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Shi SS, Yang XZ, Zhang XY, Guo HD, Wang WF, Zhang L, Wu P, Zhang W, Wen WB, Huo XL, Zhang YQ. Horseshoe kidney with PLA2R-positive membranous nephropathy. BMC Nephrol 2021; 22:277. [PMID: 34376183 PMCID: PMC8353813 DOI: 10.1186/s12882-021-02488-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 08/02/2021] [Indexed: 11/25/2022] Open
Abstract
Background Horseshoe kidney (HSK) is a common congenital defect of the urinary system. The most common complications are urinary tract infection, urinary stones, and hydronephrosis. HSK can be combined with glomerular diseases, but the diagnosis rate of renal biopsy is low due to structural abnormalities. There are only a few reports on HSK with glomerular disease. Here, we have reported a case of PLA2R-positive membranous nephropathy occurring in a patient with HSK. Case presentation After admission to the hospital due to oedema of both the lower extremities, the patient was diagnosed with nephrotic syndrome due to abnormal 24-h urine protein (7540 mg) and blood albumin (25 g/L) levels. Abdominal ultrasonography revealed HSK. The patient’s brother had a history of end-stage renal disease due to nephrotic syndrome. Therefore, the patient was diagnosed with PLA2R-positive stage II membranous nephropathy through renal biopsy under abdominal ultrasonography guidance. He was administered adequate prednisone and cyclophosphamide, and after 6 months of treatment, urinary protein excretion levels significantly decreased. Conclusion The risk and difficulty of renal biopsy in patients with HSK are increased due to structural abnormalities; however, renal biopsy can be accomplished through precise positioning with abdominal ultrasonography. In the literature, 20 cases of HSK with glomerular disease have been reported thus far. Because of the small number of cases, estimating the incidence rate of glomerular diseases in HSK is impossible, and the correlation between HSK and renal pathology cannot be stated. Further studies should be conducted and cases should be accumulated to elucidate this phenomenon.
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Affiliation(s)
- Shuai-Shuai Shi
- Department of Nephrology, Heji Hospital of Changzhi Medical College, Changzhi, 046011, Shanxi, China
| | - Xian-Zu Yang
- Graduate School of Changzhi Medical College, Changzhi, 046000, Shanxi, China
| | - Xiao-Ye Zhang
- Graduate School of Changzhi Medical College, Changzhi, 046000, Shanxi, China
| | - Hui-Dan Guo
- Department of Nephrology, Heji Hospital of Changzhi Medical College, Changzhi, 046011, Shanxi, China
| | - Wen-Feng Wang
- Department of Jin Yu Renal pathology center, Taiyuan, 030000, Shanxi, China
| | - Li Zhang
- Department of Nephrology, Heji Hospital of Changzhi Medical College, Changzhi, 046011, Shanxi, China
| | - Peng Wu
- Department of Imaging, Heji Hospital of Changzhi Medical College, Changzhi, 046011, Shanxi, China
| | - Wei Zhang
- Department of Nephrology, Heji Hospital of Changzhi Medical College, Changzhi, 046011, Shanxi, China
| | - Wen-Bin Wen
- Department of Nephrology, Heji Hospital of Changzhi Medical College, Changzhi, 046011, Shanxi, China
| | - Xiao-Lei Huo
- Department of Histology and Embryology, Changzhi Medical College, Changzhi, 046000, Shanxi, China
| | - Yi-Qiang Zhang
- Department of Biochemistry, Changzhi Medical College, Shanxi, Changzhi, 046000, People's Republic of China.
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Chaabouni Y, Guesmi R, Hentati Y, Kammoun K, Hmida MB, Mnif Z, Boudawara T, Hachicha J. Minimal change disease in horseshoe kidney. Pan Afr Med J 2017; 26:243. [PMID: 28690757 PMCID: PMC5491730 DOI: 10.11604/pamj.2017.26.243.11438] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 02/18/2017] [Indexed: 11/23/2022] Open
Abstract
The horseshoe kidney is a frequent urological birth defect. The most frequent complications are urinary tract infections, stones and hydronephrosis. The occurrence of glomerular disease in horseshoe kidney is rare. Therefore, we report the first case of minimal change disease occurring in a patient with horseshoe kidney in literature. A 22-year-old Caucasian man without personal or family medical history admitted to the pneumology department for a pulmonary artery embolism. In presence of a generalized oedema, a biological assessment was performed yielding intense nephrotic syndrome with urine protein excretion 22g/day. The abdominal ultrasound revealed a horseshoe kidney. Hence a scanno-guided kidney biopsy was taken yielding minimal change disease. High dose steroids were started, then gradually tapered with good response. Horseshoe kidney is the most common renal fusion anomaly, with a prevalence of 0.25% among the general population. The occurrence of glomerular nephropathy in horseshoe kidney has been reported in few cases. We report the first case of minimal change disease occurring in a patient with horseshoe kidney in literature. The mechanism of the association between the horseshoe kidney and these renal pathologies could not be explained in the previous reports. There is no literature data indicating a high rate of glomerulonephritis in horseshoe kidneys. The co-incidence of two renal diseases in this patient can be only a coincidence. The question that arises is whether this glomerulopathy is associated or not with this anatomical abnormality. Further studies are needed to answer this question.
