Horseshoe Kidney Research Articles

Intraperitoneal laparoscopic technique in trendelenburg position: an effective surgical method for pyelolithotomy, pyeloplasty, and heminephrectomy in patients with horseshoe kidneys

PurposeTo evaluate the safety and feasibility of intraperitoneal laparoscopic surgery in Trendelenburg position (ILSTP) for pyelolithotomy, pyeloplasty, and heminephrectomy in patients with horseshoe kidneys (HSKs).MethodsBetween March 2021 and March 2024, three patients with HSKs underwent ILSSP. Of these three patients, two with pelvi-ureteric junction obstruction with recurrent kidney stones underwent pyelolithotomy and pyeloplasty, one with symptomatic nonfunctioning left moiety of a HSK was managed with heminephrectomy.ResultsMean operating time was 114 ± 64.8 (44–172) min, and estimated blood loss was 63.3 ± 51.3 (20–120) ml. The mean hospital stay was 3.3 ± 1.5 (2–5) days. There were no major intra- or post-operative complications.ConclusionsILSTP is a feasible and effective technique for performing pyelolithotomy, pyeloplasty, and heminephrectomy in patients with HSKs.

Intriguing Presentation of Proteinuria Associated with Immature Glomeruli in a Child with Horseshoe Kidney

Intriguing Presentation of Proteinuria Associated with Immature Glomeruli in a Child with Horseshoe Kidney

Intraoperative dexmedetomidine administration and acute kidney injury in patients undergoing unilateral partial nephrectomy: a retrospective study

Partial nephrectomies are associated with an increased risk of acute kidney injury (AKI), but dexmedetomidine administration may improve renal outcomes. We hypothesized that intraoperative dexmedetomidine administration would be associated with a decrease in AKI development in patients undergoing unilateral partial nephrectomy. In this retrospective study, adult patients who underwent unilateral partial nephrectomy from April 2016 to October 2023 were included. Exclusion criteria were a history of end-stage renal disease, ineligible procedures (i.e., aborted procedure, conversion to radical nephrectomy, surgery on a horseshoe kidney), and reoperation within three days of the initial nephrectomy. Patients were categorized according to whether they received intraoperative dexmedetomidine. The primary outcome was AKI incidence within three days of surgery; AKI was defined according to the Kidney Disease Improving Global Outcomes definition. Propensity score matching (PSM) was conducted to account for potential confounders (age, body mass index, sex, American Society of Anesthesiologists score, final surgical approach, clamping-related ischemia for >15 min). We included 1,632 patients; 214 received dexmedetomidine and 1,418 did not. Before PSM, the AKI rate was 31.2% in patients who received dexmedetomidine and 25.7% in patients who did not (p = 0.081). After PSM, the AKI rate was 31.3% in patients who received dexmedetomidine and 27.6% in those who did not (p = 0.396). The post-PSM odds ratio for AKI following dexmedetomidine administration during unilateral partial nephrectomy was 0.910 (95% CI: 0.585–1.142; p = 0.677). Intraoperative dexmedetomidine was not associated with a reduction in postoperative AKI incidence or severity after unilateral partial nephrectomy.

Case Report of First Kidney Transplant in Mexico Using Horseshoe Kidney from a Cadaveric Donor in a Single Recipient

Case Report of First Kidney Transplant in Mexico Using Horseshoe Kidney from a Cadaveric Donor in a Single Recipient

Pelvi-ureteric junction obstruction in a case of horseshoe kidneys with lower pole crossing vessels:a rare case and its management

Pelvi-ureteric junction obstruction is one of the most common urological conditions found in children. Horseshoe kidneys are a predisposing factor and to find a vascular anomaly causing the obstruction is rare. A 2-year-old girl with two episodes of culture-positive febrile urinary tract infections (UTI), was found to have right sided hydronephrosis. Renal scan revealed decreased functioning of right kidney with scars. A contrast CT scan showed a horseshoe kidney with pelvi-ureteric junction obstruction on right side with dilatation of renal pelvis. During laparoscopic pyeloplasty, lower pole crossing vessels were detected, not reported on CT scan. A dismembered pyeloplasty with transposition of uretero-pelvic anastomosis anterior to lower pole vessels was done. Anomalous vasculature of kidney should be kept in mind during surgery in such cases. A dismembered pyeloplasty along with transposition of anastomosis is necessary to prevent recurrence.

