Hydronephrosis, or, in other words, hydronephrotic transformation of the left kidney, is a disease that affects the renal calyx of the pelvis. The enlarged organ presses on the vessels of the kidneys, which, in turn, causes disturbances in its functioning, as well as the urinary system as a whole.
Causes of occurrence
The pathological condition develops due to a violation of the passage of urine, as a result of which the systems and tissues of the kidneys expand, and their activity is disturbed. Congenital and acquired causes of hydronephrotic transformation of the left kidney are distinguished. A congenital type of disease is often diagnosed from infancy. Its main reason is the irregular structure and location of the urinary organs, as well as a disease of the vascular renal system. The most common source of pathology is the incorrect location of the ureters, kidneys, or nephroptosis. Hydronephrotic transformation of the kidney can be caused by anomalies in the structure of the valves of the urinary organs or their underdeveloped state.
Urolithiasis
Among the acquired causes are most often called a violation of the outflow of urine due to blockage by the stones of the paths - urolithiasis. Inflammatory and infectious pathologies and the formation of a tumor type in the organs of the urinary system and prostate can lead to defects in the discharge of urine in men. Hydronephrotic transformation of the left kidney in women occurs due to fungal and viral infections, against which various inflammations, malignant and benign urogenital organs develop.
Neurological and other disorders
In rare cases, hydronephrotic transformation can be caused by neurological disorders or spinal cord injuries that disrupt the formation and discharge of urine. Another reason can be the injury of several or one urinary organ, due to which scar tissue rapidly grows, which violate the patency of the urethra, ureters and other urinary organs. According to the frequency of diagnosis, the latter becomes a hydronephrotic transformation of both kidneys, which is formed as a result of renal tuberculosis - the multiplication of pathogenic bacillus.
There is a hydronephrotic transformation of the left kidney against the background of influenza.
Classification
In order to prescribe the correct therapy, the hydronephrotic transformation of the left kidney was first classified according to location, time of development, and severity. Renal hydronephrosis can develop as a primary or secondary pathology.
Primary hydronephrosis (it is also congenital) is formed during intrauterine development of the baby. This kind of disease occurs no more than in 1% of newborns.
Secondary (acquired) r idronephrotic transformation of both kidneys is formed due to pathologies of the urinary organs, injuries and diseases of the musculoskeletal system, neurological disorders. Depending on the location of changes in the organs, the disease differs as unilateral and bilateral.
Hydronephrotic transformation of the right kidney is observed in approximately 47% of diagnostic cases. The transformation of the left organ with its characteristic modifications of the pyelocaliceal system is diagnosed a little more often. Six patients out of a hundred have a hydronephrotic transformation of both kidneys.
Symptoms
It is very difficult to determine the pathological process at the initial stage, since the disease proceeds without obvious symptoms. To establish at the first stage hydronephrotic transformation of the kidney, or pyeloectasia, is possible only through instrumental research methods. Mostly, the transition from one stage to another is observed against the background of the development of the process of inflammation, increased mobility of organs, with injuries, urolithiasis and other pathologies of the genitourinary system.
Hydronephrotic transformation in the second and third stages is characterized by the appearance of a pain syndrome localized in the lumbar region on the left or on the right, which depends on which side the disease develops. The pain is paroxysmal, sharp, may intensify with movement or increased load. Depending on the source disease, the pain syndrome can radiate to the groin, pelvic part of the abdomen and the inner femoral surface. Often with inflammation processes, as well as with neoplasms and urolithiasis, pain, burning and pain can occur during emptying of the bladder. Patients are often disturbed by false desires for little need, emptying occurs in small portions, then a feeling of incompleteness of emptying appears. The daily amount of urine output is reduced, sometimes in favor of nighttime urine output.
Signs of intoxication
With the addition of inflammation and in the process of moving along the urinary organs of the stones, the patient shows signs of intoxication, among which the most common are flatulence, nausea, constipation, diarrhea, and vomiting. At the terminal stage and during hydrocalicosis, the patient has sleep disturbances and decreased performance. Complaints of fatigue have been reported. Since the enlarged kidney presses on the vascular system, the renal pressure increases, which provokes the appearance of hypertension. Hydronephrotic transformation also affects general clinical marks of blood and urine. Azotomy, leukocyturia, uremia, proteinuria develop.
