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Date of last update: 8/13/2017.

Forum Name: Urology Topics

Question: Complications with horseshoe kidney?

 Nov1607 - Sun Jun 20, 2010 9:48 pm

To start out i have endometrosis and had survey about a yr ago and recently stopped hormone therapy after six months. I have had atleast 5 kidney stones in the past year and same amount of infections. I was having problems urinating and was sent to a urologist who detected that I had a horseshoe kidney. He said it caused no problems or complications but after reading up I'm not sure about that. I have constant occuring pain and cannot hold my urine and if I have to I cry in pain, I cannot get any answers out of any of my doctors and am unsure what I should do to stop the pain stones infections and complications ? Please help
 Dr.M.Aroon kamath - Wed Jun 23, 2010 6:21 am

User avatar Hi,
Increased risk for certain problems is associated with horse shoe kidneys:
- Obstruction.
- Urinary tract Infections (associated with vesico-ureteric reflux)
- Renal Stones
- Renal malignant tumors: increased risk of carcinoid tumors, transitional cell carcinomas, Wilms' tumor & sarcomas.

Ureteropelvic junction (UPJ) obstruction is perhaps the most usual associated finding in horseshoe kidney. A majority of the symptoms in individuals with horseshoe kidneys is caused by this.

UPJ obstruction is usually caused by certain anatomical factors such as
- the high insertion of the ureter into the renal pelvis,or
- the crossing of the ureter over the isthmus to gain attachment to the renal pelvis.

20-60%. of cases may develop stone disease. UPJ obstruction , the resultant urinary stasis & super-added UTI predispose to the development of stones. The abnormal orientation of the calyces also affects urinary drainage, thus contributing to the increased risk of stone formation.Dilated or abnormal pelvi-calyceal system is usually seen on imaging studies, but not all of them indicate obstruction. Nonobstructive dilatation must be distinguished from obstructive dilatation using diuresis radioisotope renal scans.

Stones, urinary stasis, vesicoureteral reflux - all of these contribute to urinary tract infections.

As general & metabolic factors also play a part in stone formation just as in individuals without horseshoe kidneys, folowing general guidelines should be followed.
- must drink plenty of liquids (enough to put out over 2000 ml of urine/day - for adults)
- metabolic factors should be excluded(Metabolic evaluation) &
- any suspicion of UTI should lead to prompt investigation and treatment.

Horseshoe kidney poses special chalanges to the urologists for open/laparoscopic/or endoscopic management of stones, because of the shape and skewed orientation of the pelvi-calyceal system and high location of the pelvi-ureteric junction.

Considering your symptoms, one needs to exclude any pathology in the lower urinary tract as well.A urine culture is also indicated.You may follow up with your urologist who will be able to assess you better.
Best wishes!

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