Abstract

Introduction

Horseshoe kidney is the most common type of renal fusion anomaly and mostly occurs at the lower poles, also collecting system and ureters generally protected. We aimed to share our experience about a case of horseshoe kidney with upper pole fusion accompanied with spinal deformity, neurogenic bladder and vesicoureteral reflux (VUR).

Case

Six month girl who had undergone meningomyelocele operation and ventriculoperitoneal shunt insertion, was referred to the pediatric nephrology clinic for urological examination. She was treated due to the uriner system infection. In physical examination she had scoliosis and an incision scar on the lumbosacral region. Ultrasonographic (US) examination of both kidneys was normal. Voidingcystourethrography was performed due to urinary tract infection and possible bladder problems; showed bilateral grade III VUR. Urodynamic evaluation consisted with flask neurogenic bladder. DMSA scan determined upper pole renal fusion with normal parenchyma so patient diagnosed with reverse horseshoe kidney. Prophylaxis and clean intermittent bladder catheter were initiated. In 11 months of follow-up patient had been treated for febrile urinary tract infection at once.

Conclusion

Ultrasonography is a non-invasive, radiation-free method to diagnose horseshoe kidneys, in case anatomical deformity such as scoliosis could be created difficult with US. Among these, scintigraphic examination could have an importance. We advocated that clinicians should be eager to make further investigation in clinical suspicion.