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Horseshoe Kidney

By rcarlson7 Oct 21, 2013 1792 Words
Horseshoe Kidney

The human body is a wonderful thing. It's not everyday that one takes a second to ponder about all of the wonderful things the human body can do. The brain helps us to be the most intelligent beings on earth. Our hearts beat to keep us alive. What about the kidneys? People typically do not think about what they do for us or consider them one of the human's most amazing organs. What if humans only had one kidney? Would there be any disadvantages compared to the typical human with two kidneys? First, it is important to understand what the kidneys are and what they do. The typical human has two bean-shaped kidneys located near the middle of the back, on each side of the spine. They are about the size of the average human fist or about five inches long and three inches wide. The kidney’s job is to examine and clean our blood. First the renal artery sends the blood to the kidneys. Then the kidneys examine the blood to search for excess water and other waste. The waste typically found in the blood gets there either after chemical reactions take place in the blood to break down nutrients or from the breakdown of body tissues. The kidneys also filter out any surpluses of nutrients in the blood. They can filter out two quarts of the waste listed above, as well as water, after filtering a total of roughly 200 quarts in a day. The kidneys are able to filter the waste out by using over one million microscopic fibers called nephrons. After the filtration process is completed, the water and waste combine together to create urine and is sent to the bladder through the ureter where it sits until it is time to be removed from the body. The kidneys do a few other important things. For one, they keep homeostasis in the body. Homeostasis is the balance of the volume of fluids and minerals in the body. The kidneys also create a few hormones. They create calcitriol which helps to keep a chemical balance in the body as well as supply bones with calcium. They also create rennin, a hormone that helps to regulate blood pressure. Finally, they create erythropoietin which sparks the creation of red blood cells. Horseshoe kidney is a term used to describe a case where the two kidneys fuse together in the womb. It gets its name because of the fact that its midline is just about parallel to the spine with each kidney lying on either side to resemble a horseshoe. Horseshoe kidney is the most common renal fusion anomaly and occurs in about one in every four hundred people. They fuse together when the embryo is between five and twelve millimeters long. They are believed to join together after the spine and pelvic organs grow too large too quickly and keep the two kidneys in contact for a longer time period than normal. During this time the kidneys are lower and closer to the pelvis. Because of the abnormal formation, the isthmus, or connected point of the lower poles of the kidneys, never rise and rotate like a normal kidney would and stay lower along the spine than kidneys usually are. Doctors have not yet been able to figure out why horseshoe kidney occurs in some people but not others. However, they have found kidney mutations tend to run in the family and may have something to do with the genetics of a person. Many people do not realize that they have a horseshoe kidney until later in their life when they start to encounter problems. About one third of people with a horseshoe kidney don’t realize that they even have one until it is recognized in a test later in life for other complications. The most common tests that find them for the first time are renal ultrasounds or IVU’s (intravascular ultrasound). IVU’s are usually taken after a patient has a reoccurring urinary tract infection problem. An IVU uses high frequency waves to create internal images of organs. A voiding cystourethrogram or VCUG may also be used to get a better look at a UTI or other problem with the urinary tract. This test involves using a catheter to dye the bladder. Horseshoe kidney can be diagnosed from this when there is a reverse flow or urine. Very similar to a VCUG, an IVP uses dye to show the organs involved in the urinary tract and show the flow or urine. Radiographs taken for other purposes may also show the outline of the joined kidneys. If someone does notice some symptoms there are many tests that can identify a horseshoe kidney more efficiently. Most cases can be identified with a CT or MRI imagining method. These can best show the kidney in relation to other organs. All of the methods used to look at the urinary tract system are also used after a horseshoe kidney is suspected. The doctors use those methods but focus more on the kidney than the rest of the urinary tract. To do this they may add more dye closer to the kidney. Finally, blood and urine tests can be used after a horseshoe kidney is suspected because doctors can recognize certain characteristics in the blood or urine that goes hand in hand with a horseshoe kidney.

