Due to the compression of disturbed vascular nutrition, there is atrophy of renal tissue and a significant deterioration in their functions. Hydronephrosis often the case with young women. Usually affects only one kidney. Hydronephrosis of the right kidney and left occurs with equal frequency.
What it is?
Hydronephrosis - a disease characterized by persistent and progressive expansion of the renal collecting system. This is due to the violation of the outflow of urine, which leads to atrophy of the kidney tissue.
The most common cause of congenital hydronephrosis in children - a violation of the structure of the place of origin of the ureter from the renal pelvis. For example, if the ureter straying too high, then there is his inflection. This disrupts the flow of urine from the kidney and contributes to its stagnation. Compression can be caused by improperly disposed renal artery.
Other causes of hydronephrosis:
- Gynecological diseases: cervical cancer, ovarian cyst, endometriosis, abscesses (ulcers), fallopian tubes and ovaries.
- Tumors located near the ureter and squeezing them out.
- Fungal lesions of the ureters and urethra.
- Diseases of the bladder: diverticula, tumors, reverse casting of urine from the bladder into the ureter as a result of insufficient valves function.
- Aortic aneurysm.
- Diseases of the prostate: prostatitis, benign prostatic adenoma, malignant tumors.
- Urinary stone disease (blockage ureteral stone).
- ureter and bladder injury.
Inflammatory diseases of the urinary system: urethritis (inflammation of the ureter), cystitis (bladder infections).
Depending on the severity of renal parenchyma atrophy are 4 degrees hydronephrosis:
- 1 degree - parenchyma is preserved,
- Grade 2 - slight damage to the parenchyma,
- Grade 3 - considerable damage,
- Grade 4 - lack of parenchymal kidney is not functioning.
There are three stages of the disease:
- Stage I - expanded only renal pelvis, kidney function is not altered or impaired in mild.
- Stage II - kidney sizes are increased by 15-20%, pelvis significantly expands its wall becomes thinner. Significantly disturbed evacuation ability pelvis. Kidney function is reduced by 20-40%.
- Stage III - the size of the kidney increased 1.5-2 times. Pelvis and cups greatly expanded, the kidney is a multi-chamber cavity. It has been a dramatic violation of evacuation capacity pelvis. Kidney function is reduced by 60-80%, or absent altogether.
Depending on the cause hydronephrosis may be congenital or acquired.
- ariobretonny hydronephrosis can be caused urolithiasis, tumors urinary tract damage.
- gidronefrostenoze with congenital defect may be a cellular structure or stenosis nephron pyeloureteral segment, which is due to stenosis of the ureter mucosa valve, an additional compression of the vessel and so on. d.
As congenital and acquired hydronephrosis can be aseptic or infected.
symptoms of hydronephrosis
Hydronephrosis - an acute condition and its symptoms are often similar to the symptoms of pyelonephritis.
For most of hydronephrosis characterized by the following symptoms:
- Patients may complain of how the pain in the lumbar region, and discomfort in the lower and middle abdominal (variety of localization of pain associated with a variety of factors that cause disease).
- Painful sensations are permanent, at least - paroxysmal in nature, can be aggravated by movement. The pain is caused by the kidney capsule is stretched under pressure from the growing body;
- Increased body temperature more than 38 ° C, is observed in the case of joining hydronephrosis infection;
- Dysuric disorder (micturition disorders), such as reducing the amount of urine, its darkening or opacity associated with stagnant processes in urinary system.
The rest of the signs of intoxication (headache, vomiting, weakness and drowsiness) can occur regardless of the presence or absence of infection.
At the slightest suspicion of hydronephrosis is necessary to apply the methods of diagnosis, confirming the diagnosis, determine the cause of hydronephrosis, ascertain their stage of development;
- It should be carried out a comprehensive survey: blood, urine.
- X-rays of the kidneys - the main method of diagnosis of hydronephrosis. Survey radiography allows us to determine the size of kidney stones, and to discover if they are available. In a series of intravenous Voiding may be noted slow accumulation of contrast solution into the dilated renal pelvis (pelvis) and cups. On urograms seen expanded, rounded pelvis, extended cup. With a significant breach of kidney function contrast solution may be accumulated in sufficient concentration only after 1- 2 hours or does not distinguish diseased kidney.
- To determine the degree of renal function performed radioisotope research and kidney scanning.
- Ultrasonography - to determine the increase in the dimensions and pelvis and renal calyces, degree of expansion, thickness kidney tissue.
To clarify the diagnosis may angiography, computed tomography and magnetic resonance.
The consequence of hydronephrosis can become kidney failure. In this case, the kidney stops working and does not filter the blood. Due to intoxication, death can occur.
Very common urolithiasis, as a companion in hydronephrosis. No less dangerous is the spontaneous rupture of kidney pelvis or urine cup and pour out into the abdominal cavity, causing urinogenous sepis. Also uremia may develop razvivshemsya hydronephrosis. Therefore, in cases of suspected renal disease should immediately consult a specialist.