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Affiliation(s)
- Yosr Chaabouni
- Department of Nephrology, Hedi Chaker Hospital, Sfax Tunisia.,UR12ES14, Faculty of Medicine, Sfax Tunisia
| | - Rahma Guesmi
- Department of Nephrology, Hedi Chaker Hospital, Sfax Tunisia
| | - Yosr Hentati
- Department of Radiology, Hedi Chaker Hospital, Sfax, Tunisia
| | - Khaoula Kammoun
- Department of Nephrology, Hedi Chaker Hospital, Sfax Tunisia
| | | | - Zeineb Mnif
- Department of Radiology, Hedi Chaker Hospital, Sfax, Tunisia
| | - Tahya Boudawara
- Department of Anatomopathology, Habib Bourguiba Hospital, Sfax, Tunisia
| | - Jamil Hachicha
- Department of Nephrology, Hedi Chaker Hospital, Sfax Tunisia.,UR12ES14, Faculty of Medicine, Sfax Tunisia
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Hu P, Jin M, Xie Y, Chen P, Zhang X, Yin Z, Cai G, Chen X. Immunoglobulin A nephropathy in horseshoe kidney: case reports and literature review. Nephrology (Carlton) 2015; 19:605-9. [PMID: 25142750 DOI: 10.1111/nep.12328] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2014] [Indexed: 11/30/2022]
Abstract
Horseshoe kidney is the most common congenital renal fusion anomaly. Immunoglobulin A nephropathy is a common glomerulonephritis worldwide. However, the co-occurrence of these diseases had not been reported in the literature. We report the first two cases with the occurrence of immunoglobulin A nephropathy in horseshoe kidney. The first case was a 26-year-old male with hypertension and proteinuria (1.4 g/24 h), his pathological finding was primary immunoglobulin A nephropathy. The second case was a 15-year-old female who presented with recurrent peliosis on bilateral lower extremities, haematuria and proteinuria (1.7 g/24 h). Her renal biopsy finding was Henoch-Schonlein purpura nephritis (secondary immunoglobulin A nephropathy). In both cases, renal biopsy was performed by experienced doctors under ultrasonic guidance at the renal upper pole and no postoperative complications were observed. After they were treated based on the renal pathological findings for 6 months, urine protein excretion decreased significantly and blood pressure and serum creatinine stabilized. It is possible that immunoglobulin A nephropathy occurs in a horseshoe kidney patient. Renal biopsy may be valuable and viable for horseshoe kidney patients with heavy proteinuria to identify pathologic type of glomerulopathy and to guide treatment, if renal biopsy is performed by experienced doctors at the renal upper pole under renal ultrasonic guidance.
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Affiliation(s)
- Panpan Hu
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing, China; Department of Nephrology, Cival Aviation General Hospital, Beijing, China
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Guaragna MS, Lutaif ACGDB, Bittencourt VB, Piveta CSC, Soardi FC, Castro LCG, Belangero VMS, Maciel-Guerra AT, Guerra-Junior G, Mello MPD. Frasier syndrome: four new cases with unusual presentations. ACTA ACUST UNITED AC 2013; 56:525-32. [PMID: 23295293 DOI: 10.1590/s0004-27302012000800011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Accepted: 09/20/2012] [Indexed: 11/22/2022]
Abstract
Frasier syndrome (FS) is characterized by gonadal dysgenesis and nephropathy. It is caused by specific mutations in the Wilms' tumor suppressor gene (WT1) located in 11p23. Patients with the 46,XY karyotype present normal female genitalia with streak gonads, and have higher risk of gonadal tumor, mainly, gonadoblastoma. Therefore, elective bilateral gonadectomy is indicated. Nephropathy in FS consists in nephrotic syndrome (NS) with proteinuria that begins early in childhood and progressively increases with age, mainly due to nonspecific focal and segmental glomerular sclerosis (FSGS). Patients are generally unresponsive to steroid and immunosuppressive therapies, and will develop end-stage renal failure (ESRF) during the second or third decade of life. We report here four cases of FS diagnosis after identification of WT1 mutations. Case 1 was part of a large cohort of patients diagnosed with steroid-resistant nephrotic syndrome, in whom the screening for mutations within WT1 8-9 hotspot fragment identified the IVS9+5G>A mutation. Beside FS, this patient showed unusual characteristics, such as urinary malformation (horseshoe kidney), and bilateral dysgerminoma. Cases 2 and 3, also bearing the IVS9+5G>A mutation, and case 4, with IVS9+1G>A mutation, were studied due to FSGS and/or delayed puberty; additionally, patients 2 and 4 developed bilateral gonadal tumors. Since the great majority of FS patients have normal female external genitalia, sex reversal is not suspected before they present delayed puberty and/or primary amenorrhea. Therefore, molecular screening of WT1 gene is very important to confirm the FS diagnosis.
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Affiliation(s)
- Mara Sanches Guaragna
- Centro de Biologia Molecular e Engenharia Genética, Universidade Estadual de Campinas, Campinas, SP, Brazil
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