Division of Pediatric Nephrology, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey.
Division of Pediatric Nephrology, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey.
Urology. 2015 Feb;85(2):463-6. doi: 10.1016/j.urology.2014.10.010.
To assess the clinical features, additional abnormalities, and renal consequences of children with horseshoe kidney (HSK).
The medical records of 41 children with HSK followed in our pediatric nephrology clinic between the years of 2004 and 2014 were retrospectively reviewed.
There were 22 girls (53.6%) and 19 boys (46.4%) aged 60 (2-192) months. The median follow-up time was 48 (12-120) months. HSK was incidentally found in 12 patients (29.3%), and 5 patients (12.2%) were prenatally diagnosed. Urinary tract abnormalities including vesicoureteral reflux (n = 8), ureteropelvic junction obstruction (n = 7), and duplex system (n = 3) were identified in 18 patients (43.9%). Eight children (19.5%) had bladder dysfunction, and 9 patients (21.9%) had additional systemic abnormalities. Urinary tract infection had been detected in 17 patients (41.4%). Seven patients (17%) required surgical intervention including pyeloplasty (n = 3), ureteroneocystostomy (n = 3), and upper pole heminephrectomy (n = 1). Renal scarring (RS) occurred in 10 patients (24.4%). Six patients (14.6%) developed proteinuria and 4 (9.8%) complicated with hypertension. Three patients (7.3%) progressed to chronic kidney disease (CKD). Multivariate logistic regression analysis showed that proteinuria, hypertension, and RS are independently associated with CKD.
Children with HSK might be examined for additional urologic and nonurologic abnormalities. Patients might be closely followed up for the increased risk of urinary tract infection and RS. Proteinuria, hypertension, and presence of RS seem to be the major determinants for progression to CKD in children with HSK.
评估马蹄肾（HSK）患儿的临床特征、其他异常及肾脏后果。
回顾性分析 2004 年至 2014 年期间在我院儿科肾病门诊就诊的 41 例 HSK 患儿的病历资料。
患儿中女孩 22 例（53.6%），男孩 19 例（46.4%），年龄 2-192 个月，中位数随访时间 48（12-120）个月。12 例（29.3%）患儿为偶然发现，5 例（12.2%）患儿为产前诊断。18 例（43.9%）患儿存在尿路异常，包括肾盂输尿管反流（n=8）、肾盂输尿管连接部梗阻（n=7）和双肾盂双输尿管（n=3）。8 例（19.5%）患儿存在膀胱功能障碍，9 例（21.9%）患儿存在其他系统异常。17 例（41.4%）患儿发生过尿路感染。7 例（17%）患儿接受了手术干预，包括肾盂成形术（n=3）、输尿管膀胱再植术（n=3）和上极半肾切除术（n=1）。10 例（24.4%）患儿出现肾瘢痕。6 例（14.6%）患儿出现蛋白尿，4 例（9.8%）患儿并发高血压。3 例（7.3%）患儿进展为慢性肾脏病（CKD）。多因素 logistic 回归分析显示，蛋白尿、高血压和肾瘢痕与 CKD 独立相关。
HSK 患儿可能存在其他泌尿系统和非泌尿系统异常，需要进行检查。患儿尿路感染和肾瘢痕风险增加，需要密切随访。蛋白尿、高血压和肾瘢痕的存在似乎是 HSK 患儿进展为 CKD 的主要决定因素。
