Does horseshoe kidney require treatment?

Usually no: Most horseshoe kidneys r in fact 2 normal kidneys attached at the lower end. Some subjects have hydronephrosis due to obstruction at kidney ureteropelvic juction ; may require surgical correction. Very occasional patient might have severe persistent or recurrent abdominal pain which might benefit from division of isthmus joining both kidneys. Was fashionable procedure 50yrs ago, thankfully no more.