The Clinical Study On Horseshoe Kidney

Objective:⑴Horseshoe kidney (HSK) is a common congenital renal anomaly that isoften misdiagnosed or missed in diagnosis. This work presents further understandingof clinical manifestations and imaging of HSK and assesses reliability of quantifyingglomerular filtration rate (GFR) with single photon emission computed tomography(ECT) for HSK patients.⑵Horseshoe kidney (HSK) is common congenital renalfusion anomaly. However, when HSK is combined with glomerulopathy, few HSKpatients receive renal biopsy because of apprehension about postoperativecomplications of puncture, which leads them to be unable to obtain appropriatetreatment. This study aims to raise the level of diagnosis and treatment for HSKpatients with glomerulopathy.Methods:⑴We retrospectively studied the general information, clinicalmanifestations when initially diagnosed, complications and imaging of patients whowere diagnosed with HSK at the Chinese PLA General Hospital between January2008and June2013. We also compared GFR of horseshoe kidney patients quantifiedby ECT and eGFR estimated by CKD-EPI equations.⑵We analyzed clinical data,laboratory examination and imaging of HSK patients and renal biopsy pathologicalfindings. Furthermore, we compared the blood pressure, urine protein and serumcreatinine after treatment with before treatment，we also summarized indications,value, approaches and hazards of renal biopsy for HSK patients.Results:⑴Clinical data:①Fifty-three patients with HSK including30males and23females, for a male-female ratio of1.3:1, were enrolled in the study.②Clinicalmanifestations at initial diagnosis: Twenty-eight cases (52.8%) were discoveredbecause of symptoms，as waist pain and abnormal uroscopy，related to urologicaldiseases, and25cases (47.2%) were discovered incidentally because ofnon-urological diseases or physical examinations.③Complications: The complications of HSK related to urinary system were more common including renalparenchymal damage （proteinuria, hematuria and impaired renal function，16cases,accounting for30.2%), urinary tract infection (cases,18.9%), urolithiasis (10cases,18.9%), hydronephrosis (10cases,18.9%), renal cyst (7cases,13.2%).④Imaging：Ultrasonography (US) was performed in25patients. In19patients, US indicatedHSK, and six cases were missed by US but later confirmed by computed tomography(CT). Of16patients who received intravenous pyelography (IVP),15had their HSKdiscovered, and in one case, HSK was not found but later identified by CT. HSK wasidentified by CT in29patients, by magnetic resonance imaging (MRI) in10, and bypositron emission tomography (PET) in two. Single photon emission computedtomography (ECT) was performed in13patients and revealed indistinct kidneyoutlines appearing U-shaped or displayed unilateral renogram invisibility.⑵Dataquantified by ECT: the GFR quantified using ECT was dramatically lower than theeGFR estimated by CKD-EPI equations (GFR-eGFR=-52.0±25.0, p<0.001).⑶Dataon renal biopsy: Five patients who were not only diagnosed with HSK by imaging butalso diagnosed with glomerulopathy by renal biopsy were enrolled.①These patients’clinical manifestation involves polyuria at night， edema of lower extremity,hypertension and abnormal uroscopy.②their urine protein excretion was more than1g/24h and their serum creatinine nomal was or increased.③The imaging findings allidentified the HSK definitely and revealed the fusion of bilateral renal lower poles.④All of these five patients had indications of renal biopsy and had not absolutecontraindications of renal biopsy as aberrant renal great vessels. Their blood pressurewas controlled below140/90mmHg and the blood coagulation function of thepatients was normal. After securing informed consent, renal biopsy was performed byexperienced doctors under ultrasonic guidance using a standard needle biopsy gun atthe “renal upper pole”. None of the patients presented any postoperativecomplications.⑤The patients were diagnosed with focal segmentalglomerulosclerosis, membranous nephropathy, primary immunoglobulin Anephropathy, Henoch-Sch nlein purpura nephritis(secondary immunoglobulin A nephropathy) and lupus nephritis by renal biopsy.⑥Appropriate medication wasadministered based on the renal pathological findings. These patients were followedup once a month. The curative effects were followed for six months, revealing thaturine protein excretion decreased significantly and that blood pressure and serumcreatinine stabilized.Conclusion:⑴HSK often results in asymptomatic presentation before complicationsoccurs. The common complications of HSK include renal parenchymal damage，urinary tract infection, lithiasis and hydronephrosis. If the patients present symptomsrelated to complications, imaging is needed to screen for HSK. US can easily result inmissed diagnosis or misdiagnosis, CT and MRI are optimal methods for diagnosingHSK.⑵The GFR of HSK patients quantified using ECT is dramatically lower thanthe eGFR estimated by CKD-EPI equation, which suggest it is greatly unreliable toevaluate the GFR with ECT for HSK patients.⑶Glomerulopathy is a importantcomplication of HSK. After the value and risks of renal biopsy were comprehensivelyevaluated, it is important to determine the pathological type of glomerulopathy forHSK patients, which will aid in guiding treatment and postpone progress of thedisease.