Transcript Medical Student Case Study: Horseshoe Kidney in an Infant August 2013 Emma Simpson Konrad Bienia MD & Eric Sutherland MD The Patient • 5 mo old.

Medical Student Case Study:
Horseshoe Kidney in an Infant
August 2013
Emma Simpson
Konrad Bienia MD & Eric Sutherland MD
The Patient
• 5 mo old boy
• Ex-preemie (35 weeks)
• Previous admission for community-acquired
viral infx
• O/p visit for assessment of HSK seen on
prenatal US
• Fever (Tmax 101’)
• FTT (Zeroeth percentile in all parameters.)
• Stage 1 Chronic Kidney Disease
• Abnormal urinalysis
Renal Embryology
• Because who doesn’t love embryology?
4 weeks
9 weeks
http://academic.amc.edu/martino/grossanatomy/site/Medical/CASES/R&R/pop%20ups/hydronephrosis%20anspop_up4.htm
Fusion Abnormalities
• Crossed, fused ectopia
– The estimated incidence is around 1 out of 1,000
births
– Male: Female; 2:1
• Horseshoe Kidney
– 0.25% of the general population
– More common in men.
Horseshoe Kidney Pathology
Clinical History & Physical Exam
• MAINLY asymptomatic – autopsy finding
• UTI and fever in neonates
• Abdominal surgery: BEWARE
• Mostly of interest to radiology nerds.
• Can have sequelae related
to poor drainage…
http://elettrogenica.tumblr.com/page/2
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DDx
• Depends on symptoms.
• Chronic Kidney Disease
in a newborn
– Premature
birth/trisomies/nonaneuploidic anomalies
– Acute Kidney Injury
becoming chronic
• Congenital
• Hypoxic ischemic injury
• Toxic injury
http://en.wikipedia.org/wiki/Autosomal_dominant_polycystic_kidney
What does a diagnosis mean?
• Clinical Sx
– Nausea, abdominal discomfort, kidney
stones and urinary tract infections at greater
frequency than those without renal fusion.
• Risks
– Trauma
– Renal calculi
– Transitional cell carcinoma of renal
pelvis/Wilms tumor
– Chronic Kidney Disease
Imaging Modalities for HSK
• Ultrasound
• Fluoroscopy - IVU
• CT and MRI
• ACR: Do not irradiate babies
• PLUS: Very specific area to be imaged, and
can be easily visualized. Babies are small.
Cheap and fast.
https://www.akronchildrens.org/cms/procedures_tests/Ultrasound_infant_hip/
Normal US Right Kidney
http://www.ultrasoundpaedia.com/normal-kidney/
Normal US Kidney
http://www.ultrasoundpaedia.com/normal-kidney/
Left Longitudinal Retroperitoneal US: HSK
MRN: 6566544
Right Longitudinal Retroperitoneal US: HSK
MRN: 6566544
Transverse Retroperitoneal US
MRN: 6566544
Horseshoe Kidney
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No tx for HSK
Adequate hydration
Symptomatic management
In this pt:
– Lost to follow-up
– Mom moved out of state
– Social Services concerns
Thank You
References
• Gupta, M., A. K. Pandey, and N. Goyal. "Horseshoe Kidney--a
Case Report." Nepal Med Coll J 9.1 (2007): 63-6. Print.
• http://radiopaedia.org/
• Carmody, J. B., and J. R. Charlton. "Short-Term Gestation,
Long-Term Risk: Prematurity and Chronic Kidney Disease."
Pediatrics 131.6 (2013): 1168-79. Print.
• http://en.wikipedia.org/wiki/Horseshoe_kidney
• http://www.chop.edu/img/urology/horseshoe-kidney.html
• http://renalfellow.blogspot.com/2008/09/horseshoe-kidneyversus-crossed-fused.html
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