Among the many different pathologies of kidney development, their abnormal horseshoe-shaped form is quite common. According to statistics, such an unusual phenomenon is detected in one newborn baby out of 400. By the way, in boys this anomaly is detected much more often. Usually, a horseshoe-shaped kidney in a child is a single deviation in the development of the baby, but in some cases it is formed in parallel with other pathologies.
A little information
A horseshoe-shaped kidney is a congenital malformation of the excretory system. In this case, an isthmus is formed between the organs. In general, these are buds fused together, which visually resemble a horseshoe. This is what determines such an unusual name for the disease.
In most cases (approximately 90% of all diagnosed), the organs are fused with the lower poles. Much less often they are connected by the upper and middle points - such anomalies are the most dangerous, since they are accompanied by numerous failures in the activity of the urinary system.
Varieties
Doctors distinguish several forms of splicing:
- asymmetric - the kidneys are connected by different points, while their pelvis is unfolded, and sometimes the organs are completely horizontal, visually it looks like the letter S or L;
- disk-shaped - the kidneys connect at the edges or in the middle;
- in the form of a biscuit - the connection occurs in the center of the organs.
The horseshoe-shaped kidney in children is distinguished by a pathological structure and defects in the vascular structure. With this anomaly, a large number of additional arteries are formed, which equip a separate blood flow in the isthmus of the organ. The code of the horseshoe-shaped kidney in children according to ICD-10 is Q63.2.
Features
In approximately 30% of babies, the disease is accompanied by additional pathologies:
- polycystic kidney disease;
- hydronephrosis;
- hydrocephalus;
- urolithiasis;
- Williams tumor, forming during the period of fetal development of the embryo;
- disturbances in the work and structure of the digestive tract.
But still, in most children, the horseshoe-shaped kidney is the only defect and does not manifest itself in any way. For this reason, the diagnosis of pathology often happens quite by accident, during a routine examination.
According to Dr. Komarovsky, a horseshoe-shaped kidney in a child does not require special therapy if the anomaly is not accompanied by any malfunctions in the urinary system and in no way interferes with the normal life of the baby. In this situation, doctors usually engage in dynamic observation.
Pathogenesis
The prerequisites for the formation of a horseshoe-shaped kidney in children are always all kinds of intrauterine developmental disorders.
In an embryo, organs are built in several main stages:
- forearms;
- primary rudiments;
- secondary kidneys.
During the formation of secondary kidneys, they move to the zone of the kidney bed, located in the lumbar region. The final construction of organs is completed after the birth of the baby.
With violations of the process of formation and movement in children, a horseshoe-shaped kidney is formed. The abnormal organ is located slightly below the normal bed.
Causes
Various factors can provoke pathology:
- infectious diseases of a woman during the period of bearing a baby;
- chronic defects of the reproductive system of the expectant mother;
- prolonged uncontrolled use of all kinds of medicines during pregnancy;
- addictions and any form of dependence of the father or mother of the child;
- adverse environmental conditions;
- genetic diseases of future parents;
- adverse effects of chemicals or radiation on the mother's body.
True, doctors often fail to establish a specific cause of the pathology.
Symptomatology
In those cases when the horseshoe-shaped kidney in children is a single pathology and various diseases do not accompany it, the expressed signs of this phenomenon are completely absent. An anomaly is usually detected by accident at the time of a routine examination.
The first signs of the disease occur most often in adulthood, but the patient simply does not associate the emerging symptoms with the kidneys. The clinical picture is determined by several factors:
- pressure of the isthmus on the ureter;
- abnormal placement of internal organs due to the presence of an isthmus;
- increased innervation of damaged elements.
All these conditions entail the occurrence of some symptoms:
- digestive disorders in the form of flatulence and regular constipation;
- vomiting and nausea;
- pain in the lower back or abdomen, which is repeatedly amplified during physical activity;
- impaired appetite;
- swelling of the extremities;
- blood in the urine;
- weight loss for no reason;
- disruptions in the menstrual cycle;
- phlebeurysm;
- renal colic;
- emotional changes in the form of nervousness and depression;
- pain at the time of bladder emptying;
- changes in the transparency and color of urine.
The danger of a horseshoe-shaped kidney in a child
Despite the complete absence of severe symptoms, pathology can lead to the development of very serious consequences. Due to the fact that the isthmus is located in the lumbar region, it puts pressure on the ureter. This entails the occurrence of pyelonephritis, hydronephrosis, urolithiasis, glomerulonephritis.
Against the background of the pressure of the isthmus on the intestines, full peristalsis is disturbed, because of which its chronic inflammation appears.
