Horseshoe kidney

Horseshoe kidney, also known as "horseshoe kidney" or "horseshoe kidney anatomical variant", is an anatomical feature of the kidney structure. This anatomical variant is not a pathology or disease, but rather a variation in kidney structure that may be present in a portion of the population.

The horseshoe kidney gets its name because of its shape, which resembles the shape of a horseshoe. With a horseshoe kidney, the two kidney organs are usually closer together and may be closer to the spine than in people with typical kidney anatomy.

In most cases, horseshoe kidney is an accidental anatomical feature and it can exist without causing any symptoms or problems. In most cases, it is found incidentally during medical tests such as a kidney ultrasound or CT scan.

It is important to note that a horseshoe kidney does not require treatment unless it causes symptoms or compliments. However, in rare cases, it may be associated with certain medical problems such as urinary tract infections or kidney stone formation. If you have any kidney-related symptoms or conditions, it is important to discuss them with your doctor for diagnosis and treatment. [1]

Causes of the horseshoe kidney

Horseshoe kidney (or horseshoe kidney anatomical variant) is an anatomical abnormality that forms early in embryonic kidney development. It is not a disease, but rather a variation in the structure of the kidney. Reasons why a horseshoe kidney forms in some people may include the following:

1. Genetic factors: Some people may be predisposed to abnormal kidney development due to hereditary factors. Genes can influence organ development and structure.
2. Embryonic development: Abnormalities in kidney structure may develop during embryonic development, when the organs are forming. Irregularities in this process can lead to anatomical variations, including the horseshoe kidney.
3. Other factors: Certain environmental or medical conditions during embryonic development can also affect the formation of the kidney structure.

A horseshoe kidney is not something a person can control or prevent. It is an anatomical variation that can exist in some people without causing problems or symptoms. [2]

Pathogenesis

The pathogenesis of this anomaly is related to abnormalities in the intrauterine development of the kidneys. This process can be caused by genetic factors, environmental factors or a combination of both.

Possible mechanisms for the development of horseshoe kidney include:

1. Genetic factors: Some cases of horseshoe kidneys may be associated with inherited genetic mutations or abnormalities. Genes that control kidney development can be damaged or mutated, which can lead to unusual kidney shapes.
2. Intrauterine factors: Various intrauterine factors may play a role in the development of the horseshoe kidney, such as lack of blood supply to the fetus, impaired urine production, or pressure on organs in the abdomen, which can affect kidney development.
3. Environment and risk factors: Certain environmental exposures or risk factors, such as the use of alcohol, nicotine, or certain medications during pregnancy, can affect fetal kidney development and contribute to abnormalities, including the horseshoe kidney.
4. Developmental gene mutations: Some genes that control kidney development can be damaged or mutated, which can lead to abnormalities in the structure of the kidney.
5. Heredity: In some cases, horseshoe kidney may have a familial predisposition and may be inherited.

It is important to note that horseshoe kidney can manifest to varying degrees and have different variations of anomalies. [3]

Symptoms of the horseshoe kidney

Horseshoe kidney may have several symptoms and signs, but they may not be noticeable or may cause minimal pain and discomfort. The following are the possible symptoms and signs associated with horseshoe kidney:

1. Lower back pain: A person may experience pain or discomfort in the lower back, especially in the area where the horseshoe kidney is located.
2. UrinaryDisorders: Some people with a horseshoe kidney may experience urinary disorders, such as frequent urination or a feeling of bladder failure.
3. Abdominal pain: Pain or discomfort in the abdomen, especially in the lower back area, may be associated with a horseshoe kidney.
4. Hypertension: Some people with a horseshoe kidney may have high blood pressure (hypertension), although this is not a typical symptom.
5. Urinarytract infections: Increased risk of urinary tract infections because the urinary tract may be compromised or less efficient due to anatomical features.
6. Hydronephrosis: In some cases, a horseshoe kidney can cause hydronephrosis, which means that urine stagnates in the kidney due to improper anatomy, which can cause pain and other symptoms.

It is important to note that many people with a horseshoe kidney may not experience symptoms and only find out they have this abnormality through an examination or diagnosis for another reason. If you have symptoms or suspect you have a horseshoe kidney, it is important to see your doctor for further tests and evaluation of your condition. [4]

Horseshoe kidney in a child

If your child has been diagnosed with a horseshoe kidney, it is important to get a consultation with a pediatrician or pediatric urologist to evaluate the condition and determine further treatment or follow-up.