Diagnostics
To determine the diagnosis and establish the pathology, the primary source of hydronephrotic transformation of the left kidney in a child and an adult, specialists prescribe instrumental and laboratory studies to the patient. The patient needs to pass urine and blood for bacteriological, general clinical and, if necessary, biochemical analysis. Then the patient is examined, and in the process, the doctor palpates the lumbar region to determine the location of the kidneys and the changes that have occurred here.
External inspection is carried out in vertical and horizontal position. The next stage is an ultrasound examination of the renal vessels and the organ itself.
Treatment: advice from nephrologists
Based on diagnostic information, the specialist will prescribe a treatment aimed at combating the cause of urine discharge defects, normalizing kidney function and eliminating the symptoms that arose against the background of pathology. Based on the information obtained during the examination, the nephrologist advises the patient on conservative or surgical treatment, depending on which one will be more effective.
Conservative treatment
A fairly long therapy is prescribed when a pathology occurs as a result of inflammation in the genitourinary organs (due to urolithiasis). The specialist prescribes a course of medicines and determines the diet. All drugs are prescribed to eliminate infectious and inflammatory processes. Antibacterial and anti-inflammatory drugs are used. For the dissolution and further elimination of calculi, diuretics and uroseptics are prescribed. You can relieve pain with the help of antispasmodic and analgesic drugs. For the treatment of hypertension, ACE inhibitors are prescribed that normalize the pressure in the patient.
Operation
Surgery is prescribed when conservative therapy has not brought the expected results. Also indications for surgical treatment are:
- urolithiasis, not amenable to traditional methods;
- abnormalities in the structure and location of the organs of the urinary system;
- benign lesions that need removal;
- malignant tumors;
- complete termination of the body.
To restore the system’s performance depending on the source that led to the appearance of hydronephrotic transformation, various methods of surgical intervention are used. The most commonly used method is catheterization and stenting, which helps restore urinary outflow. The operation is done under general anesthesia. A special tube is inserted into the ureter or kidney, through which urine is discharged. If diseases of the urinary system become the cause of urinary stagnation, interventions to eliminate these anomalies are used. Endoscopic operations are extensively practiced. With urolithiasis, stones are crushed using the following types of lithotripsy: laser, contact or remote. Less commonly used abdominal open surgery methods. This type of surgical intervention is used when there is a need for kidney transplantation or removal.
Reasons for the development of hydronephrotic transformation of the left kidney in the fetus
The fetal kidneys in the fourth month of pregnancy already have a structure and work like the kidneys of a human adult. It is at this time that an ultrasound specialist can draw the first conclusions about the health of this body through ultrasound. The cause of the ailment is:
- Blocking or obstruction of the ureter in the area of its connection with the pelvis or in the area of connection of the ureter and bladder.
- The development of two, not one ureter.
- The reverse outflow of urine into the kidneys, which can provoke inflammation.
- Polycystic, the result of which is the inferior development of one kidney. In this case, the second in most cases is completely healthy and works in double mode.
- The fetus-boy may have obstruction of the urethra, in which the back valve interferes with the bladder, and he, in turn, eventually stretches the kidney.
- Lifestyle and style of the mother before pregnancy (work with toxic substances, bad habits, living in contaminated places).
- Genetic predisposition (if the first child has problems with this organ, you need to be examined when planning a new pregnancy).
- Past viral pathologies in the first trimester (flu).
Therapy
Any treatment for hydronephrotic kidney transformation during pregnancy is risky because the fetus is very vulnerable. That is why a pregnant woman is only observed with unilateral hydronephrosis. The second kidney of the baby (if only she is healthy) works fully for two. However, the problem is aggravated with bilateral hydronephrosis. In this case, the woman may even be offered termination of pregnancy.
As such, the treatment of hydronephrotic transformation of the left kidney in a newborn is carried out only in the first months of life. However, it may not be necessary in most cases, since the child’s body is so unpredictable that the disease and all its signs disappear without a trace. If the pathology remains, and the baby’s condition worsens, the specialist prescribes either complex therapy or surgery. Usually a favorable result is observed (over 90% of children recover completely after surgery, but constant monitoring is necessary).