Vascular and urological anomalies in children with horseshoe kidneys

Year 2023, Volume: 16 Issue: 3, 420 - 428, 01.07.2023

Hatice Kübra Zora , İlknur Girişgen , Ayşe Rüksan Ütebey , Furkan Ufuk , Tülay Becerir , Selçuk Yüksel

https://doi.org/10.31362/patd.1252453

Abstract

Purpose: Horseshoe kidney is the most common fusion anomaly that congenital systemic and urological anomalies accompany most of the patients. In this study, we aimed to investigate its association with vascular anomalies and especially nutcracker syndrome along with accompanying urological and other systemic anomalies in children with horseshoe kidney.
Materials and methods: Twenty-six patients are diagnosed with horseshoe kidney in our clinic and 22 healthy children of the same age and sex were included in the study. All children were prospectively evaluated using Doppler ultrasonography in terms of renal artery and renal vein flow velocities, lumen diameters and vascular anomalies and presence of nutcracker syndrome.
Results: Urological anomaly was found in 50% of the children with horseshoe kidneys, and systemic anomaly in 44% of them. In Doppler ultrasonographic evaluations performed on patients to detect vascular pathologies and nutcracker syndrome; findings of nutcracker syndrome were present in 2 patients in the horseshoe kidney group, while they were detected incidentally in 1 patient in the control group. An accessory renal artery originating from the left common iliac artery was found in a case with horseshoe kidney, and a circumaortic left renal vein in one case.
Conclusions: In our study in which we investigated nutcracker syndrome based on the presence of vascular anomalies accompanying horseshoe kidneys in children, nutcracker syndrome findings were found in similar numbers in both groups.
We think that these children should be followed for a long time in terms of chronic kidney damage and vascular pathologies that may occur in adulthood.

Keywords

Horseshoe kidney, child, nutcracker syndrome, vascular anomalies, urological anomalies

Atnalı böbreği olan çocuklarda vasküler ve ürolojik anomaliler

Abstract

Amaç: Atnalı böbrek, konjenital sistemik ve ürolojik anomalilerin çoğu hastaya eşlik ettiği en yaygın füzyon anomalisidir. Bu çalışmada atnalı böbrek anomalisi bulunan çocuklarda eşlik eden ürolojik ve diğer sistemik anomaliler yanında vasküler anomaliler ve özellikle nutcracker sendromu ile birlikteliğinin araştırılması amaçlandı.
Gereç ve yöntem: Kliniğimizde atnalı böbrek tanısı alan 26 hasta ile aynı yaş ve cinsiyette 22 sağlıklı çocuk çalışmaya dahil edildi. Tüm çocuklar prospektif olarak renal arter ve renal ven akım hızları, lümen çapları ve vasküler anomaliler ve nutcracker sendromu varlığı açısından Doppler ultrasonografi ile değerlendirildi.
Bulgular: Atnalı böbrekli çocukların %50'sinde ürolojik anomali, %44'ünde sistemik anomali saptandı. Vasküler patolojileri ve nutcracker sendromunu saptamak için hastalarda yapılan Doppler ultrasonografik değerlendirmelerde; atnalı böbrek grubunda 2 hastada nutcracker sendromu bulguları mevcutken, kontrol grubunda 1 hastada saptandı. Atnalı böbrek anomalili bir olguda sol ana iliak arterden köken alan aksesuar renal arter ve bir olguda da sirkumaortik sol renal ven saptandı.
Sonuç: Atnalı böbrek anomalili çocuklara eşlik eden vasküler anomalilerin varlığından yola çıkarak nutcracker sendromunu araştırdığımız çalışmamızda, nutcracker sendromu bulguları her iki grupta da benzer sayıda bulundu. Bu çocukların erişkin dönemde ortaya çıkabilecek damar patolojileri ve gelişebilecek kronik böbrek hasarı açısından uzun süre takip edilmesi gerektiğini düşünmekteyiz.

