Updated: 12/20/2018

Horseshoe Kidney

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Overview

Snapshot
  • A 2-year-old boy is ThisMRI section demonstrates the classic appearance of a horseshoe kidney where the fused inferior poles of the kidney are trapped under the inferior mesenteric vesselreferred by his pediatrician to a nephrologist for recurrent urinary tract infections. He was born at 39 weeks and appeared healthy at birth; however, he has developed significantly more urinary tract infections than expected for a child of his age. Physical exam reveals increased fullness in the abdomen and an MRI scan is obtained. Urine cultures are obtained and empirical antibiotics are started pending culture results. 
Introduction
  • Clinical definition
    • congenital malformation of the renal system resulting in fused kidneys
  • Epidemiology
    • common malformation found in 1/400 live births
    • twice as common in males
  • Pathogenesis
    • fusion of the lower poles of the kidneys (most common)
    • trapping of the fused kidneys under the inferior mesenteric artery
    • arrest of the normal retroperitoneal ascent of the kidneys
  • Associated conditions
    • Turner syndrome
    • trisomy 18 (Edwards syndrome)
  • Prognosis
    • typically very good
    • most patients remain asymptomatic
Presentation
  •  Symptoms
    • asymptomatic (most common)
    • increased rate of urinary tract infections
    • hydronephrosis due to
      • ureteropelvic junction obstruction
    • renal stones
  • Physical exam
    • abdominal fullness upon palpation
Imaging
  • Kidney ultrasound
    • indications
      • initial evaluation of symptomatic patients
  • Voiding cysturethrogram
    • indications
      • further evaluation of abnormal anatomy
    • findings
      • fusion of kidney poles trapped under the inferior mesenteric artery
  • Intravenous pyelogram
    • indications
      • for evaluation of symptomatic kidney stones
    • findings
      • filling defect at the level of the obstruction
Differential
  • Unilateral renal agenesis
  • Posterior urethral valves
  • Multicystic dysplastic kidney
  • Duplex collecting system
Treatment
  • Conservative
    • no treatment for asymptomatic patients
  • Medical
    • antibiotics
      • indication
        • urinary tract infections
      • outcomes
        • very good
Complications
  • Postrenal kidney failure due to kidney stones
    • rare since most cases are asymptomatic
    • treatment
      • removal of kidney stones
  • Hydronephrosis if obstruction is left untreated
  • Anomalous original of multiple renal arteries may complicate surgery 
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(M1.RL.15.33) A 10-year-old Caucasian female with Turner's syndrome underwent an abdominal imaging study and was discovered that the poles of her kidneys were fused inferiorly. Normal ascension of kidney during embryological development would be prevented by which of the following anatomical structures? Tested Concept

QID: 100987
1

Inferior vena cava

16%

(8/51)

2

Superior mesenteric artery

4%

(2/51)

3

Inferior mesenteric artery

73%

(37/51)

4

Celiac artery

2%

(1/51)

5

Splenic artery

2%

(1/51)

M 1 E

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