The diagnosis can be made with many different imaging modalities such as ultrasound, intravenous pyelogram, CT, and MRI.Common features that can be found on imaging include:

Midline symmetrical fusion (present in 90% of cases) or lateral asymmetric fusion (present in 10% of cases) of the lower poles
Position of fused kidneys are lower than normal with incomplete medial rotation
Renal pelvis and ureters are positioned more anteriorly and ventrally cross the isthmus
Isthmus that may be positioned below the inferior mesenteric artery
Variant arterial supply that can originate from the abdominal aorta or common illiac arteries
Lower poles of kidney that extend ventromedially and may be poorly defined

Treatment
Symphysiotomy, which involves separating the fused isthmus in order to release the kidneys, used to be a recommended treatment for this condition but has fallen out of favor due to complications and minimal benefit. Furthermore, kidneys can remain in their original abnormal location after the surgery. Instead, management focuses on treating the sequelae should the patient become symptomatic.While treatment typically does not differ from that of patients with normal kidney anatomy, kidney stones can warrant a different approach. Extracorporeal shockwave lithotripsy, a possible treatment for kidney stones, can be less effective in patients with horseshoe kidneys due to the abnormal anatomy causing difficulties with localizing the energy to the stones. Also, due to the kidney obstruction that can commonly occur with this renal fusion, clearance of the resulting stone fragments can also be impaired.
Chondromalacia patellae (also known as CMP) is an inflammation of the underside of the patella and softening of the cartilage. The cartilage under the kneecap is a natural shock absorber, and overuse, injury, and many other factors can cause increased deterioration and breakdown of the cartilage. The cartilage is no longer smooth and therefore movement and use is very painful. While it often affects young individuals engaged in active sports, it also afflicts older adults who overwork their knees.Chondromalacia patellae is sometimes used synonymously with patellofemoral pain syndrome. However, there is general consensus that patellofemoral pain syndrome applies only to individuals without cartilage damage. This condition is also known as Chondrosis. The term literally translates to softening (malakia) of cartilage (chondros) behind patella in Greek. Cause
The condition may result from acute injury to the patella or chronic friction between the patella and a groove in the femur through which it passes during knee flexion. Possible causes include a tight iliotibial band, neuromas, bursitis, overuse, malalignment, core instability, and patellar maltracking.Pain at the front or inner side of the knee is common in adults of all ages especially when engaging in soccer, gymnastics, cycling, rowing, tennis, ballet, basketball, horseback riding, volleyball, running, combat sports, figure skating, snowboarding, skateboarding and even swimming. The pain is typically felt after prolonged sitting. Skateboarders most commonly experience this injury in their non-dominant foot due to the constant kicking and twisting required of it. Swimmers acquire it doing the breaststroke, which demands an unusual motion of the knee.