Horseshoe kidney pathophysiology
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
Most people with horseshoe kidneys are totally asymptomatic and their kidneys function normally throughout their lives. About quarter of cases are found incidentally, usually during a CT scan due to some other problem. Nonetheless, there are lots of other patients who are predisposed to certain medical sequel due to the embrogenesis or intrinsic anatomical abnormalities.
Pathophysiology
Most people with horseshoe kidneys are totally asymptomatic and their kidneys function normally throughout their lives. About quarter of cases are found incidentally, usually during a CT scan due to some other problem. Nonetheless, there are lots of other patients who are predisposed to medical sequelae due to the embrogenesis or intrinsic anatomical abnormalities. These issues include:[1]
- Ureteropelvic junction obstruction : It is the most common problem in horseshoe kidney. It is caused by crossing of ureter over the fused isthmus leading to its obstruction.
- Nephrolithiasis : Stones usually occur when there is obstruction leading to decreased urine output and stasis of urine which create environment for stone formation.
- Recurrent infections : Again due to stasis of urine, because stasis of urine create medium for bacterial growth.
- Hydronephrosis : Basically it is caused by back-flow of urine due to obstruction of ureteropelvic junction.
- Increased incidence of certain cancers such as renal cell carcinoma, Wilm's tumor and Carcinoid tumors.[2]
Genetics
- No genetic determination of horseshoe kidney is known, although it has been seen in identical twins and in siblings within the same family.[3]
Associated Conditions
Horseshoe kidney has been seen associated with other genetic disorders such as Turner syndrome,Edwards syndrome and Down's syndrome.[4][5]
Gross Pathology
Grossly, horseshoe kidney is usually fused at the lower of the kidney that is continuous along the mid line anterior to the great vessels. However complete fusion of the kidney produces a mass in the pelvis giving rise to two or more ureters.
Microscopic Pathology
On microscopic histopathology analysis, horseshoe kidney is normal unless there is secondary infection or obstructive nephropathy.
References
- ↑ Natsis K, Piagkou M, Skotsimara A, Protogerou V, Tsitouridis I, Skandalakis P (2014). "Horseshoe kidney: a review of anatomy and pathology". Surg Radiol Anat. 36 (6): 517–26. doi:10.1007/s00276-013-1229-7. PMID 24178305.
- ↑ Neville H, Ritchey ML, Shamberger RC, Haase G, Perlman S, Yoshioka T (2002). "The occurrence of Wilms tumor in horseshoe kidneys: a report from the National Wilms Tumor Study Group (NWTSG)". J Pediatr Surg. 37 (8): 1134–7. PMID 12149688.
- ↑ Natsis, Konstantinos; Piagkou, Maria; Skotsimara, Antonia; Protogerou, Vassilis; Tsitouridis, Ioannis; Skandalakis, Panagiotis (2013). "Horseshoe kidney: a review of anatomy and pathology". Surgical and Radiologic Anatomy. 36 (6): 517–526. doi:10.1007/s00276-013-1229-7. ISSN 0930-1038.
- ↑ Kirkpatrick JJ, Leslie SW. PMID 28613757. Missing or empty
|title=(help) - ↑ Kleta, Robert; Brämswig, Jürgen H. (2000). "Horseshoe kidney and Turner syndrome". Nephrology Dialysis Transplantation. 15 (7): 1094–1094. doi:10.1093/ndt/15.7.1094-b. ISSN 1460-2385.