Here are some important things to consider when diagnosing a child with horseshoe kidney:

1. Medical Evaluation: The doctor will perform a medical evaluation and determine which part of the kidney has the abnormality and how much it affects the functionality of the kidney.
2. Treatmentplan: Treatment of a horseshoe kidney depends on its characteristics and symptoms. In most cases, if the abnormality does not cause serious symptoms or complications, treatment may not be necessary and regular medical follow-up is recommended for the patient.
3. Medical follow-up: If the horseshoe kidney is not causing pain or other symptoms, the child may simply be under the care of a doctor to monitor the condition. Regular checkups, such as ultrasound scans, can be used to monitor the condition of the kidney.
4. Symptom Management: If a horseshoe kidney is causing pain, urinary tract infections, or other problems, your doctor may prescribe appropriate treatment, including analgesics, antibiotics, and other medications.
5. Surgery: In some cases, especially if the horseshoe kidney leads to serious complications, surgical treatment may be necessary. Surgical intervention may involve resection (removal of part of the kidney), but this is decided on an individual basis.

Discuss your child's condition with a medical professional to develop the best treatment or monitoring plan that meets your child's specific needs.

Horseshoe kidney and pregnancy

A horseshoe kidney (horseshoe kidney anatomical variant) by itself is not usually a medical obstacle to pregnancy. Many women with this anatomical feature successfully make it through pregnancy and labor without experiencing any problems. However, in rare cases, there may be some considerations and complications that should be taken into account:

1. Increased risk of urinary tract infections: A horseshoe kidney can contribute to urinary retention and increase the risk of urinary tract infections. Pregnant women already have an increased risk of urinary tract infections, so it's important to stay safe and seek medical attention when symptoms appear.
2. Monitoring: Pregnant women with a horseshoe kidney may require additional medical monitoring to monitor kidney health and prevent complications.
3. Low back pain: Low back pain may occur if you have nephrolithiasis (kidney stones) or other complications related to a horseshoe kidney. It is important to see a doctor when pain occurs to evaluate the causes and provide the necessary treatment.
4. Co-management of pregnancy: If you have a horseshoe kidney and are planning a pregnancy or are already pregnant, it is important to discuss this with your doctor. Your doctor will be able to provide advice and recommendations specific to your situation and help manage your pregnancy in a way that minimizes risks and ensures your health and the health of your unborn baby.

Horseshoe kidney is not a contraindication for pregnancy, but requires careful medical observation and, if necessary, treatment. Careful management of the pregnancy together with your doctor can help to achieve a healthy and safe outcome.

Forms

Horseshoe kidney is a developmental anomaly of the kidneys that can have different variants and shapes depending on the exact anatomical structure. The different types of horseshoe kidney are listed below:

1. Inferior pole horseshoe kidney (inferior pole horseshoe kidney): In this form of horseshoe kidney, the upper pole of each kidney is connected to each other and the lower poles take the shape of a horseshoe. This is the most common type of horseshoe kidney.
2. Superior pole horseshoe kidney (superior pole horseshoe kidney): In this form, the upper pole of each kidney is connected and the lower poles form a horseshoe. This variant is less common.
3. Suspended horseshoe kidney (suspended horseshoe kidney): In this variety, the lower poles of the kidneys are connected to each other, but the horseshoe is horizontal, unlike the vertical form.
4. Vertical horseshoe kidney (vertical horseshoe kidney): In this form, the upper pole of each kidney is connected and the horseshoe is vertically down between the lower poles.
5. Horseshoe kidney with anectophragmus: This type ofhorseshoe kidney is characterized by the presence of an anectophragmus, or thin connecting bridge that connects the two kidneys between the upper and lower poles.
6. Horseshoe kidney with additional defects: Horseshoe kidney may be combined with other developmental anomalies such as duplex (double) kidney or arteriovenous anomalies.

Complications and consequences

A horseshoe kidney usually does not present serious complications and does not require treatment unless it causes symptoms or is associated with other medical problems. This anatomical variant can exist in some people without causing pain or discomfort and is discovered most often by accident during medical tests. [5]

However, in rare cases, horseshoe kidney may be associated with certain complications or conditions such as:

1. Development of kidney stones: If there is an abnormal kidney structure, including a horseshoe kidney, there may be an increased risk of kidney stone formation (nephrolithiasis). This can lead to lower back pain, lower abdominal pain, and other symptoms associated with urolithiasis.
2. Increased risk of urinary tract infections: Abnormal kidney structure can also contribute to urinary retention and increase the risk of urinary tract infections such as cystitis or pyelonephritis.
3. Hydronephrosis: In some cases, abnormal kidney structure can cause hydronephrosis, which means enlargement of the kidney due to urinary blockage. This can cause pain and inflammation.

