Main Article Content
Chemolysis of kidney stone is not unheard of. However, to our knowledge, there is no previous report of chemolysis of a kidney stone in a horseshoe kidney. We report the first ever case of chemolysis of a stone in a horseshoe kidney. As part of his visible haematuria workup 4 years ago, a 66-year-old gentleman with a history of gout was found to have a horseshoe kidney. In early 2017, he was seen in the urology clinic with some non-specific abdominal pain without a recent history of visible haematuria, lower urinary tract symptoms, and urinary tract infections. His CT KUB (computed tomography of kidneys, ureters and bladder), revealed a 1.3cm stone in his horseshoe kidney [Figure 1 and 2]. At the same time, his CT KUB has also picked up some retroperitoneal lymphadenopathy in the abdomen and pelvis which were suspicious of lymphoma. His serum uric acid level was noted to be normal. Subsequently, he underwent a laparoscopic right iliac lymph node biopsy which confirmed nodal marginal zone non‑Hodgkin's B-cell lymphoma. He was reviewed by the haematology team and they decided to adopt a watch and wait approach to his disease with quarterly CT CAP (computed tomography of chest, abdomen and pelvis) scans. During this period of time, he had several gout attacks and he was started on allopurinol i.e. 100mg once a day. He also considerably increased his daily fluid intake. 6 months after his initial CT KUB, he was found to be completely stone free on his CT scan [Figure 3 and 4].
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Copyright of articles published in all DPG titles is retained by the author(s). The author(s) grants DPG the rights to publish the article and identify itself as the original publisher. The author grants DPG exclusive commercial rights to the article. The author grants any party the rights to use the article freely for non-commercial purposes provided that the original work is properly cited.
2. Bauer SB, Perlmutter AD, Retik AB. Anomalies of the upper urinary tract. In: Walsh PC, Retik AB, Vaughan ED Jr, Wein AJ (eds). Campbell’s Urology, Vol. 2, 6th edn. Philadelphia, PA: Saunders; 1992.
3. Basar H, Basar R, Basar MM and Erbil M. The comparison of the incidence of horseshoe kidney in autopsy cases versus urologic patient population. Okajimas Folia Anat Jpn 1999;76:137–40.
4. Weizer AZ, Silverstein AD, Auge BK, et al. Determining the incidence of horseshoe kidney from radiographic data at a single institution. J Urol 2003;170(5):1722–6.
5. Nino‐Murcia M, DeVries PA, Friedland GW. Congenital anomalies of the kidneys. Clin Uroradiol 2000;1:690–63.
6. Kölln CP, Boatman DL, Schmidt JD, Flocks RH. Horseshoe kidney: a review of 105 patients. J Urol 1972;107(2):203–4.
7. Domenech‐Mateu JM, Gonzalez‐Compta X. Horseshoe kidney: a new theory on its embryogenesis based on the study of a 16‐mm human embryo. Anat Rec 1988;222:408–17.
8. Raj GV, Auge BK, Assimos D, Preminger GM. Metabolic abnormalities associated with renal calculi in patients with horseshoe kidneys. J Endourol 2004;18(2):157–61.
9. Pawar AS, Thongprayoon C, Cheungpasitporn W, Sakhuja A, Mao MA, Erickson SB. Incidence and characteristics of kidney stones in patients with horseshoe kidney: A systematic review and meta-analysis. Urology Annals 2018;10(1):87–93.
10. Blackard CE, Melliger GT. Cancer in a horseshoe kidney. Arch Surg 1968;97:616–27.
11. Buntley MD. Malignancy associated with horseshoe: kidney. Urology 1976;8:146–48.
12. Symons SJ, Ramachandran A, Kurien A, Baiysha R, Desai MR. Urolithiasis in the horseshoe kidney: a single-centre experience. BJU Int 2008 Dec;102(11):1676–80.
13. Trinchieri A, Montanari E. Prevalence of renal uric acid stones in the adult. Urolithiasis 2017;45(6):553–62.
14. Sakhaee K. Epidemiology and clinical pathophysiology of uric acid kidney stones. J Nephrol 2014;27(3):241–45.
15. Maalouf NM. Metabolic syndrome and the genesis of uric acid stones. J Renal Nutrit . 2011;21(1):128–31.
16. Gentle DL, Stoller ML, Bruce JE, Leslie SW. Geriatric urolithiasis. J Urol 1997;158(6):2221–4.
17. Gutman AB, Yü TF. Uric acid nephrolithiasis. Am J Med 1968; 45(5):756–79.
18. Knoll T, Schubert AB, Fahlenkamp D, Leusmann DB, Wendt-Nordahl G, Schubert G. Urolithiasis through the ages: data on more than 200,000 urinary stone analyses. J Urol 2011;185(4):1304–11.
19. Asplin JR. Uric acid stones. Semin Nephrol 1996;16:412–24.
20. Neto M, Pilloff B, Simon J. Dissolution of renal uric acid calculus with allopurinal and alkalization of urine: a case report. J Urol 1976;115(6):740–1.
21. Harbaugh JT. Dissolution of renal calculus with allopurinol: a case report. J Urol 1968;100:412.
22. Godfrey RG, Rankin TJ. Uric acid renal lithiasis: management by allopurinol. J Urol 1969;101:643.
23. Alexander S, Brendler H. Treatment of uric acid urolithiasis with allopurinol: a xanthine oxidase inhibitor. J Urol 1967;97:340.
24. Türk C, Neisius A, Petrik A, et al. Urolithiasis. Eur Urol 2018. Available at: http://uroweb.org/guideline/urolithiasis/
25. Rodman JS, Williams JJ, Peterson CM. Dissolution of uric acid calculi. J Urol 1984;131(6):1039–44.
26. Becker G. The CARI guidelines. Kidney stones: uric acid stones. Nephrology 2007;12 Suppl 1:S21–S5.