Horseshoe kidney
Introduction
Introduction of the shoe kidney The hoof-shaped kidney is also a common congenital malformation. One case can be seen in every 500-1000 autopsy, male or female, about 4:1. It can be found at any age, and about half of it occurs in 30-40 years old. between. basic knowledge The proportion of illness: congenital dysplasia, the incidence rate is about 0.003% - 0.01% Susceptible people: no specific population Mode of infection: non-infectious Complications: hydronephrosis
Cause
Hoof kidney disease
Congenital factors (60%):
The hoof-shaped kidney is the lower part of the kidney (more than 90% of the lower pole) is formed in the midline of the body to form a hoof-shaped shape. The general scholar believes that the shape of the kidney is abnormal, which is the kidney-forming tissue cells of the kidneys in the early stage of the embryo. As a result of the fusion between the two umbilical arteries, the fusion part is mostly at the lower pole, forming the isthmus. The isthmus is composed of renal parenchyma (more or less) and connective tissue, and is located before the abdominal aorta and inferior vena cava. On the bifurcation, the two kidneys cannot rotate normally due to the limitation of the lower pole fusion, so that the kidney vertebral angle is just opposite to normal. The renal artery can come from the radial artery, from the abdominal aortic bifurcation, or from the inferior mesenteric artery. The ureter is shorter than the normal ureter and descends to the bladder before the isthmus.
The incidence of horseshoe-shaped kidney is very low, about 1 in 400 newborns, and the incidence of males in the normal population is about 0.5%. The ratio of male to female is 2:1 in clinical age, but in It is more common in children during autopsy. Mainly due to the congenital anomalies of horseshoe kidney patients combined with other systems, some of which are prone to early death. There is insufficient evidence for the familial inheritance of horseshoe kidneys.
Prevention
Hoof kidney prevention
1, control diet structure, reasonable diet. With the vigorous development of the social economy, people's living standards have improved, the supply of food is very rich, and a series of diseases caused by excessive nutrition or high-fat foods caused by unreasonable diets, such as hyperuricemia and hyperlipidemia, are common. Obesity, etc., almost always damage the kidneys, leading to chronic kidney damage. Therefore, diet should be a reasonable diet, low salt, low fat, low sugar, eat more foods rich in plant organic active alkali, eat less meat, eat more vegetables.
2, the right amount of water does not urinate. Drink plenty of water every day to urinate at any time, and the urinary system is not susceptible to stones. People who drink less water and have less urinary excretion often have inflammation of the urinary tract. The habit of urinating is very unfavorable to the kidneys, because urine often stays in the bladder for a long time, which is easy to cause bacterial growth; bladder pressure increases, and urine reflux causes bacteria to infect the kidneys through the bladder and ureters, causing pyelonephritis.
3. Pay attention to the urine. For example, foamy urine that does not disappear for a long time is a manifestation of proteinuria; white turbid urine is a manifestation of inflammation of the urinary tract and a large amount of phosphate excretion; urinary burning, urinary frequency and urgency can be determined to be urinary tract infections. Early observation can be detected early by observing urine.
Complication
Hoof kidney complications Complications hydronephrosis
Horseshoe kidney is easy to cause complications such as hydronephrosis and infection. During pregnancy, the uterus compresses the ureter, which is more likely to cause impaired renal function.
Symptom
Hoof-shaped kidney symptoms Common symptoms Abdominal pain Left and right lumbar abdominal pain, poor urination, nausea and vomiting
The most common clinical manifestations of hoof-shaped kidneys are three types: the first is the umbilical pain mass. The second is the symptoms of gastrointestinal disorders, such as abdominal pain and constipation. The third category is complications of the urinary system, such as infection, stagnant water, stones, and the like. Most cases are found during surgery or misdiagnosed as other diseases of the abdomen such as appendicitis, pancreatitis, and duodenal ulcer.
Examine
Hoof kidney examination
The diagnosis of the disease was confirmed by pyelography. On the pyelogram, the angle between the longitudinal axis of the kidney and the spine (the kidney vertebral angle) was shown downward, rather than as normal, sometimes on the venography, due to one side of the kidney. If the poor or technical conditions are not developed, the developer is mistaken for renal insufficiency, and this should be noted when considering the diagnosis.
