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.
Causes
The main mechanism of renal tissue atrophy in hydronephrosis - persistent increase in urinary incontinence pressure system. Initially, under the action of pressure causes expansion of renal pelvis, which leads to further reduction urodynamics. Subsequently, when the pelvis is already maximally dilated, the pressure begins to rise inside the kidney that promotes the compression of, and then the destruction of cells in the kidney tubules - atrophy occurs.
Hydronephrosis can be
- birth
- purchased.
Congenital hydronephrosis caused by malformation of the fetus urinary system, because of which the flow of urine from the kidney partially or completely obstructed. These defects include:
- forming additional container, the operation of which compresses the urethra and prevents normal urodynamics;
- intrauterine stenosis (luminal diameter reduction) of the ureter or a valve apparatus.
Acquired hydronephrosis is often a consequence of the following states:
- urolithiasis disease (Stones of small diameter can freely leave the renal pelvis, with a current of urine, but can not get enough of the thin ureter and will close its lumen);
- tumor kidney disease or abdominal cavity (in the body during the growth of tumor can compress the renal pelvis or ureter, causing urodynamic disorders);
- various urinary system damage or nearby organs and tissues (e.g., sometimes during inflammatory diseases such as cystitis or pyelonephritisConsequence of inflammation becomes narrowing of the lumen of the urinary tract, which leads to the development of hydronephrosis);
- spasm or urinary tract stenosis (the result of stress, hypothermia, tremors internal organs after incidence), which can be so strong that it is able to almost completely prevent the passage of urine;
- nephroptosis or nephroptosis (condition where the ligaments of one or two kidneys It is not strong enough, resulting in its stretchability, kidney omission below, followed by a bend ureter).
form of hydronephrosis
Hydronephrosis may be congenital or acquired, and each of these species, in turn, is an aseptic (without joining infection) and positive (with the development of infection).
In addition, providing 4 degree of hydronephrosis, which differ in the degree of destruction of kidney tissue:
- without damage to the kidney tissues (kidney function is not compromised);
- slight damage (kidney function has been reduced by 10-40%);
- significant damage (kidney function has been reduced by 40-80%);
- total loss of renal parenchyma with a stop body functioning.
symptoms of hydronephrosis
Hydronephrosis - an acute condition and its symptoms are often similar to the symptoms 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).
- pain 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;
- dizuricheskie disorder (micturition disorders), such as reducing the amount of urine, its darkening or opacity associated with stagnant processes in the urinary system;
- fever more than 38 ° C, is observed in the case of joining hydronephrosis infection;
- other signs of intoxication (headache, vomiting, weakness and drowsiness) can occur regardless of the presence or absence of infection.
Diagnostics
Diagnosis and treatment of hydronephrosis engaged urologist.
For diagnosis using the data of the following studies:
- survey and examination of the patient, on the basis of which the expert assesses the state of the patient and collects the main complaints. Already at this stage, the doctor may suspect hydronephrosis and order tests, allowing to confirm and clarify the diagnosis;
- general blood analysis (KLA) is carried out in order to determine the activity of the immune system, and hence the activity of the inflammatory process;
- urinalysis (urine if possible) helps you to estimate how much the reduced renal function, and whether the accession of infection to the main process;
- excretory urography. This special study is to introduce into the bloodstream an X-ray contrast and obtaining a number of radiographic images in which the contrast will fill the urinary system. On the basis of how, with what intensity and how fast and symmetrically pictures are move the contrast, the doctor will be able to accurately judge how the disease develops in patient;
- renal ultrasound and urinary system. It conducted as an additional method of research, if you want to specify how much atrophied kidney tissue. In addition, ultrasound helps to find and classify the cause that caused the disease.
After the examination the doctor sets the final diagnosis, differential diagnosis to rule out primary acute pyelonephritis, glomerulosclerosis, acute renal failure and some others that are similar in clinical presentation of diseases and prescribe treatment.
treatment of hydronephrosis
Hydronephrosis therapy is of two kinds:
- conservative, used in the early stages of the disease;
- operative, which is used to treat more severe cases.
Conservative treatment
The purpose of medical treatment - to encourage the flow of urine from the kidney, as well as to influence the factor that caused the violation of urodynamics.
For removal of spasm of the urinary tract, which may trigger a delay of urine flow is used spasmolytics (e.g., no-spa, pinaverium bromide, Barboval). In the initial stages of spasmolytic therapy sufficient to prevent disease progression.
But any organic lesions of the urinary tract, this therapy has no effect, and the only treatment is surgery.
operative therapy
The goal of surgery - the creation of artificial paths for the flow of urine from the kidney, and the elimination of the root causes of disease.
The choice of surgical technique depends on what it was called hydronephrosis. There are two of the most common operations (having many modifications) used to treat hydronephrosis:
1. Transurethral catheterization followed by stenting of the ureter, when applied resistant defies drug correction ureter spasm.
The meaning of this operation consists in introducing a catheter through the urethral canal, and equipped with a camera carrying the stent - a special device that looks like a small spring. The stent is placed at the site of narrowing of the urinary tract, and then straightened. After the spring is made short, the permeability of this portion is reduced, the catheter is removed and the patient is placed under surveillance. Usually, this operation does not take more than 40-60 minutes and the patient can be discharged home the next day for outpatient monitoring.
2. Overlay nephrostomy (creation of artificial paths for the flow of urine) is applied in cases where the urinary tract patency can not be restore urgently (for example, by compression of the tumor to remove a long-term advance is required examination).
There are many versions of this operation, which differ in location and access type and volume of interventions, but the basic meaning of the surgical manipulation as follows: through the incision or puncture catheter is inserted over the skin in the kidney pelvis, the other end of which is fixed on a special device skin. Thus, the urine through the catheter starts to flow outwardly where collected in a sterile container - urinal. For the duration of the operation takes up to 1 hour, and after the control ultrasound study and recommendations on nephrostomy for patient care can be discharged home. Such nephrostomy can function sufficiently long time necessary to identify and eliminate the underlying cause of urinary tract obstruction.
Complications and prognosis
As with any acute disease of the internal organs, the prognosis of hydronephrosis depends on how promptly and properly to the patient assisted.
Thus, in the early detection and adequate treatment of the disease, most patients maintain kidney function. At untimely recourse hydronephrosis leading to massive and irreversible changes in the kidney tissue: formed kidney failure - serious and difficult to treat disease are served.
