eMedicine Specialties > Urology > Congenital Urologic Conditions

Horseshoe Kidney: Workup

Author: Robert C Allen, Jr, MD, Consulting Staff, Alaska Urological Associates
Contributor Information and Disclosures

Updated: Dec 9, 2008

Workup

Laboratory Studies

  • Once a horseshoe kidney is diagnosed or suspected, further laboratory and imaging evaluation should be performed to assess the status of the kidneys and to look for treatable causes of renal pathology.
  • Urinalysis with urine culture should be performed. Abnormalities of the urine sediment should be evaluated as clinically indicated. Infection should be treated.
  • Serum chemistry with creatinine is recommended to determine baseline renal function.

Imaging Studies

  • Intravenous pyelography (IVP) protocol CT scanning (CT scanning of the abdomen and pelvis, with and without intravenous contrast) is the best initial radiologic study to determine anatomy and relative renal function.
  • Abdominal and pelvic CT scanning (see Image 2) or renal ultrasonography is helpful to screen for the presence of stones, masses, or hydronephrosis.

Other Tests

  • Further studies are performed as indicated and tailored to the clinical situation. These include dedicated CT scanning of the kidneys with and without intravenous contrast, diuresis renal scanning to assess renal function and drainage, and voiding cystourethrography to rule out concomitant vesicoureteral reflux. The frequency of vesicoureteral reflux in association with horseshoe kidney warrants voiding cystourethrography in all pediatric patients.

More on Horseshoe Kidney

Overview: Horseshoe Kidney
Workup: Horseshoe Kidney
Treatment: Horseshoe Kidney
Follow-up: Horseshoe Kidney
Multimedia: Horseshoe Kidney
References
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References

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  2. Peters CA. Robotic pyeloplasty--the new standard of care?. J Urol. Oct 2008;180(4):1223-4. [Medline].

  3. Bellman GC, Yamaguchi R. Special considerations in endopyelotomy in a horseshoe kidney. Urology. Apr 1996;47(4):582-5; discussion 585-6. [Medline].

  4. Atug F, Castle EP, Burgess SV, et al. Concomitant management of renal calculi and pelvi-ureteric junction obstruction with robotic laparoscopic surgery. BJU Int. Dec 2005;96(9):1365-8. [Medline].

  5. Al-Tawheed AR, Al-Awadi KA, Kehinde EO, et al. Treatment of calculi in kidneys with congenital anomalies: an assessment of the efficacy of lithotripsy. Urol Res. Oct 2006;34(5):291-8. [Medline].

  6. Bauer SB, Perlmutter AD, Retik AB. Anomalies of the Upper Urinary Tract. In: Walsh PC, Retik AB, Vaughan ED Jr, Wein AJ, eds. Campbell's Urology. Vol 2. 6th ed. Philadelphia, Pa: WB Saunders; 1992:1376-81.

  7. Bégin LR, Guy L, Jacobson SA, et al. Renal carcinoid and horseshoe kidney: a frequent association of two rare entities--a case report and review of the literature. J Surg Oncol. Jun 1998;68(2):113-9. [Medline].

  8. Chammas M Jr, Feuillu B, Coissard A, et al. Laparoscopic robotic-assisted management of pelvi-ureteric junction obstruction in patients with horseshoe kidneys: technique and 1-year follow-up. BJU Int. Mar 2006;97(3):579-83. [Medline].

  9. Davidovic LB, Kostic DM, Jakovljevic NS, et al. Abdominal aortic surgery and horseshoe kidney. Ann Vasc Surg. Nov 2004;18(6):725-8. [Medline].

  10. Dewan PA, Clark S, Condron S, et al. Point of technique: Ureterocalycostomy in the management of pelvi-ureteric junction obstruction in the horseshoe kidney. BJU Int. Aug 1999;84(3):366-8. [Medline].

  11. Doménech-Mateu JM, Gonzalez-Compta X. Horseshoe kidney: a new theory on its embryogenesis based on the study of a 16-mm human embryo. Anat Rec. Dec 1988;222(4):408-17. [Medline].

  12. Ferko A, Krajina A, Jon B, et al. Juxtarenal aortic aneurysm associated with a horseshoe kidney. Transfemoral endoluminal repair. Arch Surg. Mar 1997;132(3):316-7. [Medline].

