Jul-Aug;32(4). pii: gin/32.4.4. Review. Italian. PubMed PMID: 26252260.
    • 5: Natsis K, Piagkou M, Skotsimara A, Protogerou V, Tsitouridis I, Skandalakis P. Horseshoe kidney: a review of anatomy and pathology. Surg Radiol Anat. 2014 Aug;36(6):517-26. doi: 10.1007/s00276-013-1229-7. Epub 2013 Nov 1. Review. PubMed PMID: 24178305.
    • 6: Tan YK, Cha DY, Gupta M. Management of stones in abnormal situations. Urol Clin North Am. 2013 Feb;40(1):79-97. doi: 10.1016/j.ucl.2012.10.001. Review. PubMed PMID: 23177637.
    • 7: Petrović M, Andrejević V, Djurasić L, Stamenković V, Acimović M, Pejcić T, Dragoslav B, Hadzi-Djokić J. Tumors of the horseshoe kidney--characteristics and literature review. Acta Chir Iugosl. 2012;59(1):53-5. Review. PubMed PMID: 22924304.
    • 8: Caglar K, Kibar Y, Tahmaz L, Tekin A, Yenicesu M, Vural A. Polycystic horseshoe kidney. Clin Nephrol. 2001 Jun;55(6):487-8. Review. PubMed PMID:11434362.
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