Disease

Kidney fusion

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In the chapter on neurogenic disorders of urination, the diagnosis and treatment of this pathological condition are presented in detail. Among the many reasons for the development of this disease in children, detrusor-sphincter dysinergy is often diagnosed - bladder dysfunction, due.

Anomalies of location (dystopia) are the result of a violation of the normal movement of the primary kidney from the pelvis to the lumbar region. Depending on at what stage the kidney moved upward, there was a stop, pelvic, lumbar, iliac dystopia are distinguished.

One of the most common malformations of the upper urinary tract. There is no consensus on the etiology and pathogenesis of this disease to date. Some researchers associate the development of a megaureter with functional or congenital obstructions in the juxtasical or intramural ureter.

About 1.5-5% of children are born with testicular anomalies. Distinguish anomalies in the number, structure and position of the testicles. Anomalies in numbers include monorchism, anorchism, and polyorchism. Anorhism. The anomaly is the congenital absence of both testicles, which is accompanied by hypogonadism and eunuchoidism.

Agenesis (congenital absence of the bladder) is an extremely rare abnormality that usually combines with malformations incompatible with life. Children with this anomaly are usually born dead or die at an early age. Bladder doubling. The rarity of diagnosis is the second.

This anomaly is the result of the absence or arrest of the development of the Wolf duct in the corresponding half of the urinary tract. In many cases, when the kidney agenesis is absent, the vas deferens is also absent, which confirms the etiological role of the congenital absence of the Wolf duct. Renal aplasia

This is the most common quantity anomaly. The doubled kidney is much longer than normal along the length; its embryonic lobation is often developed. Between the upper and lower kidney there is a furrow of varying severity.

Causes of kidney fusion

The fusion is caused by the fusion of two metanephrogenic blastomas at the very early stage of embryonic development - before the migration of the kidneys from the caudal departments of the embryo begins. As a result, the processes of migration of renal structures into the lumbar region of its rotation are disrupted. Therefore, fused kidneys are always dystopian. The ingrowth of the ducts of metanephros occurs without abnormalities, so the histological structure of the kidneys is not broken, and the ureters always flow into the bladder in a typical place. The vast majority of patients with fusion of the kidneys (88.6%) have abnormal blood circulation.

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Symptoms of kidney fusion

The fusion of the kidneys can be one-sided (I-shaped kidney) and bilateral (horseshoe-shaped, biscuit-shaped or lumpy, L-shaped kidney). S-shaped kidney also refers to unilateral renal adhesions.

Bilateral renal fusion can be symmetrical (each kidney is homolaterally located) or asymmetric (one of the kidneys is heterolaterally).

With symmetrical fusion, the kidneys can connect with their lower poles. rarely upper, forming the so-called horseshoe-shaped kidney, or the entire surface, creating a biscuit or lumpy kidney.

A horseshoe-shaped kidney is the most common form anomaly (0.25% of the population). Among all the defects, it occurs quite often - 2.8%. Fusion is usually noted in the lower segments, and in 1.5-3.8%, in the upper segments. A horseshoe-shaped kidney in 70% of cases has an abnormal blood supply (according to our data, 84.62%). The structure of the renal calyxes is unusual: the upper group is more developed, the lower group is underdeveloped.

Diseases in a horseshoe-shaped kidney occur much more often than in a normal one, from 75 to 80% of cases. According to A.V. Ayvazyan and A.M. War-Yasenetsky. the pathological process in a horseshoe-shaped kidney is detected in 68.6% of cases, with hydronephrosis most often occurring - 41.7%, urolithiasis - 23.6%. pyelonephritis - 19.4%, AH - 15.2%. With hydronephrosis, plastic surgery is combined with resection of the isthmus. If kidney stones are found, all modern treatment methods are used, including DLT and KLT. as well as open operating aids. However, the share of the latter in the structure of surgical treatment decreases from year to year due to the advent of minimally invasive techniques. Treatment of pyelonephritis is aimed at restoring urodynamics and prescribing pathogenetic treatment.

An extremely rare anomaly not described in the classification of N.A. Lopatkina and A.V. Cradle, carry the so-called disk-shaped kidney, in which fusion occurs not only by all poles, but also by the medial lateral surfaces.

A galet-shaped or lumpy kidney has a common cortical substance and a fibrous capsule. This extremely rare malformation is diagnosed with a frequency of one case per 26,000 autopsies. In this case, the organ is usually located in the small pelvis homolaterally or heterolaterally. The pelvis is always located anteriorly. In clinical practice, a lumpy kidney can be mistaken for a retroperitoneal tumor and removed.