Imaging examination is the most important basis for determining the diagnosis. It has the following characteristics: the position of the kidneys is low; the axial direction of the kidney is changed from the normal inner upper to the lower and the outer to the inner or the lower, and the vertical axis of the two kidneys is formed. The angle from the acute angle to the obtuse angle; the renal pelvis is facing forward, the renal pelvis is backward, the lower pole renal pelvis is inward and located inside the ureter, which is characterized by the ureteral approach; the isthmus connects the two kidneys together, especially when CT examination The susceptibility of tumors in the isthmus of the hoof-shaped kidney is increased, which may also be related to embryonic factors. Renal cell carcinoma accounts for about 50% of the tumors of the hoof-shaped kidney.
[Image performance]
1. Urinary tract plain film and angiography: according to the kidney shadows on both sides close to the spine and low position, the long axis is parallel or the upper pole is inclined outward and the lower pole is close inward to suspect the horseshoe kidney, sometimes the connected isthmus profile. Urography can be clearly diagnosed. The most obvious sign is that the lower pelvis is pointing to the midline. The upper end of the long axis of the kidney and kidney pelvis has an inverted "eight" shape inward and the ureter is close to the midline.
2. B-ultrasound: It can be clearly shown that the lower poles of the two kidneys are connected, crossing the inferior vena cava and the front of the abdominal aorta.
3. CT: It can directly show the fusion of the two kidneys, that is, the isthmus crossing the front of the aorta, and due to poor kidney rotation, the renal pelvis is located in front of the kidney, and the ureter crosses the front side of the isthmus. However, the position of the horseshoe kidney is generally low, and it is necessary to scan to a lower position to determine the diagnosis.
4. MR and nuclides can also show the fusion of the two kidneys from the coronal position.
Diagnosis
Hoof-shaped kidney diagnosis
Imaging examination is the most important basis for determining the diagnosis.
Differential diagnosis
1. The disc-shaped kidney is a fusion of the poles or the medial side of the two kidneys, which can produce similar symptoms, but it is located in the anterior or pelvis, with a nodular surface and a blunt and irregular lumps of the edge: urography The shadow is disc-shaped, the renal pelvis and renal pelvis are poorly rotated, and the ureteral path is abnormal. Ultrasonography and radionuclide kidney scan are two kinds of deformed images of disc-shaped fusion.
2. Block kidney (cake-like kidney) may also have low back pain, abdominal mass and gastrointestinal symptoms, but in the middle of the lower abdomen or pelvis touched a cake-like mass, substantive, surface nodular, blunt edge; urinary tract angiography shows two kidneys Blended into a circular shadow. The position is low, the shape of the renal pelvis and renal pelvis is irregular, and the ureter becomes short; the ultrasonography and radionuclide kidney scan are deformed images of the two kidneys in a block-like fusion.
3. The sigmoid kidney is a fusion of the upper renal pole and the contralateral renal pole. The abdomen touches the mass and is easily confused with it. However, the urography is kidney-shaped, the two kidneys are parallel, the renal pelvis is abnormal, and the renal pelvis is abnormal. Fullness; retroperitoneal angiography with two kidney fusion in a zigzag shape; ultrasound examination and radionuclide kidney scan two kidneys in a B-shaped fusion of deformed images.
4. Abdominal tumors can touch the abdominal mass, but often have abdominal pain, abdominal distension and other manifestations of digestive tract obstruction; digestive tract barium meal X-ray examination shows intestinal compression deformation or filling defects; urography pyelonephritis renal morphological normal; combined with medical history can be identified.
5. Idiopathic retroperitoneal fibrosis : the lower abdomen can touch the unclear edge, hard texture of the mass, but often accompanied by low heat, erythrocyte sedimentation rate and other systemic symptoms; urography confirms the disappearance of the psoas muscle, the renal pelvis and renal dilatation The ureter is displaced to the midline.