Is a horseshoe-shaped kidney dangerous in a child? Definitely yes! Indeed, among other things, such babies have a significantly increased risk of nucleating tumors in the kidneys, including malignant ones. In addition, a small patient may experience renal failure. Compression of blood vessels in the kidneys often becomes a prerequisite for the onset of varicose veins.
In the fairer sex, an abnormal kidney can cause premature birth. In addition, an enlarged embryo can put pressure on the isthmus, due to which hydronephrosis and heart attack of the affected organ develops. This phenomenon carries a huge danger to the life of the child and mother.
Diagnostics
The identification of pathology is difficult due to the specifics of the anomaly. To make a diagnosis, you need to do a lot of research, both laboratory and instrumental.
As for clinical tests, it is necessary to carry out:
- detailed blood chemistry;
- urine testing according to Zimnitsky and Nechiporenko;
- general blood and urine tests;
- bacterial crops.
Instrumental diagnostic methods bring more reliable results and make it possible to study in detail the clinical picture of a horseshoe-shaped kidney (according to ICD-10, the ailment code is Q63.2). Most often, several basic techniques are used.
- Ultrasound Using ultrasound, you can detect pathology in the development of the baby during pregnancy. A specialist can evaluate the structure, parameters of the organ and the general state of blood circulation. But such a technique does not give a reliable picture, which is why auxiliary examinations are necessary.
- Excretory urography. A child is injected with a special substance into the bloodstream, after which an X-ray of the kidneys is performed. The results clearly demonstrate patency of arteries and veins in the pelvic organs.
- Duplex scanning of blood vessels. With its help, it is possible to accurately determine the usefulness of blood circulation in organs.
- CT and MRI. In the pictures, one can well consider anomalies in the development of the organ. Photos of a horseshoe-shaped kidney allow you to get acquainted with the possible varieties of pathology and help determine it.
- Retrograde pyelography. It makes it possible to identify the pathological location of the kidneys, the presence of an isthmus, as well as assess the general condition of the pelvis.
- Fine needle biopsy. Only necessary for suspected neoplasm.
It is the correct diagnosis that enables the doctor to correctly choose the appropriate treatment.
Therapy
If a horseshoe-shaped kidney is diagnosed in a newborn baby, it is registered with a urologist or nephrologist. Treatment in this case is symptomatic. For example, with pyelonephritis, the baby is prescribed suitable antibiotics. To eliminate pain, analgesics and antispasmodics are prescribed.
Surgical intervention is advisable only with severe pain, the formation of kidney stones, tumors, as well as with dysfunction of an abnormal organ.
Surgical therapy involves the separation of shares and fixing them in a normal position. Surgical intervention is performed using laparoscopy or an open method, depending on the general condition of the baby and the form of the pathology itself.
For the treatment of a horseshoe-shaped kidney in a child, several types of operations are used:
- nephrostomy fixation - used to normalize the outflow of urine;
- partial resection - performed with organ dysfunction;
- complete removal (nephrectomy) - advisable in case of damage to the organ by a tumor, tuberculosis or in case of renal failure.
If the horseshoe-shaped kidney does not affect the quality of life of the child, therapy is not carried out at all.
Further forecasts
According to reviews, a horseshoe-shaped kidney in a child is far from always a cause for great concern. In general, the further prognosis for children with such a diagnosis is favorable. As a rule, a small patient leads a quite familiar lifestyle, with almost no restrictions. Only one thing is important - the child should be constantly monitored by doctors. Even if serious complications arise after the operation is completed on time, the baby pretty quickly and without problems returns to normal life.
Regarding military service, the horseshoe-shaped kidney is considered an unapproachable disease due to the high probability of complications. Group B is assigned to a young person with such a diagnosis. In other words, he is fit for service exclusively in a martial law.
A horseshoe-shaped kidney is a fairly common anomaly that is congenital in nature. If any concomitant complications are not diagnosed in a small or adult patient, then the disease does not require specific therapy. People with this pathology need only systematically undergo preventive examinations to prevent the occurrence of negative consequences.
Conclusion
To summarize what was said earlier:
- A horseshoe-shaped kidney is a congenital pathology, which consists in connecting certain points of organs with the formation of an isthmus.
- An anomaly can be a single developmental abnormality or be accompanied by other diseases: pyelonephritis, renal failure, arterial hypertension, hydronephrosis and other diseases.
- The causes of the onset of pathology are intrauterine malformations in the development of the embryo.
- A horseshoe-shaped kidney can be completely asymptomatic.
- In the absence of pronounced clinical manifestations, the anomaly does not require specific treatment.