Renal Fusion

　　The fusion of two posterior kidneys occurs in the early embryonic stage, when the kidneys are still in the pelvis and the position is very low. Therefore, they rarely rise to the normal position that the kidneys should reach, and even can stay in the pelvis. At this time, this kidney can receive blood supply from multiple vessels in this area (such as the aorta, iliac vessels, etc.). In patients with both ectopia and fused kidneys, 78% have extrarenal urinary system malformations, and 65% will show other defects in the urinary and reproductive systems.

　　Due to the high incidence of ectopic renal vessels and one or two ureters arching around or crossing over the renal mass. Fused kidneys are prone to ureteral obstruction. Therefore, hydronephrosis, stones, and infection are more common. A large fused kidney occupying the sacral凹面 can also cause dystocia.

　　1. Infection:The main manifestations are double球菌 pneumonia, peritonitis, subcutaneous infection, urinary system infection, etc. The onset of infection is often insidious.

　　2. Thrombotic and embolic complications:This is one of the serious and fatal complications of the disease. The next is pulmonary artery or venous thrombosis, and thrombophlebitis of peripheral veins. Hua Qiong, Department of Nephrology, Affiliated Hospital of Henan Academy of Traditional Chinese Medicine

　　3. Promote cardiovascular disease:Due to long-term hyperlipidemia, especially an increase in low-density lipoprotein plasma concentration, it can accelerate atherosclerosis. In recent years, it has also been found that it can exacerbate the progressive sclerosis of the glomeruli.

　　1. Symptoms:Most patients with fused kidneys are asymptomatic, but some may develop ureteral obstruction, and gastrointestinal symptoms similar to peptic ulcer, gallstones, or appendicitis (renal-enteric reflex) may also occur. If there is ureteral obstruction causing hydronephrosis or stone formation, it is more prone to infection.

　　2. Signs:Physical examination is usually negative, unless an abnormal position of the renal mass can be felt. For horseshoe kidneys, it may be possible to feel a mass (isthmus) in front of the lower lumbar vertebra. In cases of crossing ectopia, a mass can be felt in the hypochondrium or lower abdomen.

　　There is no special prevention for this disease. It is congenital.

　　1. To prevent renal fusion, attention should first be paid to the following two points to prevent it:

　　1. Nutrition should be balanced, and a reasonable diet is necessary. The yin deficiency symptoms of renal fusion are generally considered to have biological factors, that is, genetically fragile, naturally tense, and nervous. Such people are most prone to fear.

　　2. The effect of vitamins is significant.

　　2. Prognosis

　　Most cases have a good prognosis. When ureteral obstruction and infection occur, surgical intervention should be taken to improve renal drainage, which also makes antibacterial treatment more effective.

　　1. Laboratory examination

　　Urine analysis is normal except for infection, and renal function is also normal, unless all the fused renal blocks are affected at the same time.

　　Second, X-ray examination

　　In the horseshoe kidney, if the renal axis is visible in the plain film, it is parallel to the spine, and sometimes the isthmus can be identified. The plain film can also show a large soft tissue mass in one side of the hypochondrium without a kidney shadow on the other side. If the renal parenchyma still has function, it can be diagnosed clearly through excretory urography. The increased density of renal tissue makes the position and shape of the kidney clearer, and urography can also show the renal pelvis and ureter.

　　1. In the horseshoe kidney, the renal pelvis is located on the anterior surface of the renal mass, while the renal pelvis of the normal kidney is located on the inside of the kidney. For horseshoe kidneys, the most valuable diagnostic clue is that the lower pole renal calyx is directed towards the midline and is closer to the midline than the ureter.

　　2. The crossed transposed fused kidney shows 2 renal pelvises and 2 ureters, one of which must cross the midline to urinate at the inherent bladder position.

　　3. A kidney in the shape of a cake or mass located in the pelvis (pelvic fusion kidney), but its ureter and renal pelvis can be visualized, and it can compress the top of the bladder.

　　Third, CT scan

　　It can clearly depict the outline of the kidney, but it is not essential. For pelvic fusion kidneys or those located in the hypochondrium, the insertion of the ureteral catheter in the plain film will provide the first clue for diagnosis, retrograde urography will show the position of the renal pelvis and changes caused by infection or obstruction, and renal scintigraphy can show kidney masses and their outlines, like ultrasonic images.

　　1. Avoid foods high in potassium for renal fusion, such as: animal organs, pumpkin seeds and other dried fruits, soy sauce and preserved foods, monosodium glutamate, noodles, etc. Eat less fried food, avoid seafood such as sea fish and sea crabs; spicy, coriander, dog meat, etc.

　　2. For renal fusion, it is recommended to consume high-fiber foods, low-fat diet, and light food; milk, eggs (protein), poultry, lean meat, vermicelli, potato skin, etc.

　　(The above information is for reference only, please consult a doctor for details.)

　　Generally no treatment is required, unless infection or obstruction occurs, the isthmus of the horseshoe kidney can be incised to improve its drainage, and if one pole of the horseshoe kidney does not drain properly, it can be removed.

　　Prognosis:Most cases have a good prognosis. When there is ureteral obstruction and infection, surgical means should be taken to improve kidney drainage, which also makes antibacterial treatment more effective.