  13. Gleason PE, Kramer SA. Ectopic Kidneys and Renal Fusion Anomalies. AUA Update Series. 1995; Lesson 33;XIV:268-71.

  14. Hohenfellner M, Schultz-Lampel D, Lampel A, et al. Tumor in the horseshoe kidney: clinical implications and review of embryogenesis. J Urol. Apr 1992;147(4):1098-102. [Medline].

  15. Krishnan B, Truong LD, Saleh G, et al. Horseshoe kidney is associated with an increased relative risk of primary renal carcinoid tumor. J Urol. Jun 1997;157(6):2059-66. [Medline].

  16. Lampel A, Hohenfellner M, Schultz-Lampel D, et al. Urolithiasis in horseshoe kidneys: therapeutic management. Urology. Feb 1996;47(2):182-6. [Medline].

  17. Murphy JT, Borman KR, Dawidson I. Renal autotransplantation after horseshoe kidney injury: a case report and literature review. J Trauma. May 1996;40(5):840-4. [Medline].

  18. O'Hara PJ, Hakaim AG, Hertzer NR, et al. Surgical management of aortic aneurysm and coexistent horseshoe kidney: review of a 31-year experience. J Vasc Surg. May 1993;17(5):940-7. [Medline].

  19. Schuster T, Dietz HG, Schütz S. Anderson-Hynes pyeloplasty in horseshoe kidney in children: is it effective without symphysiotomy?. Pediatr Surg Int. 1999;15(3-4):230-3. [Medline].

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  21. Stroosma OB, Schurink GW, Smits JM, et al. Transplanting horseshoe kidneys: a worldwide survey. J Urol. Dec 2001;166(6):2039-42. [Medline].

  22. Viola D, Anagnostou T, Thompson TJ, et al. Sixteen years of experience with stone management in horseshoe kidneys. Urol Int. 2007;78(3):214-8. [Medline].

  23. Yohannes P, Smith AD. The endourological management of complications associated with horseshoe kidney. J Urol. Jul 2002;168(1):5-8. [Medline].

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Further Reading

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Keywords

horseshoe kidney, horseshoe-shaped kidney, deformed kidney, renal fusion anomaly, kidney fusion anomaly, ureteropelvic junction obstruction, UPJ obstruction, ureter-pelvic junction obstruction, renal stones, kidney stone, stone formers, Wilms tumor, vesicoureteral reflux,

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Contributor Information and Disclosures

Author

Robert C Allen, Jr, MD, Consulting Staff, Alaska Urological Associates
Robert C Allen, Jr, MD is a member of the following medical societies: American College of Surgeons and American Urological Association
Disclosure: Nothing to disclose.

Medical Editor

Erik T Goluboff, MD, Professor, Department of Urology, College of Physicians and Surgeons, Columbia University; Director of Urology, Allen Pavilion, New York Presbyterian Hospital
Erik T Goluboff, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Association, American Urological Association, Medical Society of the State of New York, New York Academy of Medicine, Phi Beta Kappa, and Society for Basic Urologic Research
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Mark Jeffrey Noble, MD, Consulting Staff, Urologic Institute, Cleveland Clinic Foundation
Mark Jeffrey Noble, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, American Urological Association, Kansas Medical Society, Sigma Xi, Society of University Urologists, and Southwest Oncology Group
Disclosure: Nothing to disclose.

CME Editor

J Stuart Wolf Jr, MD, FACS, David A Bloom Professor of Urology, Director of Division of Minimally Invasive Urology, Department of Urology, University of Michigan
J Stuart Wolf Jr, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Catholic Medical Association, Endourological Society, Society for Urology and Engineering, Society of Laparoendoscopic Surgeons, Society of University Urologists, and Society of Urologic Oncology
Disclosure: Terumo Corporation Consulting fee Consulting; Omeros Corporation Consulting fee Consulting

Chief Editor

Stephen W Leslie, MD, FACS, Founder and Medical Director, Lorain Kidney Stone Research Center; Clinical Assistant Professor, Department of Urology, University of Toledo
Stephen W Leslie, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, National Kidney Foundation, and Ohio State Medical Association
Disclosure: Nothing to disclose.

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