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    "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">To the Editor&#44; </span></p><p class="elsevierStylePara">Horseshoe kidney &#40;HK&#41; was first described by Berengario da Carpo in 1552&#46; Thirty-three percent of cases are asymptomatic and the remaining may present with complications such as multicystic renal dysplasia&#44; obstructive uropathies&#44; hydronephrosis&#44; lithiasis&#44; infections and neoplasias such as renal carcinoma and Wilms&#8217; tumour or urothelial tumour&#46;<span class="elsevierStyleSup">1</span></p><p class="elsevierStylePara">We present the case of a 27-year-old male&#44; who came to the emergency department for abdominal pain located in the left flank&#46; From his medical record&#44; we discovered that he had a recent history of arterial hypertension &#40;AHT&#41;&#46; His blood pressure was 160&#47;90mm Hg in the physical examination&#46; We performed an abdominal ultrasound &#40;not shown&#41; in which cystic images were observed on the superior pole of the left kidney&#44; which presented with a mild cortical atrophy&#46; Given that a kidney disease was suspected&#44; a computerised tomography &#40;CT&#41; scan was performed&#44; showing that the cystic images corresponded to dilation of the pyelocaliceal system &#40;Figure 1&#41; in a HK &#40;Figure 2&#41;&#46; We performed a left pyeloplasty which resolved the obstructive problems&#58; the patient being asymptomatic at present&#46;</p><p class="elsevierStylePara">HK is the most common type of renal fusion anomaly&#46; It appears in 1 out of every 400 births&#44; with a higher incidence in men &#40;2&#58;1&#41;&#46; The isthmus is usually located anterior to the large abdominal vessels&#46; Hydronephrosis due to obstruction in the pyeloureteral junction is observed in a third of all HK&#44; being factors which contribute to the upper ureter entering the renal pelvis and isthmus or blood supply anomalies&#46;<span class="elsevierStyleSup">2</span> It has been documented that Wilms&#8217; tumours&#44; clear-cell&#44; neuroendocrine&#44;<span class="elsevierStyleSup">3 </span>and urothelial carcinomas and nephroblastomas<span class="elsevierStyleSup"> </span>can be found in HK&#46; It can be associated with congenital&#44; genito-urinary&#44; bone&#44; gastrointestinal&#44; myelomeningocele and cardiovascular anomalies&#46; Pyeloureteral junction stenosis &#40;PJS&#41; is the most common congenital alteration of the upper urinary tract&#44; and is most associated with HK&#46; In most cases&#44; PJS is due to a destruction of the muscular fibres and an increase in the amount of collagen in the pyeloureteral junction&#46; The most common clinical sign is lumbar back pain&#44; but for chronic obstruction&#44; activation of the renin-aldosterone system would lead to vasoconstriction of the afferent arteriole&#44; with a consequent reduction in renal blood flow and AHT developing&#46; In spite of this&#44; given hydronephrosis and HK&#44; the most common cause is lithiasis&#44; followed by PS&#46;<span class="elsevierStyleSup">4</span> HK is diagnosed using imaging tests&#46; CT with modern multidetectors can perform a multiplanar reconstruction and confirm the diagnosis given the ultrasound finding&#44; whereas renal gammagraphy is used to find out whether the parenchyma is functioning correctly&#46; Treatment is performed using laparoscopic and endoscopic pyeloplasty in any of its variants&#46; At present&#44; robotic surgery has proven its utility in obtaining good pyeloplasty results for primary and secondary stenosis&#44; both for children and adults and for different causes&#46;<span class="elsevierStyleSup">5</span></p><p class="elsevierStylePara">In summary&#44; when a young patient presents with AHT &#40;related or not to HK&#41;&#44; one should consider that it may owe to a PJS&#46; Abdominal CT scans are a good diagnostic method for assessing this condition&#46;</p><p class="elsevierStylePara"><a href="grande&#47;10607&#95;108&#95;17668&#95;en&#95;f1a&#95;10607&#46;jpg" class="elsevierStyleCrossRefs"><img src="10607_108_17668_en_f1a_10607.jpg" alt="Abdominal CT scan after administering I&#46;V&#46; contrast agent&#46; A&#41; nephrogenic phase&#46; Cystic formation in the left kidney at the height of the hilum &#40;arrow&#41;&#46; B&#41; Excretory phase&#46; The passage of the contrast agent is observed&#44; confirming that it corresponds to d"></img></a></p><p class="elsevierStylePara">Figure 1A&#46; Abdominal CT scan after administering I&#46;V&#46; contrast agent&#46; A&#41; nephrogenic phase&#46; Cystic formation in the left kidney at the height of the hilum &#40;arrow&#41;&#46; B&#41; Excretory phase&#46; The passage of the contrast agent is observed&#44; confirming that it corresponds to d</p><p class="elsevierStylePara"><a href="grande&#47;10607&#95;108&#95;17669&#95;en&#95;f1b&#95;10607&#46;jpg" class="elsevierStyleCrossRefs"><img src="10607_108_17669_en_f1b_10607.jpg" alt="Abdominal CT scan after administering I&#46;V&#46; contrast agent&#46; A&#41; nephrogenic phase&#46; Cystic formation in the left kidney at the height of the hilum &#40;arrow&#41;&#46; B&#41; Excretory phase&#46; The passage of the contrast agent is observed&#44; confirming that it corresponds to d"></img></a></p><p class="elsevierStylePara">Figure 1B&#46; Abdominal CT scan after administering I&#46;V&#46; contrast agent&#46; A&#41; nephrogenic phase&#46; Cystic formation in the left kidney at the height of the hilum &#40;arrow&#41;&#46; B&#41; Excretory phase&#46; The passage of the contrast agent is observed&#44; confirming that it corresponds to d</p><p class="elsevierStylePara"><a href="grande&#47;10607&#95;108&#95;17670&#95;en&#95;f210607&#46;jpg" class="elsevierStyleCrossRefs"><img src="10607_108_17670_en_f210607.jpg" alt="3D reconstruction of the previous test&#59; horseshoe kidney with multiple accessory arteries &#40;arrows&#41;&#46;"></img></a></p><p class="elsevierStylePara">Figure 2&#46; 3D reconstruction of the previous test&#59; horseshoe kidney with multiple accessory arteries &#40;arrows&#41;&#46;</p>"
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