Challenge Treatment GH with Turner Syndrome Having Cardiac and Renal Malformation: About A Case Report

In GH deficiency, rhGH is deemed appropriate when epiphyses are open, while Turner's syndrome poses unique considerations due to associated malformations like cardiac aortic bicuspidity and aortic coarctation. Renal malformations, including Horseshoe kidney and hydronephrosis, further highlight the complexity of Turner's syndrome, requiring a comprehensive, multidisciplinary approach to care. We report the case about of an elderly child 3 years and 5 months old patient with cardiac and renal malformations notably a tight postductal isthmic coarctation and a left pyeloureteral junction syndrome with dilatation of the pyelocalic cavities, admitted for further management of a staturo-ponderal delay. She presented with functional signs of constipation, no chills, no digestive disorders and no hypoglycemic malaise. On physical examination, dysmorphic features included low hairline and short neck, pterygium coli, low ear implant, hypertelorism, nipple spread, keloid lesion on face. Test results showed a 45x karyotype in favour of Turner syndrome, HBA1c: 5.6%, the rest of the tests were normal. GH was indicated in the patient after cardiac surgery for coarctation of the aorta and pyelo-caliceal junction. The patient was referred for heart and kidney surgery. It is crucial to closely monitor height velocity during catch-up growth, particularly in patients with concurrent conditions leading to short stature. Additionally, there is an emphasis on educating parents about the potential impact of Turner syndrome on aspects such as growth, growth hormone (GH) substitution, ovarian failure, malformations, and related health risks.

Bromadiolone may cause severe acute kidney injury through severe disorder of coagulation: a case report

BackgroundBromadiolone is a wide-use long-acting anticoagulant rodenticide known to cause severe coagulation dysfunction. At present, there have been no detailed reports of acute kidney injury (AKI) resulting from bromadiolone poisoning.Case presentationA 27-year-old woman was admitted to the hospital due to severe coagulopathy and severe AKI. Coagulation test revealed a prothrombin time exceeding 120 s and an international normalized ratio (INR) greater than 10. Further examination for coagulation factors showed significantly reduced level of factors II, VII, IX and X, indicating a vitamin K deficiency. The AKI was non-oliguric and characterized by gross dysmorphic hematuria. Following the onset of the disease, the patient’s serum creatinine rose from 0.86 to 6.96 mg/dL. Suspecting anticoagulant rodenticide poisoning, plasma bromadiolone was identified at a concentration of 117 ng/mL via gas chromatography/mass spectrometry. All other potential causes of AKI were excluded, except for the presence of a horseshoe kidney. The patient’s kidney function fully recovered after the coagulopathy was corrected with high doses of vitamin K and plasma transfusion. At a follow-up 160 days post-discharge, the coagulation function had normalized, and the serum creatinine had returned to 0.51 mg/dL.ConclusionBromadiolone can induce AKI through a severe and prolonged coagulation disorder. Kidney function can be restored within days following treatment with high-dose vitamin K1.

TUMOR IN HORSESHOE KIDNEYS: A CASE REPORT AND LITERATURE REVIEW

Objective: This study aims to report a renal tumor in a horseshoe kidney successfully treated with an open left nephrectomy. Case(s) Presentation: A 3 years old girl with a lump in the left abdomen and intermittent hematuria was referred to our hospital. Whole abdominal contrast CT scan showed the presence of a left renal mass in a horseshoe kidney that infiltrates the left renal artery and is attached to the spleen. The patient underwent preoperative chemotherapy followed by surgical resection. Discussion: In a horseshoe kidney, renal tumors are uncommon. The limited kidney mobilization and access to the renal hilum and the abnormal and highly variable vasculature make surgical treatment of a tumor in a horseshoe kidney extremely difficult. Conclusion: Open surgery continues to be the treatment of choice for horseshoe kidney tumors due to their anatomical complexity, particularly in cases where the tumor is difficult to eradicate. Keywords: Renal tumor, horseshoe kidney, surgical management.

Robot‐assisted pyeloplasty for ureteropelvic junction obstruction complicating horseshoe kidney

IntroductionHorseshoe kidney is characterized by midline fusion of the lower poles of both kidneys. We report a case where robot‐assisted pyeloplasty was performed for hydronephrosis complicating horseshoe kidney.Case presentationA 31‐year‐old man repeatedly developed fever since childhood. He visited a local clinic for fever and left back pain, where he was diagnosed and treated for acute pyelonephritis. Abdominal computed tomography led to a diagnosis of horseshoe kidney and associated left ureteropelvic junction obstruction. He was referred to our hospital for pyeloplasty because of persistent left back pain. Robot‐assisted left pyeloplasty was performed using the Anderson–Hynes technique with four ports because crossing vessels were discovered intraoperatively. Isthmusectomy was not performed. The postoperative course was favorable. Computed tomography performed approximately 2 years post‐surgery showed improvement in hydronephrosis. No left back pain was reported.ConclusionOur case experience suggests the utility of robot‐assisted pyeloplasty for patients with horseshoe kidney.

