Why Do Turner Syndrome Patients Need Kidney Ultrasounds?

It is completely normal to associate Turner syndrome (TS) primarily with growth hormone treatments and heart monitoring. However, a baseline kidney (renal) ultrasound is a standard and crucial part of the initial diagnosis, regardless of a child’s age ^[1][2]. This screening is necessary because approximately 17% to 35% of individuals with Turner syndrome are born with structural differences in their kidneys, known as congenital renal anomalies ^[3][2][4]. While these differences are often entirely asymptomatic and unseen from the outside, identifying them early helps your care team prevent and manage long-term complications like infections and high blood pressure ^[5][6].

Common Kidney Anomalies in Turner Syndrome

The kidneys filter waste from the blood and produce urine. In many girls with TS, the kidneys or their connecting tubes form differently during fetal development. The most frequently seen structural differences include:

• Horseshoe Kidney: This is the most common kidney anomaly in Turner syndrome ^[3][7]. It happens when the two kidneys fuse together at the bottom during development, forming a “U” or horseshoe shape.
• Duplicated Collecting Systems: The collecting system is the series of tubes that drain urine from the kidney to the bladder. Some girls are born with an extra tube or “duplicated” system ^[7][8].
• Renal Agenesis: Some girls are born with only one kidney (unilateral renal agenesis) ^[8]. The single kidney often functions perfectly well on its own.
• Hydronephrosis: This refers to a swelling of the kidney. While not a primary structural formation issue itself, doctors look for this swelling on the ultrasound because it is a key indicator of an underlying structural blockage or urine backing up ^[7][8].

Why Does Structural Screening Matter?

Even if your daughter’s kidneys function perfectly to filter her blood, structural anomalies can create mechanical issues. Recognizing these anomalies early allows doctors to proactively monitor for two primary risks:

1. Urinary Tract Infections (UTIs): Structural differences like a horseshoe kidney or duplicated tubes can disrupt the normal flow of urine. This can cause urine to pool (stasis) or flow backward toward the kidneys, significantly increasing the risk of recurrent UTIs ^[3][6].
2. High Blood Pressure (Hypertension): Hypertension is remarkably common in Turner syndrome, affecting roughly one-quarter of pediatric patients and up to 58% of adults ^[9][10]. While the exact cause is complex and involves multiple factors, kidney structure anomalies can contribute to this risk ^[10][11].

What to Expect from the Ultrasound

The baseline renal ultrasound is a painless, non-invasive imaging test that uses sound waves to create a picture of your daughter’s kidneys and urinary tract ^[1]. There is no radiation involved.

Depending on your daughter’s age and the specific clinic’s instructions, she may be asked to arrive with a full bladder so the technician can see her urinary tract more clearly. For young children, it often helps to explain the process beforehand: tell them the technician will squirt some warm, squishy jelly on their tummy and rub a smooth camera wand over it to take pictures of their insides.

If the ultrasound is clear, your daughter’s care team will simply continue routine blood pressure monitoring. If an anomaly is found, it does not necessarily mean she requires surgery or immediate intervention. Most often, it simply means her doctors will be more vigilant about checking her blood pressure and testing for UTIs if she has unexplained fevers, pain during urination, or unusual wetting accidents ^[1][5]. You may also be referred to a pediatric nephrologist (kidney specialist) or urologist for specialized guidance ^[1].