Navigating a Rare Renal Condition: Managing a Tumor in a Horseshoe Kidney By Dr. Mohan Keshavamurthy

Horseshoe kidney, a rare congenital anomaly occurring in approximately 1 in 500 individuals, presents unique challenges when dealing with renal masses. The anatomical variation can complicate both diagnosis and surgical management. Here, we present a compelling case of a 66-year-old female homemaker from Bangalore who underwent a meticulous evaluation and treatment for a renal tumor in a horseshoe kidney.

Case Overview

The patient, with a known history of diabetes mellitus and hypertension, experienced right lower abdominal pain persisting for a month. Notably, she did not report hematuria, lower urinary tract symptoms, or bowel disturbances, and she had no prior urological interventions.

A CT scan of the abdomen and pelvis provided a crucial diagnosis: 

• Horseshoe kidney, characterized by fusion at the midline below the inferior mesenteric artery.
• Exophytic lesion (4x4.9x3.9 cm) at the lower pole of the right kidney, abutting the calyces. 
• Heterogeneously isodense mass with necrotic areas, demonstrating post-contrast enhancement. 
•  No signs of vascular invasion or lymphadenopathy, suggesting localized pathology.

Understanding the Surgical Challenges

The horseshoe configuration of the kidneys introduces complexities in renal surgery due to:

• Aberrant vascular supply, requiring meticulous planning to preserve kidney function.
• Increased risk of complications, given the proximity of the mass to vital structures.
• Limited surgical access, demanding expertise in minimally invasive and robotic-assisted techniques.

Treatment Approach and Outcome

After a comprehensive evaluation, the patient was advised on the most suitable surgical intervention to ensure tumor removal while maintaining optimal renal function. Robotic-assisted nephron-sparing surgery was considered to minimize invasiveness, reduce recovery time, and enhance precision.

Post-surgical recovery was smooth and uneventful, with the patient experiencing relief from her symptoms and a successful follow-up showing no complications.

Advancing Urological Care with Expertise

This case underscores the importance of specialized urological expertise in managing complex renal anomalies. At Fortis, we remain committed to leveraging cutting-edge surgical techniques and personalized treatment plans to achieve the best possible outcomes for our patients.

Dr. Mohan Keshavamurthy | Fortis Hospital BG Road Bangalore