Case Study - October 2012

This 62 yr old male was referred to the haematuria clinic with visable
haematuria. 

  1. What are the 2 main findings on the CT?
  2. What is the incidence of the congenital anomaly?
  3. How does it arise?
  4. What genetic conditions can this be associated with?
  5. What symptoms do these patients have?

Reveal Answer

1. There is a 7x5 mm stone in the isthmus of a horseshoe kidney.

2. It is the most common kidney fusion anomaly and affects 1 in 500, with a M:F ratio of 2:1.

3. There are two theories:

a. The horseshoe kidney is formed during organogenesis, when the inferior poles of these early kidneys touch, fusing in the lower midline.

b. Alternatively,  horseshoe kidneys is the result of a teratogenic event involving the abnormal migration
of posterior nephrogenic cells, which then coalesce to form the isthmus and hence abnormal fusion of the kidneys.

4. Turners Syndrome (15%) and Trisomy 18.

5. Patients are usually asymptomatic , so these are usually picked up incidentally.  Vesicoureteral reflux is present in about half of patients and ureteral duplication in 10%. Hypospadias or undescended testis is present in 4% of males and bicornuate uterus or septate vagina is present in 7% of females.  Patients may have an increased incidence of stones and  infections.  There is an increased risk of Wilms tumour and carcinoid tumour.  The horseshoe kidney is also more prone to trauma as it is not protected by the rib cage.

The cookie setting on this website is set to ‘allow cookies’ to give you the very best experience.

If you continue without changing this setting, you consent to this - but if you want, you can change your setting at any time using the ‘change cookie setting’ link at the bottom of this page.

Cookie Setting







Our Cookies

Cookie NamePurpose
eu_ask This is used to store the cookie setting you set in the form above.
If you choose 'Do Not Allow Cookies' we will need to store this information as a cookie with the value N.
If you choose 'Allow Cookies' or do not make a choice, we will store this information as a cookie with the value Y.

The value is kept for one year.

3rd Party Cookies

Cookie NamePurpose
Google Analytics This website uses Google Analytics, a web analytics service provided by Google, Inc.
Google Analytics sets a cookie in order to evaluate your use of the website and compile reports for us on activity on the website.
Google stores the information collected by the cookie on servers in the United States.
Google may also transfer this information to third parties where required to do so by law,
or where such third parties process the information on Google's behalf.
Google will not associate your IP address with any other data held by Google
By using this website, you consent to the processing of data about you by Google in the manner and for the purposes set out above.

How to reject or delete this cookie

http://www.google.com/intl/en/privacypolicy.html