Letter to the Editor Saime Paydas Esmeray Acarturk Cukurova University Medical Faculty, Departments of Nephrology and Cardiology, Balcali Hospital, Adana. Turkey Dear Sir, In this study we describe a case of horse shoe kidney in association with the endocar dial cushion defect. A 33-year-old male was admitted to hos pital for hypertension. Six years ago he had been hospitalized for lead intoxication. He was working in a storage battery. At that time bradycardia was detected. Cardiac investiga tion showed a congenital endocardial cushion defect. He had an Autime 2 model dual chamber pace maker implanted. He was treated 4 times for lead intoxication after wards. Finally he stopped actively working with lead. Two years ago at his latest ad mission hypertension was found but he did not regularly take medicine for hypertension. Physical examination revealed a pulse of 76/ min, blood pressure of 190/130 mm Hg, 3/6 holosystolic murmur in the mesocardiac and apical region. Laboratory examinations were as follows: hematocrit 48%, WBC 4,800/mm3, platelet count 200.000/mm'. BUN 20 mg/dl, glucose90 mg/dl, Na 139 mEq/I, K4.7 mEq/ I, alkaline phosphatase 88 IU/I, AST 54 IU/1, ALT 27 IU/I, uric acid 5.2 mg/dl, Ca 8.8 mg/dl, P 3.2 mg/dl, creatinine clearance 98 ml/min : proteinuria was negative, urine sedi ment was normal. Telecardiography dis closed cardiomegaly and pacemaker image. Left ventricular hypertrophy and pacemaker rhythm were determined on electrocardio graphy. With the échocardiographie examin ation a perimembranous ventricular defect and a primum atrial septal defect were found (fig. I). A rapid-sequence intravenous pyelo- gram and renal computerized tomography disclosed a horseshoe kidney. Enalapril ma- leate (10 mg/day) was started. Follow-up hypertension was controlled with enalapril maleate. Nephron 1993:63:479 A Case with Endocardial Cushion Defect and Horseshoe Kidney Fig. 1 . Apical four-chamber view of the patient with cushion defect showing the peri membranous ventri cular septal defect (VSD) and primum atrial septal defect (ASD). He had been followed for 2 years and blood pressure and cardiac and renal func tion were stable. Horseshoe kidney is a relatively common condition (1 in 400 of the population). Two kidneys fuse across the midline, most com monly at the lower poles. Other developmen tal abnormalities such as Turner’s syndrome or Trisomy 18 accompany the horseshoe kid ney. [1]. No chromosomal abnormality was found in our patient. In the literature renal and cardiac abnormalities together such as Down syndrome and renal dysplasia, multiple renal cysts and Ehlers-Danlos syndrome and Kauf man syndrome with heart disease and bifur cation of renal pelvis or ureteral ectasia have been reported [3]. Huber et al. [2] have found three cases of abdominal aortic aneurysm in association with a horseshoe kidney. We pre sented here a case of a horseshoe kidney in association with an endocardial defect. References 1 Warkany J. Passarge E. Smith LB: Congenital malformations in autosomal trisomy syn dromes. Am J Dis Child 1966:112:502. 2 Huber D, Griffin A, Niesche J, Frawley J, Gray L: Aortic aneurysm surgery in the presence of a horseshoe kidney. Aust NZ J Surg 1990:60: 963-966. 3 Moffat, DB: Development abnormalities of the urogenital systems; in Chisholm GD, Williams D1 (eds): Scientific Foundations of Urology. Chicago, Year Book. 1982, pp 357-374. Dr. Saime Paydas © 1993 S. Karger AG. Basel Cukurova University Medical Faculty 0028-2766/93/ Departments of Nephrology and Cardiology 0634-0479S2.75/0 Balcali Hospital TR-01330 Adana (Turkey)