Keywords

Atnalı böbrek, çocuk, nutcracker sendromu, vasküler anomaliler, ürolojik anomaliler

References

• 1. Je BK, Kim HK, Horn PS. Incidence and spectrum of renal complications and extrarenal diseases and syndromes in 380 children and young adults with horseshoe kidney. AJR 2015;205:1306-1314. https://doi.org/10.2214/AJR.15.14625
• 2. Pawar AS, Thongprayoon C, Cheungpasitporn W, Sakhuja A, Mao MA, Erickson SB. Incidence and characteristics of kidney stones in patients with horseshoe kidney: a systematic review and meta-analysis. Urol Ann 2018;10:87-93. https://doi.org/10.4103/UA.UA_76_17
• 3. Yavuz S, Kıyak A, Sander S. Renal outcome of children with horseshoe kidney: a single-center experience. Urology 2015;85:463-466. https://doi.org/10.1016/j.urology.2014.10.010
• 4. Boatman DL, Cornell SH, Kölln CP. The arterial supply of horseshoe kidneys. AJR 1971;113:447-451. https://doi.org/10.2214/ajr.113.3.447
• 5. Ekim M, Ozçakar ZB, Fitoz S, et al. The "nutcracker phenomenon" with orthostatic proteinuria: case reports. Clin Nephrol 2006;65:280-283. https://doi.org/10.5414/cnp65280
• 6. Schwartz GJ, Muñoz A, Schneider MF, et al. New equations to estimate GFR in children with CKD. J Am Soc Nephrol 2009;20:629-637. https://doi.org/10.1681/ASN.2008030287
• 7. Cameron MA, Sakhaee K, Moe OW. Nephrolithiasis in children. Pediatr Nephrol 2005;20:1587-1592. https://doi.org/10.1007/s00467-005-1883-z
• 8. Flynn JT, Kaelber DC, Baker Smith CM, et al. Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics 2017;140:e20171904. https://doi.org/10.1542/peds.2017-1904
• 9. Medical versus surgical treatment of primary vesicoureteral reflux: report of the International Reflux Study Committee. Pediatrics 1981;67:392-400.
• 10. Hangge PT, Gupta N, Khurana A, et al. Degree of left renal vein compression predicts nutcracker syndrome. J Clin Med 2018;7:107. Published 2018 May 8. https://doi.org/10.3390/jcm7050107
• 11. Strauss S, Dushnitsky T, Peer A, Manor H, Libson E, Lebensart PD. Sonographic features of horseshoe kidney: review of 34 patients. J Ultrasound Med 2000;19:27-31. https://doi.org/10.7863/jum.2000.19.1.27
• 12. Natsis K, Piagkou M, Skotsimara A, Protogerou V, Tsitouridis I, Skandalakis P. Horseshoe kidney: a review of anatomy and pathology. Surg Radiol Anat 2014;36:517-526. https://doi.org/10.1007/s00276-013-1229-7
• 13. Bulum B, Tekcan D, Genç G, O Özkaya. Urinary tract infections in children with horseshoe kidneys: a single-center with 5 years experience. J Pediatr Inf 2015;9:108-113. https://doi.org/10.5152/ced.2015.2032
• 14. Glenn JF. Analysis of 51 patients with horseshoe kidney. N Engl J Med 1959;261:684-687. https://doi.org/10.1056/NEJM195910012611402
• 15. Cascio S, Sweeney B, Granata C, Piaggio G, Jasonni V, Puri P. Vesicoureteral reflux and ureteropelvic junction obstruction in children with horseshoe kidney: treatment and outcome. J Urol 2002;167:2566-2568.
• 16. Weizer AZ, Silverstein AD, Auge BK, et al. Determining the incidence of horseshoe kidney from radiographic data at a single institution. J Urol 2003;170:1722-1726. https://doi.org/10.1097/01.ju.0000092537.96414.4a
• 17. Segura JW, Kelalis PP, Burke EC. Horseshoe kidney in children. J Urol 1972;108:333-336. https://doi.org/10.1016/s0022-5347(17)60732-8
• 18. O'Brien J, Buckley O, Doody O, Ward E, Persaud T, Torreggiani W. Imaging of horseshoe kidneys and their complications. J Med Imaging Radiat Oncol 2008;52:216-226. https://doi.org/10.1111/j.1440-1673.2008.01950.x