Diagnostics of the horseshoe kidney

Diagnosing a horseshoe kidney involves several methods and tests to determine this abnormal kidney condition. These methods may include the following:

1. Clinical examination: The physician may perform an initial clinical examination of the patient and evaluate symptoms that may indicate the presence of a kidney anomaly. He or she may also ask questions about medical and family history.
2. Ultrasound (USG): Ultrasound is one of the most common methods for diagnosing a horseshoe kidney. This method allows you to visualize the kidneys and determine their shape, size and location. Ultrasound can be used to detect anomalies such as horseshoe kidney.
3. Computed tomography (CT) scan: CT scans can be used to obtain more detailed information about the kidneys and their anatomy. This method can be particularly useful for confirming the diagnosis of horseshoe kidney and characterizing the kidney.
4. Magnetic resonance imaging (MRI): MRI can also be used to study the kidneys and their anatomy in more detail. This method may be preferred if it is necessary to avoid the use of X-rays, as in the case of CT scans.
5. Intravenous urography (IVUG): This is a radiological study in which a contrast agent is injected intravenously and then a series of X-rays are taken to visualize structures of the genitourinary system, including the kidneys.
6. Laboratory tests: Blood tests and urine tests may be performed to assess kidney function and detect any abnormalities in kidney function.

Diagnosis of a horseshoe kidney usually begins with an ultrasound, which can give a preliminary indication of the presence of the abnormality. Other examination techniques, such as CT or MRI scans, may be required to confirm the diagnosis and provide more detailed information. Once a diagnosis is made, the doctor can develop a treatment plan and recommendations for managing this anomaly.

On an ultrasound (sonogram), such a kidney may look as follows:

1. Shape and location: Ultrasound images show that the kidney is unusually shaped like a horseshoe or crescent moon. It may be curved or otherwise altered from a normal kidney. It is usually close to the area where the kidney is normally located, but may be slightly displaced or more horizontal.
2. Size: The size of a horseshoe kidney can vary, but it is usually smaller than a normal kidney. An ultrasound can help measure the length, width, and thickness of this kidney.
3. Structure and internal features: Ultrasound can also show the structure of the internal parts of the horseshoe kidney, such as ureters and vessels, and provide information about the blood supply of this kidney.
4. Ducts and ureters: Ultrasound can also help determine how urine exits the kidney through the ureters and ducts. In the case of a horseshoe kidney, the ureters and ducts may be irregularly shaped or positioned.

Treatment of the horseshoe kidney

Treatment for horseshoe kidney depends on its specific characteristics, symptoms, and associated conditions. In most cases, if a horseshoe kidney does not cause serious symptoms or complications, treatment may not be necessary and the patient is simply advised to have regular medical follow-up.

However, if a horseshoe kidney is causing pain, urinary tract infections, or other problems, the following treatments may be needed:

1. Analgesics: Anal gesics may be prescribed for pain associated with horseshoe kidney. Nonsteroidal anti-inflammatory drugs (NSAIDs) or other pain relievers as recommended by your doctor are commonly used.
2. Antimicrobial therapy: If the horseshoe kidney leads to recurrent urinary tract infections, antibiotics may be prescribed to treat and prevent infections.
3. Surgery: In some cases, especially if the horseshoe kidney is causing serious problems or complications, surgical treatment may be necessary. One possible surgical treatment is resection (removal of part of the kidney), but this decision is made on an individual basis and the goal is to eliminate symptoms and prevent complications.
4. Medical follow-up: Patients with a horseshoe kidney are recommended to have regular medical follow-up by a doctor to monitor the condition of the kidney and evaluate symptoms. The doctor may prescribe regular checkups such as ultrasound or CT scan to monitor the condition of the kidney.

Treatment for horseshoe kidney should be individualized and based on consultation with a medical professional.

Clinical Guidelines

Clinical recommendations for managing a condition with horseshoe kidney may vary depending on the specific circumstances and needs of the patient. The following are general recommendations and interventions that may help patients with horseshoe kidney disease:

1. Regular medical follow-up: Patients with horseshoe kidney are advised to have regular check-ups with their doctor and medical tests to monitor their kidney health and detect any complications.
2. Kidney Care: It is important to emphasize kidney care and urinary tract hygiene levels to prevent infections and other problems.
3. Nutrition and hydration: Following a healthy lifestyle, including moderate salt and fat intake, can help reduce the risk of kidney stone formation. Patients are advised to increase their water intake to maintain a normal urinary pattern.
4. Treatment of Complications: If a patient with horseshoe kidney develops complications such as urinary tract infections or stone formation, it is important to see a doctor immediately for treatment.
5. Physical activity level: Depending on your health status and the limitations associated with your horseshoe kidney, your doctor may make recommendations for your physical activity level. Moderate physical activity may be beneficial for general health.
6. Treatment of Hypertension: If a patient with a horseshoe kidney develops hypertension (high blood pressure), it is important to monitor the patient and take the recommended medications to control blood pressure.
7. Genetic Counselor Consultation: In the case of a horseshoe kidney, it may be helpful to consult a genetic counselor or genetic physician to assess the risk of passing the anomaly to future generations.
8. Adherence to specialist recommendations: It is important to follow the recommendations and appointments of specialists who are involved in the care of a patient with a horseshoe kidney, including nephrologists, urologists, and other medical professionals.