Asymmetric fusion is characterized by the location of one of the kidneys heterolaterally. This happens for two reasons: the fusion of metanephrogenic blastomas with the displacement of one of them on the opposite side or the ingrowth of the metanephros ducts into one metanephrogenic blastema and the reduction of homolateral blastema.

An L-shaped kidney occurs when the lower pole of one kidney and the upper pole of the other are fused, as well as in the transverse arrangement of one of them. An S-shaped kidney is formed when the lower pole of one is connected to the upper pole of the other and when they are vertically arranged. With an S-shaped kidney, the calyx of one half of the kidney is laterally facing, the calyx of the second is medial. If the embryonic rotation is completed and the cups of both kidneys are directed in one direction, then such a kidney is called I-shaped. Thus, the I-shaped and S-shaped kidneys can be attributed to unilateral adhesions.

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General information

Renal fusion is considered in modern urology as an anomaly in the relative position of organs, in which both kidneys merge into one, but each one has its own vessels and ureters, located in their usual places and opening in the bladder. It makes up about 14% of all malformations of these organs. It is more common in males and in half of cases is accompanied by dystopia of the kidneys and other abnormalities of the location of internal organs.

Classification

Anatomical types of fusion of the kidneys can be very diverse. Among the pathology options, symmetrical are distinguished, in which each kidney is located homolaterally, and asymmetric - with a heterolateral arrangement of one of the kidneys. With symmetrical fusion, the kidneys can merge with their upper or lower poles (horseshoe-shaped kidney) or median surfaces (biscuit or lumpy kidney).

Options for asymmetric fusion include the fusion of opposite poles (the top of one kidney with the bottom of the other) in vertically located kidneys (S-shaped) or horizontally rotated kidneys (L-shaped). With the coincidence of the longitudinal axes of the kidneys fused with opposite poles, they speak of an I-shaped kidney. I- and S-shaped anomalies are referred to as one-sided fusion, other types - to bilateral fusion. The most common option is a horseshoe-shaped kidney, a rare one is a biscuit-shaped kidney.

Complications

Fusion of the kidneys contributes to the development of various pathological processes in them - pyelonephritis, hydronephrosis, nephrolithiasis (kidney stones). Against the background of this malformation, nephrogenic arterial hypertension, tumors, including kidney cancer, renal failure, often occur. The peculiar location and immobility of the fused kidneys poses a potential danger of injury to an abnormal organ.

Diagnostics

Kidney fusion can be recognized by deep palpation of the abdomen or bimanual gynecological examination in women. For a more detailed determination of the type of anomaly, ultrasound and ultrasound of the kidneys, excretory urography, retrograde pyelography, nephroscintigraphy, renal arteriography, MRI or CT of the kidneys are used. With renal ultrasound, you can directly consider the shape, location, size of the kidneys and their relationship with other organs.

X-ray contrast studies, in addition to the option of fusion of the kidneys, reveal the presence of hydronephrotic transformation of the organ, tumors, vascular pathology, kidney stones. If surgical treatment is necessary, it is extremely important to study the vascularization of abnormally located organs using ultrasound and renal angiography. To exclude urinary infections, a urine test is indicated - a general analysis, bacteriological culture on the flora and sensitivity to antibiotics.

Kidney Fusion Treatment

If the fused kidneys function normally, special treatment for the defect is not required. Patients with asymptomatic kidney fusion are advised by a nephrologist with periodic follow-up ultrasound of the kidneys and urinalysis. In case of recurrent infections of the upper urinary tract, courses of conservative therapy of pyelonephritis are conducted.

Identification of stones in the fused kidneys is the basis for drug treatment, and if the latter is ineffective, surgical removal of kidney stones: remote or percutaneous lithotripsy, pyelolithotomy, nephrolithotomy. In case of severe abdominal pain, surgical dissection of the abnormal formation, dilution of the kidneys and their fixation (nephropexy) in the physiological position are performed.

In case of damage or loss of function of one of the fused kidneys, partial or total nephrectomy is indicated. Kidney surgery during their fusion is technically laborious, since the blood supply to the abnormal organs is complicated by the architectonics of the vessels.

