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Infant has horseshoe kidney. Mild dilation of left pelvicalyceal system. Left kidney fused to right renal tissue. Worry?

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We have a beautiful 6 month old baby girl who was born with a horseshoe kidney. The U/S at birth indicated that the left left kidney measured 4.7cm and the right 2.9cm. There was mild dilation of the left pelvicalyceal system.

We have just returned from our 6 month U/S checkup on the kidney. The left kidney is now "7cm with good maintenance of the cortical thickness, though there is marked dilation of the left pelvicalyceal system (moderate). The lower pole of the left kidney is fused to the right renal tissue, which is lying slightly more inferiorly and crossing midline."

The right kidney is 3.2cm in length, with no obvious pevicalyceal dilation.

Should we be worried about this? The pead appointment is not for 2 weeks and we would like to peace of mind, or at least know where we stand.

Many Thanks XXXXXXX
Posted Tue, 22 May 2012 in Child Health
Answered by Dr. Taher Kagalwala 1 hour later

Thank you for choosing XXXXXXX as your destination for addressing your medical queries.

First of all, I am glad that you are on top of the situation in connection with the congenital problem that your precious baby is having. In many cases, congenital problems are silent and even undetected throughout life! Most of the times, problems such as horseshoe kidneys are picked up on careful ultrasound examinations done during pregnancy as in your case.

Dilatation of the outflow systems in normal kidneys often revert to normal over the next few months, and may cause undue alarm among caregivers. However, they do indicate some form of obstruction to the flow of urine, and once the kidney starts enlarging in size, they indicate the probable permanent nature of the obstruction unless the problem is correctly located and taken care of.

In the case of your baby, dilatation has occurred in one of the two kidneys, but this being a horseshoe kidney, the problem is as if the one organ is abnormal. I have a feeling that at your next appointment, the doctor may suggest going in for a renal scan or urogram to detect the level of obstruction. Most cases, the obstruction is "dynamic", which means there is no stone or any physical obstruction, but a spasm of the muscle of the ureter at the point where the pelvis of the kidney meets the calyceal system or where the calyceal system meets the start of the ureter. In Horseshoe kidneys, there may even be a physical obstruction.

In either case, the earlier the obstruction is diagnosed and relieved, the better the chance for ultimate recovery of the organ. I am unable to completely assure you of a 100% excellent outcome, but can tell you that as the other kidney is normal, it might all turn out well at the end, since humans can do well with just one functioning kidney.

At best, your doctors are able to relieve the obstruction and save the kidneys; at worst, there is a slim but real chance that some time in life, the child may have to get the abnormal kidney removed to avoid the complications which may occur ... for example, hypertension, infection, etc.

With best wishes for a favorable outcome.

- Dr. Taher
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