Rare Cause of Anuria in a Patient with Horseshoe Kidney

Horseshoe kidney is a common congenital renal fusion anomaly. Acute kidney injury occurs secondary to urinary infection or obstructive uropathy, but glomerular involvement is rarely reported. A 47-year-old female presented with symptoms of urinary infection and was hospitalized in the urology clinic. Investigations revealed renal dysfunction and active urine sediments. The patient did not respond to antibiotics and eventually became anuric after 3 weeks of initiation of symptoms. Abdominal ultrasound was suggestive of horseshoe kidney. Workup for rapidly progressive glomerulonephritis and kidney biopsy confirmed the diagnosis of anti-glomerular basement membrane disease. The patient responded to immunosuppression and plasmapheresis. The above case highlights the importance of timely renal biopsy in diagnosis and management of glomerular disease even in patients with horseshoe kidney.