General information

If the pregnancy develops normally, then the kidneys enter the abdominal cavity in its place under the adrenal glands, after birth they are finally fixed. The horseshoe-shaped organ is located lower than usual, since its inferior mesenteric artery, located above the isthmus, prevents its entry into the abdominal cavity.

The kidney-shaped kidney (“U” - kidney) is formed during the fusion of two organs, the connecting material is the isthmus from a functioning renal parenchyma or from fibrous tissue.

As a rule, organs are fused with the lower poles, in rare cases, fusion occurs simultaneously with the upper and lower poles, this pathology is called the "sigmoid kidney".

Despite the fusion, each of them has its own ureter, which flows into the bladder and its feeding vessels.

Causes of occurrence

  • chromosomal abnormalities: Down, Turner, Edward, Patau syndromes,
  • not neoplastic anomalies - Ellis-van Creveld syndrome, Loach, Kabuki, Pallister Hall.

However, a horseshoe-shaped organ also occurs in people without genetic abnormalities, most likely in such cases, the factors provoking pathology are:

  • infectious diseases during pregnancy,
  • the use of medicines
  • adverse external factors during gestation, chemicals in water and food.

The formation of the pathological process in a child

The formation of an organ with an anomaly occurs due to dysembryogenesis. The kidney during prenatal development goes through three stages:

  • predpochka,
  • primary kidney
  • secondary organ.

  1. In parallel with the second stage, the movement of both organs to the adrenal glands begins, only after birth both organs are finally fixed. P
  2. a childlike kidney is formed due to disruption of the movement process, which cannot be fully understood.
  3. As a rule, a horseshoe-shaped organ occurs in tandem with other disorders of intrauterine development:
  • malignant neoplasms,
  • anomalies of the skeleton,
  • Wilms tumor
  • disturbances in the activity of the heart,
  • pathology of the digestive tract,
  • hydrocephalus,
  • hydronephrosis.

The appearance of the clinical picture

  • pain in the navel during flexion-extension of the body,
  • pain in the lower back
  • constipation
  • violation of intestinal motility.

The pain symptom can be constant, which leads to emotional instability of a person.

Stages of flow

Symptoms may occur unexpectedly, often after mechanical injury to the organ. Throughout the patient's life, a horseshoe-shaped organ can lead to the development of diseases of the genitourinary system of various severity. So a patient with a similar anomaly may develop concomitant pathologies at different stages of the disease:

  1. Vascular squeezing by a pathological kidney causes venous intrarenal hypertension, often accompanied by hematuria.
  2. Compression of the inferior genital vein leads to the development of edema of the legs, varicose veins of the legs and small pelvis, ascites.
  3. In the event that the isthmus of the initial ureter becomes a cause of a violation of the outflow of urine from the pelvis, then the patient may develop pyelonephritis, urolithiasis, hydronephrosis.
  4. Sometimes the final stage of the disease is cancer and renal carcinoid.

Painful menstruation in women sometimes becomes the only symptom of a horseshoe kidney

. Also, this pathology can cause premature birth.

Who will contact and how to diagnose

  • If the patient develops symptoms of any of the diseases of the genitourinary system, then after admission to the therapist, he should consult a urologist and nephrologists, and if he has been diagnosed with a horseshoe-shaped kidney, then an oncologist’s consultation is also mandatory.
  • To diagnose this anomaly, as a rule, the following methods are used:
  • Survey data make it possible to identify the location and structure of the organ, possible violations in its work.

Sometimes a horseshoe-shaped kidney can be detected with deep palpation.

In addition to specific diagnostics, standard laboratory tests are mandatory:

  • clinical urine and blood,
  • blood chemistry.

These analyzes provide information on the functioning of the organ and, as a consequence, the presence of pathology in it.

Therapies

A horseshoe-shaped kidney does not need any treatment if it does not affect the patient's quality of life. In most cases, therapy is symptomatic in nature, as well as a mandatory follow-up at a nephrologist or urologist, this is necessary to avoid any secondary complications.

Traditional and drug treatment

Such drugs are diuretics, namely:

  • Furasemide - 1 tablet 2 times a day,
  • Diuver - 1 tablet 1 time.

Also antibacterial drugs, diuretics:

  • Urolesan - 8-10 drops 3 times a day,
  • Kanefron - 2 tablets 3 times a day.

  • Drotaverinum - 2 tablets in the presence of pain.

In addition to drug treatment, patients need to monitor their diet and avoid consuming large amounts of salt.