Treatment of kidney hydronephrosis
The therapy of the disease should be aimed at eliminating the causes and preservation of renal function. Perhaps the conservative and surgical treatment of hydronephrosis. Medication therapies are used to relieve pain, reduce blood pressure, uremia removal and destruction of secondary infection.
What medications are prescribed for hydronephrosis:
- broad-spectrum antibiotics - protected penicillins (augmentin), cephalosporins (tsefadoks), fluoroquinolones (levofloxacin, ciprofloxacin);
- β2-adrenoagonists hexoprenaline (ginipral) - it lowers the tone and expands the lumen of the ureter;
- myotropic antispasmodics - Drotaverinum (no-spa), papaverine;
- diuretics - frequently loop (furosemide, torasemide);
- antihypertensives - best manifest themselves ACE inhibitors (enap, prestarium) and calcium channel blockers (amlodipine);
- analgesics - opioids (morphine, promedol) in renal colic or nonsteroidal anti-inflammatory agents (movalis, nimesil).
To eliminate the use of uremia afferent detoxification methods: plasmapheresis, hemodialysis.
Surgeons use in the treatment of kidney hydronephrosis transformation of several key techniques.
In the early stages of the disease effectively an extension of the lumen of the ureter, and later - shows a plastic pelvis and size correction. If hydronephrosis transformation undergone right kidney, then the surgical treatment of high risk of injury to the pancreas.
In just a few days before the operation is established catheter or cystostomy to facilitate drainage of urine and reduce the load on the affected organ. If partial preservation of kidney function specialists perform one of the following operations:
- Creating an additional mouth between the kidney and mochetonikom.
- Flap plastic surgery.
- Endotomiya stiktury applied to reduce the size of the pelvis.
- kidney plastic using laparoscopic techniques.
- Probing of the ureter.
Equally important is the diet, consisting in reducing the amount of protein and increased fiber consumption. This reduces the load on the affected organ, and to facilitate the patient's condition. The recovery period takes about 14 days.
In the last stages of the pathological process, the kidney is removed. This decision is made based on the results of diagnostic examination, if the body of the function is lost.
Hydronephrosis in neonates
Hydronephrosis newborn or postnatal hydronephrosis is a consequence of antenatal (ANC) hydronephrosis. Hydronephrosis - an extension of renal pelvis and / or an increase in the size of kidney due to violation of the outflow of urine.
In most cases, the reason is a blockage of the urinary channel (at the junction of the ureter from the kidney or bladder, and urethra blockage) or more rare cases vesicoureteral reflux (impaired operation of the valve between the bladder and ureter, which prevents reverse flow of urine into the ureter and kidney from the bladder bladder). Hydronephrosis is usually diagnosed in the fetus during pregnancy through ultrasound study, and the doctors are ready to choosing the appropriate treatment and observation.
Treatment of hydronephrosis in children
Most children ultrasound will be held approximately every three months for the first year of life, so that professionals can properly determine the extent and progression hydronephrosis. Many children with the diagnosis of prenatal hydronephrosis are under careful medical supervision, because their state is able to eventually return to normal on their own without surgery intervention. In most cases of mild and moderate forms of hydronephrosis requires only periodic monitoring.
If hydronephrosis for the child is getting worse over time, or initially was diagnosed with a serious form, medical intervention may be necessary. The operation is usually performed pediatric urologist. The most common procedure carried out for the correction of hydronephrosis is pyeloplasty. Pyeloplasty is to remove narrowed or diseased parts of the ureter obstruction and then was re-joining the healthy part of the drainage system. The success and outcome pyeloplasty is about 95%. There are times when they can be required other operations.
Hydronephrosis during pregnancy
During pregnancy, hydronephrosis becomes serious test for women. The growing fetus can exert pressure on the ureter, thereby obstructing the normal flow of urine.
Often hydronephrosis in pregnancy progresses rapidly, causing pyelonephritis. Therefore, the expectant mother should always be seen by a doctor. At revealing hydronephrosis in pregnant women should be conservative therapy, taking into account the status of women and with minimal risk to the fetus. If necessary, surgery is inevitable, so pregnant women should be very carefully monitor their condition.
The prognosis of hydronephrosis may give different figures. Everything depends on the course of the operation and possible complications. Half of the patients after the intervention are operable complications that lead to repeated operations, systematic hospitalization and continuous therapy.
If hydronephrosis developed only the left or only the right, the relatively favorable prognosis, since even when one kidney can remove severe disease, thus save the body from infection and further diseases.
In the case of dual diagnosis surgery is not always effective. And though the double hydronephrosis occurs too infrequently, the patient can not survive without a transplant at least one kidney, as in most cases there is every indication to remove both kidneys, which is incompatible with life. If you still manage to save both kidneys, then in every second patient revealed renal failure. As with other diseases dependent on the state prediction and life stage. The sooner the operation is to be put, the greater the chance of a full, healthy life.
Outcome is this: children up to three years in 90% of cases after surgery lead a normal life. Good results were determined in 80% of children aged 3 to 15 years. Adults recover completely in fifty percent of cases.