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Horseshoe Kidney-All about Horseshoe kidney 2020

What is Horseshoe Kidney


Horseshoe kidney in other words renal fusion or super kidney is a congenital disorder. It doesn’t show symptoms, on the contrary, it is diagnosed accidentally during routine checkups.

It develops during the fetus stage between 7th to 9th weeks of pregnancy. Basically, the kidneys develop into a position taking a U or horseshoe shape just above the waist on each side of the body.

Its probability is very uncommon incidentally 1 in 500 and it’s more common in men.  The merged part is the isthmus of the horseshoe kidney.

After fusing they attached at the lower base or the end. In the case of a horseshoe kidney, it is more probability to get hurt rather than a normal kidney when there is any trauma in the abdominal area.

This rare condition can lead to kidney drainage resulting in noncancerous cysts, kidney cancer, UTI(Urinary Tract Infections), Kidney stones, Nephroblastoma.

This creates a problem in the heart and blood vessels as well as in the nervous system. It also occurs along with some genetic disorders; for example, Edward syndrome and Turner syndrome.

In most of cases merger or fusion occurs at the lower pole. horseshoe kidney also shows a larger variation in the origin and number of renal arteries and veins.


Signs and Symptoms of Horseshoe Kidney


It is a rare condition with no symptoms at all but can show stomach ache. One-third of the patients remain undetected their entire life until and unless the problem is discovered accidentally through an Ultrasound or CT imaging.

But the condition may lead to some abnormalities which  have been listed below-:

1. Kidney Obstruction-Commonly causes ureteropelvic junction obstruction (UPJ) . It is a condition in which the area connecting ureter to the renal pelvis is obstructed leading to urinary stasis which in turn raises risks of infection and stone formation.The blockage in the flow of urine and urine also starts backward from the bladder.

2. Kidney Infections- It is caused by the urine flowing backward i.e. urine usually flows from kidney to the bladder but it may retreat in this condition leading to urinary tract infections.

3. Kidney Stones- People affected by this condition are more prone to the development of kidney stones.

4. Kidney Cancer-   increased frequency of certain renal cancers such as transitional cell tumors, Wilms tumors also knowns as nephroblastoma which is curable, and carcinoid tumors.some of the symptoms of kidney tumors are belly mass, blood in the urine, flank pain, etc.

5. Some other symptoms are foul-smelling urine, a patient needs to urinate often, mild fever, pain while urination, loss of control on urine, etc.

6. Hydrocephaly is a condition where extra fluid intact in the brain.

7. Spina bifida is basically a type of neuro defect in which the spinal cord is formed abnormally.



Etiology


Scientists are unable to figure out a clear cut cause leading to this condition but there can be different reasons which may lead to this condition.

Different exposures to the developing fetus such as different teratogens (e.g. thalidomide, ethanol, ACE inhibitors, cocaine, gentamycin, corticosteroids, NSAIDs, and vitamin A) have been considered but without certainty.

Damage of a developing embryo's nephrogenic cell migration or abnormal migration of the kidneys due to fetal structural abnormalities is a potential factor.

Some conclude it as the abnormal migration of nephrogenic cells. Structural factors include rotation of the caudal spine.  The merger generally takes place between the fourth and sixth weeks of development.

Despite there are cases of familiar clustering there is no defined genetic cause of horseshoe kidney. But there lies one fact that there are some etiological factors that contribute to the development of horseshoe kidney.

There are some cases in which later merger is seen which is because of the fibrous isthmus rather than renal parenchyma.

Pathophysiology


Actually, kidneys are positioned in the anatomical space. Once the kidneys merge in a horseshoe shape and due to the embryogenic and anatomical factors the frequency rates of hydronephrosis, the formation of stone, certain types of cancer, and infection are higher which results in a diseased horseshoe kidney.

Diagnosis of Horseshoe Kidney


Horseshoe kidney is generally diagnosed fortuitously. It is also diagnosed before the birth of a child through prenatal tasting and cured with medicines or surgery at the early stage but other problems like urinal tract infections, kidney stones, and hypertension are figured out later.

The process involved is undergoing routine checkups such as ultrasound, computed tomography, magnetic resonance imaging, etc.

Through MRI  it is best demonstrated as the anatomy and it also detects accessory vasculature and surrounding structures.

Common results found in the above examination are:



  • In ultrasound, it is found in the shape of inverted triangular which raises suspicion of horseshoe kidney.
  • Urine check results in to check the sign of infection.
  • Kidney ultrasound helps to figure out regarding kidney stones or cysts if any.
  • In the voiding cystourethrogram which is basically a type of x-ray which is a thin flexible tube that is placed in the urethra. And x-ray images are taken during the bladder empties and fills and it gives the analysis of urine reverse flow into the ureters and kidneys.


Treatment of Horseshoe Kidney




Symphysiotomy is a process that involves the separation of the merged kidney, basically a surgery. However, it is not applied because of the complications involved.

It also does not guarantee treatment.  There are antibiotics for any infections occurred.  For kidney stones, one must need to undergo asymptomatic surgery.

The treatment basically depends upon the patient’s age general health symptoms and the condition. One should also be aware to protect the kidneys because normally ribcage and the covered layer of muscles protect the normal kidneys but in the case of horseshoe kidney it is absent to protect it.

So it is necessary to avoid any fight or sports which results in putting people at any risk. The chances of kidneys not functioning properly may also occur.

The patient with horseshoe kidney should also hydrate themselves more than normal. Larger stones which are greater than 2.5cm are not allowed ureteroscopic approaches and can be removed via surgery.




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