Horseshoe kidney: Causes, symptoms and treatment

During the embryonic period, the kidneys develop and change positions during development, they will develop in the pelvic region and gradually move up to the position below the ribcage, on either side of the lumbar spine. When moving the upper pole, the kidney rotates inward to allow the kidney to enter the spine. This process of growth and migration is completed before 8 weeks of gestation. In this process any cause of disruption will form congenital abnormalities in the kidneys of the fetus.
Horseshoe kidney is a rare structural and positional abnormality of the kidney, occurring in an incidence of 1/400-1/800 children.
In horseshoe kidney disease, instead of the kidneys on either side of the spine and separate from each other, the left and right kidneys are connected by a false isthmus, in more than 90% of cases at the lower pole of the kidney. Call the isthmus pseudorenal because the site of contact is very small, difficult to detect, and the isthmus has no function. When the two kidneys are joined together, they are shaped like a horseshoe, so it is called horseshoe kidney disease.
The location of the 2 kidneys in horseshoe nephropathy is usually low in the pelvis, because in embryonic stage the kidneys are located in the pelvis and then move up to the abdomen, but because the 2 kidneys are fused together in the pelvis. One pole should be entangled with the inferior mesenteric blood vessels, so they cannot move up to the correct position of the renal fossa, and at the same time they cannot rotate.
In addition, the pseudo-renal waist can be located symmetrically or asymmetrically on the spine.

Horseshoe kidney can cause complications such as:
Urinary obstruction, hydronephrosis. Formation of kidney stones with the rate of 20-60% of urinary tract infections. Kidney cancer: It has been found that up to 45% of renal carcinomas are seen in patients with horseshoe kidney. Because in part due to the effects from kidney retention, kidney stones and urinary infections. Due to abnormalities in position and anatomical shape, patients with horseshoe kidney are at increased risk of kidney damage during trauma. Most children do not see any other health problems with horseshoe kidney disease, however in about one-third of children with this defect there are other associated defects including the heart, nervous system, reproductive organs. reproductive, urinary, digestive, and skeletal systems.

Horseshoe kidney disease in children is related to genetic factors, but there is no basis to explain the cause of this defect. There is an increased risk of horseshoe kidney disease when a child has certain genetic disorders, especially:
Turner syndrome : A sex chromosome abnormality seen in girls. This syndrome causes problems related to height and abnormalities in the genitals of girls. Edwards syndrome: also known as Trisomy 18, an abnormality related to chromosome 18, in which the patient has 3 chromosomes 18. This syndrome causes the fetus to grow slowly in the womb, low birth weight. , intellectual disability, heart defect.

Because horseshoe kidneys still perform the function of filtering and excreting urine, most patients do not have any symptoms and are often discovered by chance through routine physical examination.
However, in people with horseshoe kidney disease, there is an increased risk of diseases in the urinary tract, so the patient has manifestations of complications or other comorbidities such as:
Other birth defects such as malformations on the heart, digestive system, nervous system... Urinary tract obstruction: Expression of dull pain in the back, heaviness in the abdomen, little urine, painful urination, frequent urination, often accompanied by urinary tract infections. Urinary tract infections: Fever, cloudy urine, painful urination, frequent urination, blood in the urine. Kidney stones: Lumbar pain, urine sediment, possible urine stones, hematuria... Usually, the clinical signs are often difficult to distinguish, there are many cases detected when doing imaging methods. Photos such as:
Ultrasound: There is hydronephrosis, abnormal kidney shape. However, ultrasound is often difficult to detect if the sonographer is inexperienced. UIV: When there are suspicious signs, or in the case of kidney stones, abnormalities in the kidneys can be detected. Sometimes some cases can be confused. CT is the modality of choice when UIV is in doubt. I can see the image of a horseshoe kidney

Usually for patients with horseshoe kidney, if no abnormalities are detected, no treatment is needed, just regular monitoring to detect early complications caused by horseshoe kidney disease.
If complications occur, treatment should be carried out:
Renal stasis: Need to recirculate to avoid hydronephrosis, usually patients have hydronephrosis due to the pseudo-renal isthmus pressing on the ureter. Therefore, the treatment method is isthmusectomy, but before surgery, it is necessary to have medical treatment first if the patient has a urinary tract infection. Urinary tract infections: Treat with antibiotics, anti-inflammatory drugs to relieve pain, if the fever is higher than 38.5 degrees Celsius, the fever will be reduced. Kidney stones: If not accompanied by hydronephrosis, the patient should drink a lot of water, should visit a medical facility if the stone is large and needs to be treated with interventional methods. Horseshoe-shaped kidneys are often difficult to detect, or are discovered incidentally during routine physical examination. You should have regular health check-ups and if there are any abnormal signs on the urinary tract, you should go to a medical facility for examination, treatment and monitoring. Regular follow-up in patients with horseshoe kidney disease is a means of preventing and detecting complications early.
Vinmec International General Hospital with a system of modern facilities, medical equipment and a team of experts and doctors with many years of experience in neurological examination and treatment, patients can completely peace of mind for examination and treatment at the Hospital.
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