The symptoms of horseshoe kidney vary greatly. About a third of people with horseshoe kidney don’t have any symptoms. They may only realize that they have one after testing is done for other purposes, testing is done during birth, or testing done because another family member has been found to have some sort of kidney mutation. The rest of the population with a horseshoe kidney notices symptoms. The main things that lead to these problems happening are variable blood supply, a midline isthmus joining the two kidneys into one, and the abnormal insertion point of the ureters into the kidney. Some of the less threatening symptoms include nausea, abdominal discomfort, and hydronephrosis, an enlargement of the kidney due to some sort of blockage. High blood pressure also occurs more frequently due to the variable blood supply and can eventually become threatening. Many others can be more threatening. Pelvureteric obstruction is the most common symptom occurring in about thirty-five percent of people with horseshoe kidney. This is most likely caused due to the high insertion point of the ureters into the kidney. Because of this, delayed pelvic emptying occurs. This can cause an increase in urine flow and also dilation of the kidneys or hydronephrosis. Another major problem occurring in anywhere between twenty and sixty percent of patients is kidney stones. A kidney stone is a calyce formed in the kidney that usually comes from the infection associated with a dilated kidney. Usually there are many kidney stones that continue to reoccur. They can cause blockage and extreme pain. Kidney stones require surgery to get rid of. The kidney stones are also a leading cause of infections that can be deadly. One of the most common infections, VUR, occurs in up to fifty percent of patients. This infection requires a mixture of saline to be inserted into the bladder and up into the kidneys. Other serious symptoms are tumors. Horseshoe kidneys are prone to both benign, non cancerous, and malignant, cancerous, tumors. The most common type of cancer is renal cell carcinoma, making up forty-five percent of tumors. This cancer is thought to be caused by kidney stones, infections, and blockages. Finally, because horseshoe kidneys tend to be lower in the back, they tend to be more vulnerable due to them having less protection. Because they are at risk of being damaged more easily, doctors will often refuse to sign papers to allow children to play certain sports. Sports they are usually not allowed to play include football, hockey, lacrosse, and other physical sports sometimes even including soccer and baseball. Kidney guards are often required for sports that have any possibilities of contact.

There is nothing a doctor can do to prevent someone from having a horseshoe kidney. However, there are many things they can do to help. One simple thing someone can do to keep their kidney healthy is drink cranberry juice. Cranberries have special qualities that can help fight bacteria in the urinary tract. If that isn’t quite enough and symptoms do occur, many of them can be dealt with through surgery or medications. However, even after these symptoms are dealt with they may continue to come back. Unfortunately, there is not much a doctor can do about this. In extreme cases, doctors can remove a kidney that is prone to infections, cancers, or is not working, and replace it with a new one. This is commonly known as a kidney transplant. During the time that the body does not have a working kidney, dialysis is performed. Dialysis cleans your blood just like a normal kidney would. There are two different kinds of dialysis, hemodialysis and peritoneal dialysis. Hemodialysis uses a machine to clean your blood. This is painful but tends to be the most efficient way. Peritoneal dialysis uses part of the lining in your abdomen to filter your blood. While on dialysis a doctor will usually prohibit you from drinking or eating various foods. Overall, a horseshoe kidney can function as well as two normal kidneys, they are just prone to some certain problems. After nineteen years the only problems I have encountered with my horseshoe kidney are slightly high blood pressure and not being able to play certain sports. These are definite problems, but are manageable. I have been with the same doctor my whole life because he knows a lot about horseshoe kidneys and knows my history with my high blood pressure. After many blood tests and heart monitoring sessions, my high blood pressure proves to be non-threatening for now. However, I do have to monitor it a few times a week, just to be safe. Hopefully in the future, doctors will discover how to better treat patients with a horseshoe kidney and recognize the risks earlier on. Improvement in treatments for horseshoe related kidney problems will also help. For now, I will make sure to drink my cranberry juice, and hope for the best. Works Cited

Chevalier, Robert L. "When is One Kidney Not enough?" Kidney international 76.5 (2009): 475-7. Web. D'Amato, Elena, et al. Horseshoe Kidney Malformation in Turner Syndrome is Not Associated with HNF-1β Gene Mutations. 23 Vol. Springer Science & Business Media B.V, 2008. Web. O'Brien, J., et al. "Imaging of Horseshoe Kidneys and their Complications." Journal of Medical Imaging & Radiation Oncology 52.3 (2008): 216-26. Web. Lucile Packard Children’s Hospital. “Horseshoe Kidney.” Lucile Packard Children’s Hospital at Stanford. 11/26/2010.

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