Ethnoscience

Alternative recipes in this case can only be auxiliary and used to cleanse the kidneys, or relieve mild inflammation.

The following recipes may apply:

  1. Rosehip root broth and hawthorn - take 1 tbsp. tablespoons of dried fruit, pour 0.5 boiling water, place in a thermos and insist 12 hours. Consume 100 mg 2-3 times a day.
  2. Beetroot and carrot juice - take 1 part of beetroot juice and two parts of freshly squeezed carrot juice - use up to two glasses during the day.
  3. Birch juice, excellently cleanses the kidneys, for this it is necessary to drink 250 ml of pure juice per day.
  4. Can be applied and medicinal baths - for 1 liter of boiling water add 0.5 tbsp. spoons of chamomile flowers, currant and birch leaves, sage and eucalyptus. Insist 30 minutes to strain and add to the bath, the procedure time is 15 minutes.

When is an operation needed?

  1. Surgery is indicated if the patient has constant severe pain, hydronephrotic transformations, stones appear, and tumors develop. The following treatment methods can be performed:
  2. These methods are aimed at relieving the patient from a congenital anomaly.
  3. The operation on the horseshoe-shaped kidney is always complicated, this is due to the large number of blood vessels feeding the organ.

How does pathology affect the patient's life

If the diagnosis is known, but there are no disturbing symptoms, then the “host of the U-kidney” can engage in any sport, except for those associated with weight lifting, professionally not advisable to play sports.

If the pathology was detected in a child, then it should be taken to the urologist's dispensary, and be observed by a specialist at least 2 times a year.
Complications

The presence of such a kidney, unfortunately, often contributes to various complications. As a rule, they become disturbances in the work of the cardiovascular and urinary system, often pathology is a provocateur of the development of varicose veins and, as a result, edema of the lower extremities.

Sometimes pathology causes the development of disorders in the nervous system, which can lead to mental disorders.

Unfortunately, in children, this anomaly in tandem with other anomalies provokes multiple disorders in the body:

  • gastrointestinal tract diseases
  • chronic heart disease
  • severe disorders of the musculoskeletal system,
  • Horseshoe kidney tumors
  • hydrocephalus.

Typically, these diseases develop in children in utero, or at an early age, the older the child becomes, the lower the risk of developing pathology.

Prevention and prognosis

  • As a preventive measure to avoid possible complications of a renal abnormality, a dispensary registration by a specialist nephrologist or urologist is necessary.
  • In the event that an operation has been performed, regular examinations should be performed to prevent reunion.
  • In order to minimize the possibility of pathology in a child, one should seriously consider the stage of pregnancy planning - cure all chronic diseases, lead a healthy lifestyle, and abandon bad habits.
  • The prognosis in the presence of this anomaly is conditionally favorable - patients can live their whole lives without ever learning about their “special kidney”.

Despite the fact that the term “anomaly” itself sounds scary, there is nothing scary in a pathological horseshoe-shaped kidney.

Violations encountered in every five hundredth person, in most cases, do not affect the quality and duration of life.

If you monitor your health and seek medical help on time, the possibility of any complications can be minimized.

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Kidney Fusion Options

There is a certain classification of the anatomical structure of fused kidneys, it consists of the following varieties:

  • L-shaped kidney is the most common type of fusion, in which the upper part of one kidney fuses with the lower part of the other or is transversely connected to one of the organs,
  • S-shaped kidneys - deliver a minimum of painful and unpleasant sensations to the patient. They are characterized by a vertical arrangement, the kidneys grow together according to the same principle as in the previous description.

These two types are related to unilateral fusion of the kidneys. There is a mutual connection of the renal structure, it, in turn, is divided into:

  • symmetrical - fusion of the kidneys purely lower poles,
  • asymmetric - fusion of the kidneys purely upper poles.

As a result, the kidney has a horseshoe shape. More complex anomalies are considered biscuit-shaped and lumpy kidneys, since such a fusion is characterized by a complete connection along the inner plane.

What it is?

A horseshoe-shaped kidney is a pathology of the development of excretory organs, which is congenital in nature, in which an isthmus is formed between the kidneys.

In other words, these are kidneys fused together and in appearance resemble a horseshoe, hence the name of the disease.

