Kidneys are a vital organic structure that performs the most difficult work. They purify the blood of toxic substances, remove excess fluid, regulate the arterial pressure. Year after year, the number of kidney pathologies is steadily increasing, which doctors associate with the deterioration of environmental conditions, poor-quality products containing chemical additives, etc. One of the most common congenital anomalies is the horseshoe kidney.
Horseshoe-shaped kidney
Horseshoe-shaped kidney is an abnormal congenital condition, the essence of which is in the fusion of the upper or lower renal poles, due to which the isthmus is formed. The ICD-10 code is Q63.1.Usually, such an anomaly is accompanied by various pathological processes such as pyelonephritis, hydronephrosis, urolithiasis, etc. According to statistics, the horseshoe-shaped kidney occupies about 15% of the total number of abnormalities of the kidney structures.
Most often the fusion of the lower poles occurs, as a result of which the kidney takes the U-shape( in 90% of cases).Each kidney has its own feeding vessels and ureter. Practically in each horseshoe-shaped kidney( in 89%) an unusual cup structure and an abnormal vascular network with impaired blood circulation.
Significantly less often the kidneys coalesce with the upper poles, middle parts or opposite poles. Such forms also have a mass of concomitant pathologies.
Causes of
The reason for the formation of the horseshoe-shaped kidney is the dysembryogenesis. Horseshoe-shaped kidneys are formed in prenatal development. Normally, the fetus develops kidneys in three stages: the preference, the primary, and then the secondary kidney. In the phase of the secondary kidney the organ migrates to its bed in the lumbar region. Finally, the kidney is formed and fixed after the birth of the child.
Horseshoe-shaped kidney formation occurs when the organ migration process is disturbed.
The reason for such violations are such factors:
- Aggressive ecological environment;
- Drug abuse;
- Pathologies of a genetic nature;
- Infectious lesions of the mother;
- Unhealthy habits of either or of one parent;
- Chronic pathology;
- Exposure to chemicals.
Signs and symptoms
Quite often, the horseshoe-shaped kidney does not manifest itself, but some children experience complications related to the cardiovascular, genitourinary or nervous system. Symptomatology may be slightly different depending on the concomitant lesion of a particular organ.
In general, these manifestations are:
- Pain syndrome that occurs in the umbilical zone when the body is bent or flexed. Pain can irradiate to the lower abdomen, epigastrium, or lower back after physical work.
- Constipation due to compression of the nerve mesenteric plexus by the isthmus of a fused organ.
- For a similar reason, the patient may be bothered by spastic intestinal pains or peristalsis disorders.
- Constant soreness causes hysteria, neurasthenia and emotional instability.
- Intra-spinal pressure increase, resulting from the compression of the vascular passages of the body of the abnormal kidney. This condition is often accompanied by impurities of blood in the urine.
- If compression of the hollow lower vein occurs, it leads to ascites and hyperthermia of the lower half of the body, legs, varicose veins.
- In the female population, the horseshoe-shaped kidney can lead to premature delivery or menstrual failure.
It happens that the abnormal organ does not cause any disturbances and is asymptomatic, and is detected by accidental examination. If the fused body is affected by some pathological process, then the clinical picture consists of the symptoms of the lesion. In addition, the affected kidney can be combined with other congenital malformations like kidney polycystosis, spina bifida, skeletal anomalies, hydrocephalus, etc.
Associated diseases and complications
Horseshoe kidneys are often accompanied by complications caused by an impaired urinary flow:
- Hydronephrosis - 41.7% of cases.
- Urolithiasis is observed in 23.6% of cases.
- Pyelonephritis - 19,4%
- Arterial hypertension - 15,2%.
Horseshoe-shaped kidney is characterized by abnormal urinary flow, which is usually associated with an improper ureteral location. Also, disturbed urine flow can be a consequence of occlusion of the lumen by a stone.
When this happens, urine begins to accumulate in the calyx and pelvis. Since it is not excreted anywhere, the kidney increases, and the cup-and-pelvic system begins to squeeze the parenchyma of the organ and its nephrons.
This leads to violations of the renal circulation, the emergence of atrophic processes leading subsequently to necrosis. When there is an irreversible death of nephrons, a partial or complete loss of renal functions occurs.
Hydronephrosis transformation or hydronephrosis develops, which is treated only by surgical methods. The kidney is divided and bred to the closest to the physiological norm location.
Hydronephrosis is by no means the only complication of the horseshoe-shaped kidney. For example, in the forming isthmus, tumor formation and renal cancer are more often formed. Urodynamic disorders contribute to the precipitation of a salt sediment, from which concrements are subsequently formed and urolithic pathology develops. The treatment is based on diet therapy, medication and instrumental surgery.
With an anomalous kidney, congenital pathologies like
- often occur side by side:
- Spina bifida is more often seen in adolescents, a protrusion appears on the spinal column, radicular tenderness resembling radiculitis;
- Polycystic is a congenital anomaly of the kidneys, manifested by cystic degeneration of the parenchyma of the organ, which leads to a pathological decrease in renal function.
Horseshoe kidney increases the patient's propensity to inflammatory pathologies, which include pyelonephritis - an infectious inflammatory process of bacterial origin. The causative agents of this complication are fungi, proteins, staphylococcal or streptococcal components, E. coli. These pathogens usually rise in the kidney along the urinary tract from the rectal tissues or genital organs.
Diagnosis
If suspicions of a horseshoe kidney are suspected, the patient is referred for procedures such as ultrasound, electronic urography, computed tomography, etc.
- According to the results of the urographic examination, the expert can draw conclusions about the low position of the organ, its insufficient mobility, shading froman isthmus, a shady stratification on a contour of a backbone.
- The retrograde pyelography allows visualization of abnormal location of the organ, isthmus, silhouette of the kidney or its pelvis.
- To study the location of the renal vasculature, angiography is performed. In addition, such a diagnosis can reveal the presence of additional vessels, the thickness and the exact location of the isthmus.
- Ultrasonic diagnosis( ultrasound) helps in detecting abnormal position of renal pelvis, changes in cup renal structures, impaired circulation in the abnormal kidney.
- When carrying out nephroscintigraphy, an accumulation of a contrasting radionuclide substance in the form of a horseshoe is fixed, as it were, enveloping the spine.
On video, the diagnosis of a horseshoe-shaped kidney by ultrasound:
Treatment
If the patient has no complaints, the kidneys function smoothly, then the patient is constantly under the supervision of a nephrologist who periodically prescribes the necessary preventive measures and conducts a diagnosis of the condition of the kidney structures. If some worsening of the condition begins, then the necessary therapy is prescribed.
If worsening is more serious, like stone formation, tumors, hydronephrosis, then surgical treatment tactics are used. Urodynamic disorders are eliminated by classical dissection of the isthmus and fixation of organs on a physiologically laid place.
Forecasts
Horseshoe-shaped kidney is the most common anomaly in the development of the urinary system. The most serious disorders occur if the surrounding organs are squeezed. The most favorable prognosis is for patients whose anomaly was detected even in early childhood, and at the same time an operation was performed to separate the kidneys.