2016 Volume 29 Issue 2 Pages 172-178
The comorbidity of non-infectious inflammatory nephropathy with horseshoe kidney is very rare. We herein report a case of an adolescent male with horseshoe kidney complicated by lupus nephritis. A 13-year-old boy was referred for an evaluation of proteinuria and hematuria. The onset of symptoms, which included fatigue, pallor, and anorexia, followed by fever occurred 2 months earlier. He was diagnosed with systemic lupus erythematosus based on physical examination and laboratory findings on admission. Abdominal ultrasonography and computed tomography showed horseshoe kidney and hydronephrosis in the left kidney. Computed tomography angiography with three-dimensional reconstruction (3D-CT) was performed in order to establish a safe puncture region and the best approach for renal biopsy. Retroperitoneal laparoscopic biopsy was performed without any complications such as massive hemorrhage. The histological diagnosis was lupus nephritis of ISN/RPS class IV-S. After induction therapies including intravenous methylprednisolone, intravenous cyclophosphamide, and oral prednisolone, he achieved remission. Thereafter, he has successfully remained in remission with combination therapy of mycophenolate mofetil and a small dose of prednisolone. This case was highlighted because preoperative 3D-CT of renal vessels provided very useful information for safely performing renal biopsy.
