Horseshoe kidney transplantation

Laparoscopic Living-Donor Nephrectomy of a Horseshoe Kidney: A Case Report and Review of the Literature

We present the case of a living-donor nephrectomy of a horseshoe kidney. The recipient was a 33-year-old male with a history of end-stage renal disease secondary to IgA nephropathy. The donor was his 33-year-old partner who on preoperative cross-sectional imaging was found to have a horseshoe kidney with a single artery, vein and ureter. The donor operation was performed using a laparoscopic hand-assisted technique with transection of the interpolar fibrotic band using a stapler device. The backtable organ preparation was performed in a standard fashion with addition of a reinforcing hemostatic suture of the stapled fibrotic band. The donated kidney was transplanted extraperitoneally in the right iliac fossa of the recipient. The patient had an unremarkable postoperative course and was discharged home on post operative day 2 with normalizing renal function. To our knowledge, this is the first living donor nephrectomy of a horseshoe kidney performed using a laparoscopic hand-assisted technique.

En Bloc Transplantation of Horseshoe Kidney from Deceased Donor: An Unusual Transplantation Utilizing Kidneys with Congenital Fusion Abnormality

Transplanting horseshoe kidneys is challenging and has higher complication rates due to the unusual anatomy of the vascular and urinary collecting systems. Most centers avoid using these kidneys for transplantation. However, if chosen carefully, these organs can be used successfully to reduce organ shortage. In this paper, we will describe the technique of procurement of horseshoe kidneys from cadaveric donors, back table preparation, and its successful implantation in a recipient. With good planning and skillful surgical techniques, horseshoe kidneys can be successfully transplanted in suitable recipients. If properly selected, these kidneys can be used to reduce the organ scarcity and diminish waitlist morbidity and mortality.

Creation of a Ureterocystostomy in a Transplanted Cadaveric Kidney with the Use of a Radiofrequency Guide Wire

A duplicated collecting system (DCS) is a common anatomical variant of the kidney. As surgeons now perform more donor cadaveric transplants than in the past, the discovery of an occluded DCS may occur in the post-transplant setting. Over a dozen articles have reported on the use of DCS in the renal transplant setting. However, to our knowledge, this case report is the first to describe the creation of a ureterocystostomy with the use of a radiofrequency (RF) guide wire, involving a previously unidentified DCS in a transplanted kidney.

Origin and Function of the Renal Stroma in Health and Disease

The renal stroma is defined as a heterogeneous population of cells that serve both as a supportive framework and as a source of specialized cells in the renal capsule, glomerulus, vasculature, and interstitium. In this chapter, we review published evidence defining what, where, and why stromal cells are important. We describe the functions of the renal stroma andhow stromal derivatives are crucial for normal kidney function. Next, we review the specification of stromal cells from the Osr1+ intermediate mesoderm and T+ presomitic mesoderm during embryogenesis and stromal cell differentiation. We focus on stromal signaling mechanisms that act in both a cell and non-cell autonomous manner in communication with the nephron progenitor and ureteric lineages. To conclude, stromal cells and the contribution of stromal cells to renal fibrosis and chronic kidney disease are described.