In 90% of cases, the kidneys are fused with the lower poles. Less often - middle or upper, these conditions are most dangerous, as they are accompanied by numerous disorders of the urinary system. In medicine are found following forms of fusion (see photo below):

  • Asymmetric (by type of letters S or L). The organs are fused at different poles, the pelvis is deployed in different directions, sometimes the kidney is placed horizontally.
  • Disc-shaped. The organs are fused in the middle and around the edges.
  • In the form of a biscuit. Fusion is observed in the central part of the kidneys.

The horseshoe-shaped kidney is characterized by an abnormal structure and a violation in the vascular structure. Many additional arteries develop, creating a separate blood supply in the isthmus of the organ. According to ICD 10, the disease has a code of Q63.1.

  • (Image is clickable, click to enlarge)
  • About in 30% of children the disease is accompanied by additional disorders:
  • In most children, the horseshoe-shaped kidney is the only pathology and does not manifest itself in any way.

According to Dr. Komarovsky, if the pathology is not accompanied by disorders of the urinary system and does not interfere with the normal life of the child, then no treatment is required. In this case, the doctors take a position dynamic observation.

Which doctor to contact

If there are pains in the lower back, navel, abdomen or hypochondrium, the presence of blood in the urine, you should contact a nephrologist or urologist. After a series of examinations (ultrasound, ultrasound, excretory urography, CT, MRI of the kidneys, etc.), the doctor will be able to make the correct diagnosis and determine the tactics of further treatment.

The fusion of the kidneys can be horseshoe-shaped, L-shaped, S-shaped and I-shaped. This congenital malformation of the urinary system is accompanied by the fusion of paired organs into one. In some cases, fusion of the kidneys is asymptomatic and does not require treatment. With significant changes in the organs of the patient, a number of unpleasant symptoms occur, the presence of anomalies contributes to the development of various concomitant diseases (pyelonephritis, hydronephrosis, urolithiasis, cancer, neoplasm, arterial hypertension and renal failure). Treatment for kidney fusion may be conservative or surgical.

A specialist at the Moscow Doctor Clinic talks about abnormalities in kidney development:

Causes of the appearance of pathology

The reasons for the formation of a horseshoe-shaped kidney are violations of intrauterine development.

The kidneys of the fetus are formed in three stages:

  1. forearms
  2. primary organs
  3. secondary kidneys.

During the development of secondary kidneys, they move to the area of ​​the kidney bed in the lumbar region. The complete formation of the kidney is completed after birth.

When the process of advancement and organ formation is disrupted, a horseshoe-shaped kidney is formed. The pathological organ is located below the normal kidney bed.

Provoking factors pathology development are:

  • infectious diseases of a woman during pregnancy,
  • chronic diseases of the urinary system of the mother,
  • prolonged uncontrolled medication during pregnancy,
  • bad habits of the mother and father of the child,
  • adverse environmental conditions
  • genetic diseases of parents
  • exposure to chemicals or radiation on the mother’s body.

However, most often the cause of the anomaly cannot be established.

What are the symptoms?

In the case when the horseshoe-shaped kidney is a single pathology and is not accompanied by concomitant diseases, no symptoms. An anomaly is detected by chance during a routine ultrasound scan.

The first symptoms appear already in adulthood, but the patient does not associate them with kidney disease. Clinical manifestations depend on the following factors:

  • pressure of the isthmus on the ureter,
  • increased innervation of the affected organs,
  • improper location of internal organs due to the isthmus.

All these factors provoke the appearance of the following symptoms:

  • pain in the lumbar region or abdomen, aggravated by physical exertion,
  • digestive disorders: frequent constipation, flatulence,
  • nausea, vomiting,
  • impaired appetite
  • weight loss for no apparent reason
  • swelling of the legs and arms,
  • menstrual failure
  • phlebeurysm,
  • blood in urine
  • pain during urination
  • renal colic
  • discoloration and transparency of urine,
  • increased emotional background, accompanied by nervousness or depressive manifestations.
  • Possible complications

    Despite the absence of severe symptoms, the disease can trigger the development of serious complications. Since the isthmus is located in the lumbar region, it presses on the ureter. This provokes the development of pyelonephritis, urolithiasis, hydronephrosis, glomerulonephritis.

    Due to the pressure of the isthmus on the intestines, normal peristalsis is disturbed, as a result chronic intestinal inflammation.

    In addition, in patients with an abnormal kidney increased risk of kidney tumorsincluding malignant, kidney tuberculosis. The patient may develop renal failure. Compression of blood vessels in an abnormal organ causes varicose veins.

