ABSTRACT
SUMMARY: Horseshoe kidney (HSK) is the most common kidney malformation. This review analyses the literature surrounding the etiology, morphology and clinical anatomy of these kidney fusion anomalies. A systematic literature search was carried out using the Science Direct and Scopus applications. HSK is characterized by three anatomic abnormalities: ectopia, malrotation and vascular changes. The study put emphasis especially on blood supply and upper urinary tract changes in HSK's patients. Arterial blood supply was analysed not only basing on Graves pattern, but also a new model of supply created on horseshoe kidneys computed tomography was taken into account. In addition, study presents clinical aspects of especially significant pathology of HSK, like hydronephrosis, stones and urinary tract infection. This study focuses also on congenital anomalies associated with horseshoe kidney.
RESUMEN: El riñón en herradura (RH) es la malformación renal más común reportada en la literatura. Esta revisión analiza la literatura que rodea la etiología, morfología y anatomía clínica de esta anomalía de fusión renal. Se realizó una búsqueda sistemática de la literatura utilizando las aplicaciones Science Direct y Scopus. El riñón en herradura se caracteriza por tres anomalías anatómicas: ectopía, malrotación y cambios vasculares. El estudio puso énfasis especialmente en el suministro de sangre y los cambios del tracto urinario superior en los pacientes con RH. El suministro de sangre arterial se analizó no solo basándose en el patrón de Graves, sino que también se tuvo en cuenta un nuevo modelo de suministro creado en los riñones en herradura. Además, el estudio presenta aspectos clínicos de patología especialmente significativa de RH, como hidronefrosis, cálculos e infección del tracto urinario. Este estudio se centró también en las anomalías congénitas asociadas con el riñón en herradura.
Subject(s)
Humans , Fused Kidney , Kidney/abnormalities , Kidney/blood supplyABSTRACT
@#Horseshoe kidney is a rare form of congenital renal malformation. It occurs in 0.25 to 3% of the population and is usually asymptomatic. Occurrence of symptoms is usually related to infection, lithiasis, and rarely, malignancy. Presented is a case of a 62-year old male with a one-year history of occasional painless hematuria associated with epigastric discomfort. On physical examination, a palpable mass was noted on the right periumbilical area, 10cm x 10cm in size and was non-tender. CT-scan with IV contrast showed 10cm x 7cm x 12cm mass on the right side of a horseshoe kidney. He underwent Radical Nephrectomy, right with Isthmusectomy. Post-operative course was unremarkable. Histopathology result showed Renal Cell Cacrcinoma, clear cell type.. Although malignancy was present in an anomalous kidney, the prognosis is the same as with normal kidneys. To date, this is the first reported case of malignancy on a horseshoe kidney in the Philippines.
Subject(s)
Fused Kidney , Carcinoma, Renal CellABSTRACT
Background and Objective:Horseshoe kidney is themost common renal fusion anomalywith a reported prevalence of 1 in 400 persons with a male to female ratio of 2:1. In many cases its presence may go unnoticed and undiagnosed because the patient may remain asymptomatic throughout life. The objective of our study is to report radiological and anatomical features of horseshoe kidney detected incidentally during retrospective evaluation of multidetector computed tomography scans. Materials and Methods: Contrast enhanced multidetector computed tomography scans of 682 patients, 355 males and 327 females, were reviewed retrospectively. Results: Seven cases of horseshoe kidney were detected incidentally, sixmales and one female,with an incidence of 1.02%. In all cases,malrotation of the kidneyswere observedwith the hilumfacing anteriorly or anterolaterally. The isthmus was made up of parenchymal tissue in all the cases and the fusion was midline in four cases and lateral in three cases. Horseshoe kidney in all cases was supplied by multiple renal arteries, varying from 3 to 6. In three cases symmetrical arterial supply and in the rest asymmetrical supplywas observed. Nephrolithiasis and hydronephrosis were noted in two patients. No other associated congenital anomaly was observed in all seven patients. Conclusion: Contrast enhanced multidetector computed tomography evaluation of patients with horseshoe kidney provide excellent information about its vascularity, collecting system and other associated conditions.
ABSTRACT
Crossed renal ectopia is one of the rarest congenital malformations where a kidney is located on the side opposite to the side of its ureteral insertion into the urinary bladder and is generally fused with the normally located ipsilateral mate. Generally this anomaly remains as a silent clinical entity and is incidentally detected during evaluation for other conditions. We report here three such cases of crossed fused renal ectopia detected by multidetector row contrast enhanced computed tomography. Crossed fused renal ectopia of inferior type was observed in a male on the right side with the ureter of the ectopic left kidney crossing the midline. In two female patients, L-shaped or tandem kidney was noted, one on the right and another on the left side. Over all in two cases the left kidney was ectopic and in one the right kidney. No renal pathologies like urinary tract infection, nephrolithiasis or hematuria were found in our patients.
ABSTRACT
Crossed renal ectopia is an unusual congenital anomaly, probably produced by abnormal development of the ureteral bud. The deformity itself produces no symptoms and the clinical presentation generally is for obstruction and infection. The pediatric patients present most often with multiple congenital anomalies, especially of the skeletal system. We report the two cases of crossed renal ectopia with fusion with review of literatures.