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I./4.1.: Epidemiológia
The term horseshoe kidney is used for the most common renal developmental anomaly. It consists of two separate kidneys connected to each other at the lower pole with normal renal parenchyma or connective tissue. It is localised in the midline, just anterior to the spinal column. It occurs in 0.25% of the population one in 400-800 live births int he USA. It is twice as common in males than in females, concordance is significant in identical twins.
I./4.2.: Signs and symptoms
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Horseshoe kidney is often associated with anomalies of the renal pelvis, the ureters, and its blood supply, therefore it is more prone to urine obstruction, infection, hydronephrosis and stone formation. It is also commonly associated with other developmental anomlies like ureter duplex, vesico-ureteral reflux, hypospadiasis, undescended testis, polycystic kidney, hydrocephalus, spina bifida, cardiovascular- (aortic aneurysm, VSD), sceletal, anomalies, atretic anus, Turner’s syndrome, 18 trisomia, or oro-facial-digital syndrome.
The severity and frequency of symptoms is highly related to the number of the associated anomalies and their severeity. In one third of the cases horseshoe kindney is an accidental finding without any syptom. In these cases generally no asociated anomaly can be found. In the other two thirds of the patients the symptoms are caused by urine obstruction of some level causing secondary urine infection and stone formation. In childhood horseshoe kidney is usually diagnosed during invstigations for urine infection. Ureter obstruction can be seen in 35% of the cases wich can lead to nephrolithiasis, ureter stone (27%) hydronephrosis, kidney failure, and recurrent pyelonephritis.
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