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Horse-Shoe Kidney

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Epidemiology

• occurs in 1 per 400-800 live births.• Horseshoe kidney is twice as common in

males as in females.

• !0 " fusion at the lower kidney

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#athogenesis

$echanical fusion holds that the horseshoekidney is formed during organogenesis%when the inferior poles of these earlykidneys touch% fusing in the lower midline.

&lternatively% more recent studies postulatethat the abnormal fusion of tissueassociated with the parenchymatous

isthmus of some horseshoe kidneys is theresult of a teratogenic event involving theabnormal migration of posteriornephrogenic cells% which then coalesce to

form the isthmus.

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#athophysiology

 'he most common associated (nding inhorseshoe kidney is ureteropelvic )unction

*+#, obstruction% which occurs in up to/" of patients. t causes most problems.bstruction is due to the high insertion ofthe ureter into the renal pelvis. 'hecrossing of the ureter over the isthmusmay also contribute to obstruction.

2tone disease could appear in the

horseshoe kidney.

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2ign 3 2ymptom

•

one third of patients with a horseshoekidney remain asymptomatic% and thehorseshoe kidney is an incidental (ndingduring radiological eamination. #hysicaleamination may reveal a midline lower-abdominal mass.

• 2ymptoms% when present% are usually dueto obstruction% stones% or infection

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 'herapy

#yeloplasti - on a horse-shoe kidney withcomplication

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+reteral 5uplication

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Epidemiology

n autopsy series% the incidence ofureteral duplication is estimated atslightly less than 1". n studies of young

children with urinary tract infections% theincidence of duplication rises to 8"

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#athogenesis

+reteral duplication consist of6

1. ncomplete ureteral duplication% in whichone common ureter enters the bladder.

7. omplete ureteral duplication% in which 7ureters ipsilaterally enter the bladder causethe ureteral bud arises twice. 'he upper

pole ureter may be ectopic at the bladderneck% e)aculatory duct% seminal vesical% orvas deferens in males% in vagina at female

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linical $anifestation

+rinary tract infection is a commonpresentation at any age. +reteralduplication and ectopic ureters can be

associated with both re9u andobstruction% predisposing to urinary tractinfection. Hematuria or pain in the

abdomen or 9ank may also occur.

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5i:erential 5iagnoses

• $ulticystic ;enal 5ysplasia

• +reteropelvic ,unction bstruction

• +rethral &nomalies and +rethral #rolapse

• +rinary 'ract nfection

•

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 'herapy

• Hemineferktomi

• =eoimplantasi ureter