    In women, a horseshoe-shaped kidney can provoke premature birth. In addition, the growing fetus presses on the isthmus, as a result, kidney infarction, hydronephrosis may develop. Such a condition poses a direct threat to the life of the mother and child.

    How is it diagnosed?

    Diagnosis of the disease presents certain difficulties in connection with the specifics of the pathology. For diagnosis a number of studies are required.

    1. Research methods combine laboratory tests and instrumental diagnostics.
    2. Lab tests include:
    3. Instrumental methods Diagnostics give the most reliable picture of the pathology. The most commonly used methods are:
    4. Proper diagnosis will allow the doctor to decide on the choice of treatment methods.

    Pathology treatment

    Patients are registered with a nephrologist and urologist. Therapy wears symptomatic. For example, with pyelonephritis, appropriate antibacterial agents are prescribed. To stop the pain, antispasmodics and painkillers are used.

    Surgical treatment is indicated in case of severe pain, kidney stones, tumors, as well as in case of loss of body functions.

    Surgical treatment involves kidney separation and fixation of organs in a physiologically normal position. Surgical therapy is carried out using laparoscopy or in an open way, depending on the condition of the patient and the severity of the pathology.

    Types of operationsused to treat pathology:

    1. Nephrostomy installation. It is used to restore the outflow of urine.
    2. Partial organ resection. It is carried out with the loss of its function by the kidney.
    3. Nephrectomy (kidney removal). It is indicated for organ damage by a cancerous tumor, tuberculosis, or renal failure.

    In the case when the horseshoe-shaped kidney does not affect the patient's quality of life, treatment is not carried out.

    How to live with a horseshoe-shaped kidney and whether they take in the army?

    The prognosis for life with this pathology is favorable. In most cases, the patient leads a normal lifestyle without significant restrictions. Even with the development of complications after a timely operation, the patient quickly returns to normal life.

    As for military service, the horseshoe-shaped kidney is an unapproachable pathology due to the high risk of complications. A young man with such a diagnosis assigned category B, that is, he is recognized as fit for service in wartime and unfit in peacetime.

    A horseshoe-shaped kidney is a fairly common congenital anomaly. If the patient has no concomitant complications, then the disease does not require specific treatment. People with this pathology should regularly undergo preventive examinations to prevent the development of complications.

    How the ultrasound looks like a horseshoe-shaped kidney in the video:

    Kidney fusion

    Fusion of the kidneys is a violation of the location and structure of the organ, which means the fusion of both kidneys into one. With the fusion of the kidneys of each of them, the presence of their own ureters and blood vessels, located in their standard place, is characteristic.

    Renal fusion is a common anomaly, accounting for approximately 14% of all congenital malformations.

    This deviation is often found in men, while in most cases it borders on dystopia of the kidneys or other disorders associated with the location of internal organs.

    Kidney fusion often affects people living near chemical plants or processing plants for metallurgy and radioactive waste.

    Anomalies in the relationship (fusion) of the kidney

    The term "kidney fusion" refers to an abnormality characterized by the fusion of two kidneys into one organ, the ureters of which flow into the bladder in the usual place. This type of abnormality occurs in 16.5% of cases of all kidney abnormalities.

    The fusion of the kidneys along their medial surface is called a biscuit-shaped kidney. When the upper pole of one kidney is connected to the lower pole of the other, a so-called S- or L-shaped kidney is formed.

    In the first form, the pelvis-ureteric segment of one kidney is facing medially and the other laterally; in the second form, the long axes of the kidneys are perpendicular to each other.

    Fig. 1. Anomalies in the relationship of the kidneys (scheme). a - S-shaped kidney, b - L-shaped kidney (rod-shaped), c - V-shaped kidney, d - horseshoe-shaped kidney.

    In this defect, the kidneys are often fused with the lower poles, less often the upper ones, connecting with an isthmus consisting of a renal parenchyma or fibrous tissue. The horseshoe-shaped kidney is lower than normal. Since the fusion of the kidneys occurs before the period of their rotation, the pelvis and ureters are located in front of the isthmus.

    Information about the frequency of the horseshoe-shaped kidneys is contradictory. According to some reports, it accounts for 8.8-16.5% of the total number of kidney malformations. This anomaly is of the greatest practical interest in this group. It is more common in men. Half of those with a horseshoe-shaped kidney also have malformations of other organs.

    The horseshoe-shaped kidney is almost motionless. A stronger fixation is the result of its many vascular connections and a peculiar form.

