Horseshoe kidney, also known as ren arcuatus (in Latin), renal fusion or super kidney, is a congenital disorder affecting about 1 in 500 people that is more common in men, often asymptomatic, and usually diagnosed incidentally. In this disorder, the patients kidneys fuse to form a horseshoe-shape during development in the womb. The fused part is the isthmus of the horseshoe kidney. The abnormal anatomy can affect kidney drainage resulting in increased frequency of kidney stones and urinary tract infections as well as increase risk of certain renal cancers.Fusion abnormalities of the kidney can be categorized into two groups: horseshoe kidney and crossed fused ectopia. The horseshoe kidney is the most common renal fusion anomaly. Signs and symptoms
Although often asymptomatic, the most common presenting symptom of patients with a horseshoe kidney is abdominal or flank pain. However, presentation is often non-specific. Approximately a third of patients with horseshoe kidneys remain asymptomatic throughout their entire life with over 50% of patients having no medical issues related to their renal fusion when followed for a 25-year period. As a result, it is estimated that approximately 25% of patients with horseshoe kidneys are diagnosed incidentally with ultrasound or CT imaging.
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.