Horseshoe kidney 

• Horseshoe kidney is an development anomaly 
• Is also referred as renal fusion
• In 1 out of  500 children
• occurs as a result failure of complete ascending up of the kidneys with the fusion of lower or upper poles
• As it ascends up from the pelvic area it get fused at the base forming an U shape/Horseshoe shape 
• This is Because of the fusion of sub divisions of mesonephric duct

• Commonly  seen in males than in females and the prevalence is seen higher in lower Poles  when compare with the upper poles
• Common site for this horseshoe kidney is in front of vertebra where the isthmus ,( the blood supply is more ),where it communicates one kidney to the other,other site is in front of aorta Causes

• The causes unknown but it is  developmental or genetic
• Other reasons for the cause might include ,as a result of environmental factors such as when the baby is exposed to toxins before birth  such as drugs or alcohol or any substances Clinical features

• It Is a fixed, non mobile, firm mass present in the midline at the level of 4th lumbar vertebrae
• On percussion, it is resonant which indicates the horseshoe kidney with may be increased risk of infection ,stone formation and hydronephrosis and Tuberculosis
• Also commonly seen with patients having down syndrome ,Turner syndrome, Edward syndrome,patau syndrome or other congenital abnormalities.
• Also seen in non chromosomal conditions such as fanconi anemia ,goltz syndrome etc

Symptoms

• Not usually seen ,mostly asymptomatic 
• Pain , nausea ,kidney stones ,urinary tract infections, difficulty during urination ,pain while urinating
• Moreover ,there is a increased risk of Kidney cancer if symptoms such as hematuria mass in abdominal region flank pain and pain during urination 

Diagnosis

Kidney functional test

• Basic tests include blood test and urine tests are included as a regular investigative procedure 
• To check the functioning of kidneys,it is done to  know the levels of estimated glomerular filtration rates , blood urea nitrogen and creatinine levels

Intravenous urography 

• In intravenous urography it reveals medialization of lower calyces and curving of ureter which is seen in the shape of a “flower vase”

Ultrasound abdomen or renal sonography 

•  Is used as a supportive investigation to know the shape and size of kidneys in case to rule out the presence of cysts or swellings 
• Sometimes  the ureters will angulate causing the Urinary stasis  which also increase of the infection and stone formation

Intravenous pyelogram or IVP

• It is indicated to know the path and rate of urine flow through the urinary tract 

Voiding cystourethrogram or VCUG

• It is indicated to know the direction of flow of urine 
• That’s means downwards towards bladder or reverse to kidneys 
• RadioNuclide scan
• Magnetic resonance imaging (MRI) or computer tomography (CT)

Treatment

• I Symptoms are not  present the treatment is usually not recommended
• There is no particular treatment for horseshoe kidney and  only the supportive treatment is advised 
• Supportive Treatment includes prescription of antibiotics,pain relievers 
• surgery is only indicated in presence of  vesicular ureteral reflux 
• Surgery is not the solution in case of pain

• Surgery is not indicated until and unless the abdominal aortic aneurysms are present
• Surgery is only indicated when the patient have possible better outcomes such as  restore urinary flow with no obstruction , vesicular ureteral reflux and remove kidney stones is the solution for the cause
• If Abdominal aortic aneurysms are present then divide the isthmus between the kidneys to compromise  the vascular blood supply
• Special attention should be maintain in children from avoiding playing sports or other vigorous exercises

Complications

• Vesicular ureteral reflux
• Retro pelvic obstruction
• Hydronephrosis
• Renal cysts
• Renal artery stenosis
• Kidney cancer
• Spina bifida
• Hydrocephaly
• Wilms tumors

Frequently asked questions