• 19. Koff SA, Mutabagani KH, Jayanthi VR. The valve bladder syndrome: pathophysiology and treatment with nocturnal bladder emptying. J Urol 2002;167:291-297. https://doi.org/10.1016/s0022-5347(05)65453-5
• 20. Limwongse C, Clarren SK, Cassidy SB. Syndromes and Malformations of the Urinary Tract. Pediatric nephrology. 5th ed. Berlin: Springer Berlin Heidelberg, 2004;121-122.
• 21. Evans WP, Resnick MI. Horseshoe kidney and urolithiasis. J Urol 1981;125:620-621. https://doi.org/10.1016/s0022-5347(17)55139-3
• 22. Lampel A, Hohenfellner M, Schultz Lampel D, Lazica M, Bohnen K, Thürof JW. Urolithiasis in horseshoe kidneys: therapeutic management. Urology 1996;47:182-186. https://doi.org/10.1016/s0090-4295(99)80412-9
• 23. Raj GV, Auge BK, Assimos D, Preminger GM. Metabolic abnormalities associated with renal calculi in patients with horseshoe kidneys. J Endourol 2004;18:157-161. https://doi.org/10.1089/089277904322959798
• 24. Andreoni C, Portis AJ, Clayman RV. Retrograde renal pelvic access sheath to facilitate flexible ureteroscopic lithotripsy for the treatment of urolithiasis in a horseshoe kidney. J Urol 2000;164:1290-1291.
• 25. Özbülbül NI, Parlak S. Üreteropelvik bileşke obstrüksiyonunun eşlik ettiği bir atnalı böbrek olgusunun bt ürografi ile tanısı. Fırat Tıp Dergisi. 2009;14:72-74.
• 26. Taghavi K, Kirkpatrick J, Mirjalili SA. The horseshoe kidney: surgical anatomy and embryology. J Pediatr Urol 2016;12:275-280. https://doi.org/10.1016/j.jpurol.2016.04.033
• 27. Davidović L, Marković M, Ilic N, et al. Repair of abdominal aortic aneurysms in the presence of the horseshoe kidney. Int Angiol 2011;30:534-540.
• 28. Kanda H, Kanai M, Araki T, Mori O. A case report: renal arteriovenous malformation associated with horseshoe kidney detected by hemorrhage due to injury. Hinyokika Kiyo 2003;49:325-328.
• 29. Gittes GK, Snyder CL, Murphy JP, Ashcraft KW. Inferior vena caval obstruction from a horseshoe kidney: report of a case with operative decompression. J Pediatr Surg 1998;33:764-765. https://doi.org/10.1016/s0022-3468(98)90213-5
• 30. Granata A, Distefano G, Sturiale A, et al. From nutcracker phenomenon to nutcracker syndrome: a pictorial review. Diagnostics 2021;11:101. https://doi.org/10.3390/diagnostics11010101
• 31. Granata A, Distefano G, Sturiale A, et al. From nutcracker phenomenon to nutcracker syndrome: a pictorial review. Diagnostics (Basel). 2021;11:101. https://doi.org/10.3390/diagnostics11010101
• 32. Sawicz Birkowska K, Apoznański W, Kantorowicz Szymik S, Urbanowicz W, Szydełko T. Malignant tumours in a horseshoe kidney in children: a diagnostic dilemma. Eur J Pediatr Surg 2005;15:48-52. https://doi.org/10.1055/s-2004-830552
• 33. Huang EY, Mascarenhas L, Mahour GH. Wilms' tumor and horseshoe kidneys: a case report and review of the literature. J Pediatr Surg 2004;39:207-212. https://doi.org/10.1016/j.jpedsurg.2003.10.019
• 34. Kapur VK, Sakalkale RP, Samuel KV, et al. Association of extrarenal Wilms' tumor with a horseshoe kidney. J Pediatr Surg 1998;33:935-937. https://doi.org/10.1016/s0022-3468(98)90678-9
• 35. Fazio L, Razvi H, Chin JL. Malignancy in horseshoe kidneys: review and discussion of surgical implications. Can J Urol 2003;10:1899-1904.
• 36. Hohenfellner M, Schultz Lampel D, Lampel A, Steinbach F, Cramer BM, Thüroff JW. Tumor in the horseshoe kidney: clinical implications and review of embryogenesis. J Urol 1992;147:1098-1102. https://doi.org/10.1016/s0022-5347(17)37486-4