P.204: Laparoscopic hand-assisted donor heminephrectomy in living donor with horseshoe kidney with non-touch technique.

P.204: Laparoscopic hand-assisted donor heminephrectomy in living donor with horseshoe kidney with non-touch technique.

Supernumerary kidney fused to the isthmus of a horseshoe kidney, with subsequent nephroblastoma, identified with dynamic renal scintigraphy

Supernumerary kidney fused to the isthmus of a horseshoe kidney, with subsequent nephroblastoma, identified with dynamic renal scintigraphy

VJY07 Robot-assisted partial nephrectomy for a renal cell carcinoma in a horseshoe kidney–video based illustration

VJY07 Robot-assisted partial nephrectomy for a renal cell carcinoma in a horseshoe kidney–video based illustration

Horseshoe kidney with teratoid type of Wilms tumor: a rare case report

BackgroundHorseshoe kidney is the most common renal fusion anomaly, and Wilms tumor is the most frequent renal malignancy in children. The occurrence of Wilms tumor in association with horseshoe kidney is a scarce anomaly. However, the arising of a teratoid type, which is a rare variant of Wilms tumor in a horseshoe kidney, is exceptionally unique.Case presentationThis report presents a 5-year-old male admitted with horseshoe kidney involved by a large heterogeneous calcified mass that was diagnose on biopsy as Wilms tumor blastemal dominant. According to the local and regional extension and metastatic tumor in the lungs, the patient underwent neoadjuvant chemotherapy and then surgery. Post-operative pathologic findings confirmed the diagnosis of teratoid Wilms tumor.ConclusionsThe occurrence of renal anomalies associated with a malignancy might be more frequent in the clinical environment. There are numerous differential diagnoses for renal tumors and masses, but the possibility of exceptional anomalies should not be denied, and clinicians should be prepared for these occasions. Although studies propose that chemotherapy has a trivial effect on teratoid Wilms tumors, it is essential to evaluate the tumor for any possibility of regression in non-teratoid regions before proceeding to upfront tumoral resection.

Preemptive treatment of type II endoleak for abdominal aortic aneurysm with renal fusion (horseshoe kidney).

To assess viability and safety of preemptive treatment of type II endoleak for abdominal aortic aneurysm (AAA) repairs. A 69-year-old man with renal fusion (horseshoe kidney) was referred for treatment of a 5.5cm AAA. His anatomy was suitable for endovascular repair. The risk for type II endoleak was increased because of multiple infrarenal arterial orifices originating within the aneurysm sac. These included an accessory renal artery that supplied the renal isthmus, a patent inferior mesenteric artery, and a pair of large lumbar arteries originating from a single orifice (8mm) at L3 spinal level. The lumbar orifice was selectively cannulated and occluded with thrombogenic coils 1week prior to his endovascular aneurysm repair. Aneurysm repair was uneventful with no signs of early or delayed endoleak and long-term follow-up of 5years. Preemptive coil embolization of perianeurysmal arteries may be considered as a safe and effective strategy for management of potential type II endoleak.

Retrograde endoscopic treatment of stones in horseshoe kidney

Retrograde endoscopic treatment of stones in horseshoe kidney

Outcomes of robot-assisted laparoscopic pyeloplasty among pediatric patients with complex renal anatomy: A retrospective comparative study

