Horse Shoe Kidney: a case report and review of its embryological, clinical and radiological significance

Horse shoe kidney (HSK) is the most common fusion a nomaly of the kidney. Nearly one third of patients with HSK have other associated anomalies. A 49 year old male presented with of bilateral loin pain on and off for the past 3 months. The pain was insidious in onset, dull aching, intermittent and non radiating. On examination he was febrile with leukocytosis and neutrophilia. Ultrasound of abdomen revealed a horse shoe kidney with stones in both renal pelvis. Intravenous Urogram (IVU) confirmed the findings of horse shoe kidney with bilateral grade III hydronephrosis and renal pelvic calculi. Patient subsequently was advised bilateral percutaneous nephrolithotomy. This manuscript reviews the embryological basis of development of HSK, the diagnostic dilemma that the radiologists would encounter in making a diagnosis and the interventional challenges that the urologists would face in treating such patients with complications of HSK. Many a time, the diagnosis is made incidentally at routine imaging. A thorough knowledge of the embryological background and preoperative imaging helps the clinicians in planning surgery as radiologists and urologists might sometimes face a diagnostic or an decision making challenges while treating such patients. This case report is presented to high light the anatomical, embryological and clinical, significance of such congenital anomalies of kidneys which will be extremely important for the clinicians and urologists to plan the appropriate modality of treatment.