Background And Purpose: Horseshoe kidneys are a complex anatomic variant of fused kidneys, with a 20% reported incidence of associated calculi. Anatomic causes such as high insertion of the ureter on the renal pelvis and obstruction of the ureteropelvic junction are thought to contribute to stone formation via impaired drainage, with urinary stasis, and an increased incidence of infection. In this multi-institutional study, we evaluated whether metabolic factors contributed to stone development in patients with horseshoe kidneys.
Patients And Methods: A retrospective review of 37 patients with horseshoe kidneys was performed to determine if these patients had metabolic derangements that might have contributed to calculus formation. Stone compositions as well as 24-hour urine collections were examined. Specific data points of interest were total urine volume; urine pH; urine concentrations of calcium, sodium, uric acid, oxalate, and citrate; and number of abnormalities per patient per 24-hour urine collection. These data were compared with those of a group of 13 patients with stones in caliceal diverticula as well as 24 age-, race-, and sex-matched controls with stones in anatomically normal kidneys.
Results: Eleven (9 men and 2 women) of the 37 patients (30%) with renal calculi in horseshoe kidneys had complete metabolic evaluations available for review. All patients were noted to have at least one abnormality, with an average of 2.68 abnormalities per 24-hour urine collection (range 1-4). One patient had primary hyperparathyroidism and underwent a parathyroidectomy. Low urine volumes were noted in eight patients on at least one of the two specimens (range 350-1640 mL/day). Hypercalciuria, hyperoxaluria, hyperuricosuria, and hypocitraturia were noted in seven, three, six, and six patients, respectively. No patients were found to have gouty diathesis or developed cystine stones. Comparative metabolic analyses of patients with renal calculi in caliceal diverticula or normal kidneys revealed a distinct profile in patients with horseshoe kidneys, with a higher incidence of hypocitraturia.
Conclusions: All patients with renal calculi in horseshoe kidneys were noted to have metabolic abnormalities predisposing to stone formation. In this initial series of 11 patients, hypovolemia, hypercalcuria and hypocitraturia were most common metabolic defects. These findings suggest that metabolic derangements play a role in stone formation in patients with a horseshoe kidney. Patients with calculi in anatomically abnormal kidneys should be considered for a metabolic evaluation to identify their stone-forming risk factors in order to initiate preventative selective medical therapy and reduce the risk of recurrent calculus formation.
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http://dx.doi.org/10.1089/089277904322959798 | DOI Listing |
Zhonghua Yi Xue Za Zhi
December 2024
Department of Urology, Guizhou Provincial People's Hospital, Guiyang550002, China.
The current study aimed to investigate the feasibility and safety of robot-assisted laparoscopic resection of the isthmus in patients with symptomatic horseshoe kidney. A retrospective analysis of clinical data from four patients with symptomatic horseshoe kidney treated between January 1, 2021 and December 31, 2023 at Guizhou Provincial People's Hospital was conducted. The main surgical procedures included robot-assisted laparoscopic resection of the isthmus, kidney fixation, pyeloplasty, and pyelolithotomy.
View Article and Find Full Text PDFCan J Urol
December 2024
Department of Urology, UC San Diego Health, San Diego, California, USA.
Nephrolithiasis is one of the most common indications for surgery in patients with a horseshoe kidney. Robotic-assisted surgery has become a staple in urologic practice, yet its application in stone management is largely undefined. We present a patient with a horseshoe kidney, who underwent a robotic-assisted laparoscopic pyelolithotomy (RPL) to treat a 3 cm stone burden.
View Article and Find Full Text PDFJ Genet Eng Biotechnol
December 2024
Center for Genomics, Helmy Institute for Medical Sciences, Zewail City of Science and Technology, Giza, Egypt; University of Science and Technology, Zewail City of Science and Technology, Giza, Egypt. Electronic address:
Radiol Case Rep
February 2025
Department of Interventional Radiology, Massachusetts General Hospital, 55 Fruit Street, GRB 298, Boston, MA, 02114, USA.
Renal fusion anomalies are rare congenital malformations that comprise horseshoe kidney and crossed fused ectopia. Renal tumors arising from these fusion anomalies are anatomically complex, and surgical management can be technically challenging because of altered renal anatomy. Percutaneous CT-guided ablation can overcome some of these anatomical constraints, and microwave ablation has the additional benefit of shorter treatment time and reduced sensitivity to heat sink effects compared to other ablative modalities.
View Article and Find Full Text PDFCureus
November 2024
Urology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, IND.
Congenital anomalies are not regularly seen in day-to-day practice. Crossed fused renal anomalies are even rarer. A 50-year-old female patient presented with right-sided pain in the abdomen with intermittent episodes of burning micturition.
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