Robot-assisted laparoscopic pyeloplasty (RALP) has been increasingly utilized in the treatment of pediatric ureteropelvic junction obstruction (UPJO) with reported success rates of >95%. Complex renal anatomy can make some cases challenging to reconstruct. To evaluate outcomes of children undergoing RALP with aberrant renal anatomy and compare it to those with simple renal anatomy. An IRB approved prospective registry was queried to retrospectively identify all patients who underwent robotic pyeloplasty at our institution from 2012 to 2022. Patients undergoing re-do pyeloplasty were excluded. Complex anatomy was defined as horseshoe kidney, ectopic/pelvic kidney, duplex collecting system, fully bifid renal pelvis and severe malrotation (≥180°). A comparative analysis of baseline demographics, pre-operative clinical/radiological characteristics, intra and post-operative details, and long-term success was performed between those patients with complex anatomy and those without. Of 405 total robotic pyeloplasty's, 375 patients (378 total pyeloplasty; 353 simple, 22 complex) met inclusion criteria. 27 re-do were excluded from analysis. The complex pyeloplasty cohort included 9 horseshoe kidneys, 8 duplex collecting systems, 3 ectopic/pelvic kidneys and 2 kidneys with severe malrotation. There was no difference in age (58 vs 31 months; p=0.38), procedure time (203 vs 207min; p=0.06), length of stay (1.4 vs 1.3 days; p=0.99), or success (91.6% vs 100%; p=0.24) between the simple and complex groups. Etiology of obstruction differed significantly between groups - high insertion was more common (3.9% vs 18.2%, p=0.02) and intrinsic narrowing was less common (60.1% vs 36.4%, p=0.04) in patients with complex anatomy. A multivariate logistic regression was adjusted for age, gender, etiology of obstruction, preoperative differential renal function and post-operative complications and found no difference in success between complex and simple RALP. The findings showed no significant differences in age, procedure time, length of hospital stay, or success rates between the two groups. Specifically, the success rates were 91.6% for the complex group and 100% for the simple group (p=0.24), indicating comparable efficacy. However, the etiology of obstruction varied significantly, with high ureteral insertion more common in the complex anatomy group (18.2% vs. 3.9%, p=0.02) and intrinsic narrowing less common (36.4% vs. 60.1%, p=0.04). Despite these differences, multivariate logistic regression, adjusted for confounders, confirmed no difference in success rates between the groups. RALP is a safe and efficacious approach in patients with complex anatomy with success rates comparable to index patients. High ureteral insertion does appear to be more common in patients with complex anatomy undergoing pyeloplasty.

An Extremely Rare Case Report of Aphallia with Horseshoe Kidney and Ureterohydronephrosis [Letter

An Extremely Rare Case Report of Aphallia with Horseshoe Kidney and Ureterohydronephrosis [Letter

Xanthogranulomatous Pyelonephritis: A pooled quantitative analysis of published cases.

Xanthogranulomatous Pyelonephritis (XGP) is a serious and rare inflammatory disease of unknown etiology. This systematic review analyzes XGP cases. We performed a literature search for "Pyelonephritis, Xanthogranulomatous." The primary composite outcome was recovery with post-surgery complications, partial recovery, death, or chronic kidney disease. The secondary outcome was any presentation or treatment complication. Predictor variables consisted of demographics, history, symptoms, and diagnosis/management. Among the 251 patients, the mean age was 36.1 years, and 57.4% were female. The most common symptom and finding were fever (55.0%) and renal stones (53.8%), respectively. There were 15.5% with the composite outcome. There were 51.0% with any presentation or treatment complication. Multivariate logistic regression analysis for the composite outcome showed that kidney of both/horseshoe (OR:3.86, 95% CI:1.01, 14.73, p = 0.048), dialysis required (OR:8.64, 95% CI:2.27, 32.94, p = 0.002), and operative treatment of nephrostomy or nephrostomy followed by nephrectomy (OR:4.57, 95% CI:1.58, 13.17, p = 0.01) were each significantly associated with increased odds. Fever (OR:3.04, 95% CI:1.63, 5.67, p <0.001) and renal stones (OR:2.55, 95% CI:1.35, 4.81, p = 0.004) were each significantly associated with increased odds for any presentation/treatment complication. In conclusion, XGP patients with involvement of both or horseshoe kidneys, dialysis requirements, or treatment of nephrostomy or nephrostomy followed by nephrectomy may require aggressive treatment to mitigate poor patient outcomes.

Case report: Conservative management of a blunt trauma to a horseshoe kidney

With trauma representing the leading cause of death in children, and renal injuries representing a large proportion of that trauma, understanding the appropriate management of renal injuries is vital to preventing pediatric morbidity and mortality. Cases involving aberrant anatomy are even more crucial to understand as there is less data on appropriate management. Here, a case is presented of a 7-year-old male presenting after a horse kick to the abdomen resulting in traumatic disruption of a previously unknown horseshoe kidney and the subsequent conservative management. The patient presented with abdominal pain, leukocytosis, and elevated liver function enzymes. An abdominal and pelvic Computed Tomography (CT) demonstrated a horseshoe kidney with a grade IV laceration to the isthmus and left lower pole of the kidney resulting in fracture/disruption of previously fused horseshoe kidneys. Additionally, there was a large retroperitoneal hematoma and hemoperitoneum. The patient was successfully managed with observation, and hemodynamic monitoring and has had resolution of hematoma and preserved kidney function through 8 months of follow-up. In conclusion, this is an example of how a patient with complicated renal anatomy can be managed conservatively to model for potential future cases.

A case of primary aldosteronism with hypertrophic cardiomyopathy and a horseshoe kidney

A case of primary aldosteronism with hypertrophic cardiomyopathy and a horseshoe kidney