thalidomide, ethanol, ACE inhibitors, cocaine, gentamicin, corticosteroids, NSAIDs, and vitamin A) have been hypothesized. Impairment of a developing embryos nephrogenic cell migration or abnormal migration of the kidneys due to fetal structural abnormalities is another potential factor. However, no definitive genetic cause has been identified. Pathophysiology
Kidneys are normally located in the retroperitoneal space between the T12 and L3 vertebrae after ascending from the pelvis during development to rest underneath the adrenal glands. In patients with this condition, the horseshoe kidney ascent is commonly arrested by the inferior mesenteric artery due to the central fusion of the kidneys. However, this is present in only 40% of cases, and, in 20% of cases, the fused kidney remains in the pelvis. Its ascension may also be restricted by its own renal artery. Additionally, during normal development, the kidneys undergo a 90 degree medial rotation while ascending. However, due to the renal fusion, this rotation is impaired resulting in abnormal placement of the ureters. This in turn can lead to urinary stasis and drainage issues. Furthermore, approximately 70% of kidneys in normal individuals are supplied by a single renal artery with the remaining 30% having embryonic collateral or accessory arteries. With horseshoe kidneys, the majority are supplied by derivatives of the abdominal aorta or common illiac arteries depending on the final position of the kidneys. Diagnosis
Horseshoe kidneys are commonly diagnosed incidentally on abdominal imaging.
Of the patients that received this treatment, 74% patients achieved surgical success, and at 1-year, 68% were saved from dying, 90% from having to have surgery or dying from the lack thereof, a 76.3% prognosis at three years.Given the many possible treatments that are to come, future research is continuing to find better methods of treating Lutembacher patients non-invasively as with percutaneous therapy. Without successfully treating Lutembachers more serious complications can occur such as heart failure or even disorders such as Eisenmenger syndrome. References
Additional references
Goldman, Lee (2011). Goldmans Cecil Medicine (24th ed.). Philadelphia: Elsevier Saunders. ISBN 978-1437727883. External links
00732 at CHORUS