These recommendations are not exhaustive and may vary according to each patient's specific circumstances. Patients with a horseshoe kidney are advised to discuss their situation and care plan with a medical professional who can provide individualized advice and recommendations to support kidney health and overall well-being.

Sports and the horseshoe kidney

This condition can occur in some people from birth, and in most cases it does not cause serious problems related to sports or physical activity. However, in rare cases, horseshoe kidney may be associated with some medical complications, and in such cases, physical activity may require special attention.

Here are a few important things to consider if you or someone you love has a horseshoe kidney and you play sports:

1. Consultation with your doctor: If you have a horseshoe kidney, it is important to consult your doctor or urologist to see if there are any specific restrictions or recommendations for physical activity, especially if you plan to participate in intense or contact sports.
2. Condition Monitoring: Regular medical monitoring can be helpful to keep track of your kidney health and detect any changes or complications that may occur.
3. Caution incontact sports: When participating in contact sports such as soccer, wrestling or boxing, it is especially important to be careful and use protective equipment to prevent injury.
4. Individualized approach: Horseshoe kidney can have varying degrees of severity and be accompanied by different physical features. It is therefore important to take individual differences and limitations into account.

In general, a horseshoe kidney is not an obstacle to physical activity and sports. However, as with any medical abnormality, it is important to get advice from your doctor and monitor your health when participating in sports.

Forecast

The prognosis for a person with a horseshoe kidney depends on several factors, including the presence of symptoms, complications, and comorbidities. It is important to note that horseshoe kidney is not a disease per se, but is an anatomical variant of the kidney structure.

In most cases, horseshoe kidney does not cause serious problems and does not require treatment unless it is accompanied by symptoms or complications. It can exist in a person throughout life without any problems.

However, in rare cases, complications associated with a horseshoe kidney may require medical intervention and treatment. For example, if nephrolithiasis (formation of kidney stones) develops, it may cause pain and require treatment to remove the stones. Complications related to urinary tract infections or hydronephrosis are also possible.

It is important to see your doctor in a timely manner if you have symptoms or complications related to horseshoe kidney to get a diagnosis and determine the best treatment.

In general, the prognosis for people with a horseshoe kidney is good, especially if it does not cause symptoms or complications. You should have regular check-ups and monitor your health so that you can receive timely medical attention if needed.

Disability

A horseshoe kidney is not in itself a cause for disability. Disability is awarded based on the severity and degree of limitation of bodily functions, not just the presence of a developmental abnormality such as a horseshoe kidney.

However, if a horseshoe kidney causes serious complications or problems with kidney function that severely limit a person's ability to lead a normal life and work, it may be necessary to seek disability in some cases.

The process of obtaining a disability may vary depending on the country and legislation in your area. To obtain a disability, you usually need medical documentation proving the existence of limitations and disabilities, as well as an evaluation by a medical and social expert commission or similar body.

If you believe that your condition related to a horseshoe kidney is causing serious limitations and making it difficult for you to live and work normally, it is recommended that you contact medical professionals and social services for advice and information about disability procedures in your area.

Horseshoe kidney and the army

The issue of military enlistment for persons with a horseshoe kidney may depend on the specific medical characteristics and restrictions set by the military authorities of the country in which you are serving or where you intend to serve. Different countries and militaries may have different health standards and requirements, including medical admissions and restrictions for military service.

To get accurate information about your ability to serve in the military with a horseshoe kidney, you should contact a medical specialist or military recruiting office in your country. They will conduct a medical evaluation of your condition and determine if you qualify for enlistment and military service.

Literature used

• Lopatkin, N. A. Urology: National Guide. Brief edition / Edited by N. A. Lopatkin - Moscow : GEOTAR-Media, 2013.
• Mukhin, N. A. Nephrology: National Guide. Brief edition / ed. By N. A. Mukhin. - Moscow : GEOTAR-Media, 2016.
• Surgery of horseshoe kidneys in pediatric age. Oleg Aleksandrovich Kulchitsky, Timur Sergeevich Shevelev, Anatoly Egorovich Soloviev. 2021
• Features of the structure of the horseshoe kidney. Baukin M.V., Frolova V.V. Articles of the 66th All-Russian Interuniversity Student Scientific Conference with international participation. Tver, 2020