    The isthmus of the kidney, connecting the lower segments of both halves, is usually located in front of the large vessels (aorta, inferior vena cava, iliac vessels) and the solar plexus, pressing them to the spine.

    Very rarely there is a retro-aortic location of the isthmus.In the absence of pain, the patient may not be aware of the existence of a horseshoe-shaped kidney.

    The main symptoms of a horseshoe-shaped kidney are the presence in the abdomen of a palpable sedentary formation on both sides of the spine, sometimes slight pain due to pressure on neighboring organs.

    Very rarely, compression of the inferior vena cava by the isthmus of the horseshoe-shaped kidney can be accompanied by venous hypertension of the lower half of the body, subsequent dilatation and venous congestion in this area with the development of edema of the lower extremities and even ascites. Due to aortic compression, pain and numbness in the lower extremities may occur.

    Due to reduced mobility and peculiar localization, the horseshoe-shaped kidney is more susceptible to injury than normally located.

    The horseshoe-shaped kidney is predisposed to the development of inflammatory diseases in it, stone formation, hydronephrosis.

    An important role in the diagnosis of this kidney anomaly belongs to X-ray and radioisotope research methods. Renal arteriography is used to study angioarchitectonics.

    It is indicated that with a horseshoe-shaped kidney, the risk of developing tumors, often hypernephroma and Wilms' tumors, is high. Usually they come from the isthmus of the kidney.

    Surgical treatment is undertaken mainly with the development of the above pathological processes in the horseshoe kidney and much less often in the presence of strong, persistent pain.

    With surgical intervention, it is necessary to remember that the pelvis is in front, and multiple vessels can go to the kidney from the aorta and iliac arteries.

    With surgical intervention in children in the case of a narrow isthmus they resort to dissecting it (istotomy) and reposition of divided kidneys.

    With a far-reaching lesion of one of the halves of the horseshoe kidney, a heminephrectomy is performed.

    Lopatkin N.A., Pugachev A.G., Apolikhin O.I. and etc.

    What is a biscuit kidney

    Galette-shaped anomalies (horseshoe-shaped kidney) - this is a type of organ fusion in which they have common poles, making up a round shape with separation of the pelvis and ureter.

    Blood circulation is performed due to the common numerous blood arteries, while the ureters are deformed in length - less than in a normal state.

    Usually, with such a disease, the left and right kidneys work together as one, the separation of functions of each of the organs is imperceptible, but is felt physically, pain and deformation of the remaining organs, most often the liver, are possible. Such deformation is manifested in an unconventional location (dystopia) or abnormally disproportionate dimensions.

    Various renal abnormalities are a fairly common occurrence in the human body. Improper functioning and location, violations in the structure and structure of the organ, as well as alteration of blood vessels - all this indicates the presence of an anomaly in the kidney.

    A common disease related to abnormal manifestations is kidney fusion. Such congenital disorders are more common than any other, therefore, they need careful diagnosis and timely treatment.

    Indeed, abnormalities at the genetic level can often lead to death, and some simply need constant monitoring and control due to pronounced symptoms and an implicit threat.

    Symptoms of the formation of a biscuit kidney

    Typically, fusion of the kidneys is not accompanied by pronounced signs, only if these are not extreme forms of the disease.

    Therefore, the detected signs are rather general in nature, which can speak of another disease.

    But if you still find similar alarms in the abdominal cavity, you should seek the help of a specialist. The following are common symptoms with a biscuit-like form of kidney crossing:

    • cutting, pulling, stitching pains in the back, closer to the lower back, as well as in the hypochondrium,
    • heaviness in the lower abdomen, concomitant constipation and flatulence,
    • an increase in temperature, often an increase in blood pressure,
    • the absence or decrease in the usual appetite rate, constant attacks of nausea and profuse vomiting are possible,
    • disorders in the psychological state against the background of a violation of the neurological system (hysteria, disorientation, neurasthenia),
    • with a compressed state of the abdominal cavity, swelling of the legs and their subsequent numbness may be noted,
    • often the patient experiences discomfort when urinating.

    With such a variety of symptoms that do not give an absolute guarantee and specific results, you should not self-medicate. Only a highly qualified specialist can diagnose kidney splicing, especially in a biscuit form, on the basis of analyzes and equipment data for the detection of renal abnormalities.

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    Watch the video: Horseshoe kidney renal fusion causes, symptoms, diagnosis, treatment & pathology (March 2020).