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Paper 3
Published in Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw, The Final FRCR, 2020
Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw
Horseshoe kidneys are often asymptomatic and discovered incidentally. They are positioned lower than normal and their ascent into the upper abdomen is halted by the inferior mesenteric artery, usually around the level of L3. On ultrasound it may sometimes not be recognised, especially if the lower poles are not well seen and the fusion not appreciated. These abnormally positioned kidneys are more prone to trauma, calculi, pyelouretitis cystica, transitional cell carcinoma (TCC) and pelviureteric junction obstruction due to poor drainage.
Urolithiasis
Published in Manit Arya, Taimur T. Shah, Jas S. Kalsi, Herman S. Fernando, Iqbal S. Shergill, Asif Muneer, Hashim U. Ahmed, MCQs for the FRCS(Urol) and Postgraduate Urology Examinations, 2020
Thomas Johnston, James Armitage, Oliver Wiseman
Horseshoe kidneys represent a common congenital renal anomaly with an incidence of 1:400. They are twice as common in men and are associated with certain genetic conditions such as Turner’s syndrome. Persistence of an isthmus, typically between the lower renal poles, arrests renal ascent usually at the level of the inferior mesenteric artery. As the kidney ascends, it takes a highly variable arterial blood supply from the aorta, iliac vessels and inferior mesenteric artery and this predisposes to a greater risk of bleeding with PCNL. An arteriogram should be considered prior to undertaking open surgery on a horseshoe kidney. There is also a failure of medial rotation of the kidneys that results in a medial orientation of the renal calyces and the isthmus causes the lower pole calyces to be deviated inwards.
Urinary system
Published in A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha, Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha
The most common renal anomaly is a horseshoe kidney occurring in 1:400 births. There is a two to one male predominance. The anomaly occurs when the lower poles (rarely occurs in upper poles) of both kidneys are joined by an isthmus. The isthmus invariably consists of a band of parenchymal tissue and has its own blood supply. However, in some cases the connective band is merely fibrous tissue. A point to be aware of during imaging is that the band prevents normal rotation of the kidneys from occurring so that each side of the renal pelvis is in an anterior position. Most patients are unaware of their horseshoe kidney; however, these kidneys are associated with ureto-pelvic obstruction so they may require medical attention. Also, a horseshoe kidney is more prone to blunt trauma – presumably due to its more anterior position (the band is located anterior to the aorta and the inferior vena cava and posterior to the inferior mesenteric artery).
Comparison of Prenatal Ultrasound and Autopsy Findings of Fetuses Terminated in Second Trimester: A Five-Year Experience of a Tertiary Center
Published in Fetal and Pediatric Pathology, 2023
Ezgi Yılmazer Yonder, Murat Cagan, Ozgur Deren, Kadri Safak Gucer
Prenatal US and autopsy were fully compatible in renal agenesis, posterior uretral valve, and megacystis. Similar results were obtained in the study conducted by Isaksen et al. in Norway [16]. Hypoplastic kidney and horseshoe kidney pathologies were detected in one fetus at autopsy. The prenatal diagnosis of these pathologies is challenging. A study showed that only 2 out of 50 cases of horseshoe kidneys were diagnosed antenatally [17]. Horseshoe kidney, which is relatively common in the population and is usually detected incidentally, may be a predisposing factor for the development of diseases such as urinary tract infections, stones, enuresis, and ureteropelvic junction obstruction. Oligohydramnios and anhydramnios, which can accompany urinary system anomalies, significantly reduce the quality of US. US findings may be misleading in these and similar situations. which can accompany urinary system anomalies [18].
Confirmation of Xp22.11 Duplication as a Germline Susceptibility Alteration in a Wilms Tumor Arising in Horseshoe Kidney
Published in Fetal and Pediatric Pathology, 2022
Hui-fang Zhou, Ina E. Amarillo, Stacy Snyder, Jorge L. Granadillo, Christopher J. O’Conor, Patrick Dillon, David Wilson, Frederick S. Huang, Louis P. Dehner, Mai He
Horseshoe kidney, or ren arcuatus, is a relatively common congenital renal anomaly defined by the fusion of the kidney lower poles, with a reported prevalence of 1 in 500 in the normal population with a male to female ratio of 2:1. The frequency is higher in those who present to urology clinics (1 in 304) and in certain chromosomal disorders, including Edward syndrome (∼67%), Turner syndrome (14-20%), and Down syndrome (∼1%) [15]. Horseshoe kidney results from an abnormal fusion of the metanephric blastema during the sixth to seventh week of gestation. This event disrupts the normal ascent of the kidneys, leading to an increased risk for renal obstruction, infection, and lithiasis. Horseshoe kidney is also associated with an increased risk for a variety of renal neoplasms including carcinoid tumor (62 − 82 fold), transitional cell tumor (3 − 4 fold), and Wilms tumor (2 fold) [15]. According to the report from the national Wilms tumor study group (NWTSG), in which all Wilms tumor cases registered from 1969-1998 were reviewed, the frequency of Wilms tumor arising in horseshoe kidney is 0.48%. It is still unclear what mechanisms govern the predisposition of horseshoe kidney patients to Wilms tumor [15].
Features of Turner syndrome in patients managed at the adult endocrinology clinic, Steve Biko Academic Hospital
Published in Journal of Endocrinology, Metabolism and Diabetes of South Africa, 2023
Renal abnormalities occur in 30–40% of patients with Turner syndrome, with the most common abnormalities related to the collecting system.1 Other abnormalities include horseshoe kidneys. Only three of the patients in this study had renal anomalies, with two of them being in the mosaic Turner syndrome group.