Are there any special considerations to take into account when managing patients with recurrent nephrolithiasis who are found to have a horseshoe kidney?

Interesting question! Horseshoe kidneys are particularly susceptible to stones, primarily in the lower poles. Stones are typically composed of calcium oxalate.

Renal embryology was a neglected topic during my medical education. The prometanephros are located near the fetal cervical spine. They subsequently migrate to the fetal pelvis and from there rise to their adult position in the mid retroperitoneum unless the lower poles are fused, in which case they get hung up on the inferior mesenteric artery. I picture the lithogenic problem relating to the lower poles having to drain “uphill"!

I have never tried surgically separating the horseshoe moeity for better drainage. Rather, I use standard treatment for calcium oxide stone formers, includi...