Such a pathology as kidney reflux, the symptoms of which are not clearly expressed at the initial stages, is rare. In most cases, the disease affects children and the elderly. Consider the causes of the disease, types, degrees of development, signs, as well as how to diagnose and treat.
What is vesicoureteral reflux of the kidney?
Normally, the pressure in the bladder, when full, should cause the canal to close. Thus, urine exits through the urethra. Reflux, which is translated from Greek as “reverse movement”, is a violation of the outflow of urine, during which it returns to the urea. Such a pathology is possible with an inoperative, underdeveloped or weak valve.
Each time when the bladder is filled, part of the urine returns to it, and over time, a change in the capacity of the organ is observed. In this case, urine can be thrown both while going to the toilet in a small way, and as the bladder fills. Urine reflux in the kidneys in the first stages of the disease does not manifest itself. It can be detected only by examining the pelvic organs.
Types of pathology
Urologists divide such a pathology as vesicoureteral reflux of the kidney into active and passive. With the active form of the disease, the backflow of urine into the ureter occurs only during urination. At this time, the muscles of the bladder come in tone, and simultaneously with the release of urine outward, urine is poured into the ureters, and then into the kidneys. During this, a person may feel lower back pain and discomfort when going to the toilet. Such a pathology is most often caused by valve insufficiency.
With a passive form of reflux, urine is thrown back as the organ is filled with urine. In this case, valve insufficiency is more pronounced, and urine returns continuously. The volume in this case depends on the degree of violation, the condition of the valve and the ability of the urine to contract.
Doctors also classify pathology according to:
- etiological factor - it can be congenital or acquired;
- by nature - unilateral or bilateral;
- during the course of the disease - constant or intermittent.
It is noted that even a slight violation in the valve or the anatomical structure of the bladder can lead to reflux and significantly affect the normal functioning of organs.
Degrees of disease
There is a generally recognized classification according to which urologists establish the degree of pathology. It is on this that the future choice of treatment for kidney reflux depends.
Levels of reverse urine reflux into the ureter according to classification:
- First degree. Due to valve insufficiency, a slight reflux of urine occurs. In this case, the structure and volume of the bladder does not change. At this stage, there are no pronounced symptoms, and complications, both infectious and non-infectious, are minimal.
- Second degree. Outflow of urine is observed throughout the ureter, but without dilatation, that is, urine does not reach the kidney area. At this stage, pathology can progress, although there are also no obvious signs. It can be detected during a planned or preventive examination of the pelvic organs.
- Third degree. Urine reaches the area of the kidneys and reduces their functionality by 20%. At the same time, the ureter increases in size and its structure and tissues are modified. Symptoms are moderate and the risk of infection is increased.
- Fourth degree. The ureter increases significantly in volume. Kidney function is reduced by 50%. A person feels significant discomfort, body temperature rises and swelling appears. If the process is two-way, this can pose a threat to the life of the patient.
- Fifth degree. Symptoms are pronounced. The ureter not only increases in size, but also bends. Itching appears on the skin, diuresis, nausea and vomiting. Here you can’t do without medical help.
Causes of occurrence
Depending on how and when kidney reflux develops, it can be primary and secondary. In the first case, it is due to congenital anomalies, that is, the abnormal formation of organs occurs even during the intrauterine development of the baby. The reverse outflow of urine may be due to a doubling of the ureter, gaping or dystoria of the mouth, as well as a short submucous tunnel in a particular section of the ureter.
The secondary form does not occur independently, but against the background of other pathologies of the urinary system.
Among the causes of secondary reflux are:
- stenosis of the neck of the urea;
- urethral canal structure;
- prostate adenoma;
- bladder inflammation (cystitis);
- damage to the shape or structure of the ureter during surgery.
Symptomatology
Symptoms of kidney reflux for a long time are hidden. In the initial stages, the patient may experience minor and periodic aching pain in the lumbar region. They often appear after urination. Children who are not yet able to describe the nature of the pain may complain of pain in the lower abdomen, as well as in the groin.
The manifestation of the disease depends directly on the degree of pathology. If at the first stage the urine comes back in small quantities, then symptomatically this process will not manifest itself in any way. Starting from the third degree, there is an expansion and modification of the structure of the ureter. Often, the patient has all the signs of pyelonephritis, namely: the temperature rises, health worsens, urine becomes dark and cloudy and pains appear in the lower abdomen.
In most cases, reflux can be detected already at the stage of development of complications. It can manifest itself in the form of frequently appearing cystitis, chronic pyelonephritis and enuresis.
Possible complications
Regardless of the reasons that led to the injection of urine into the ureter and kidneys, reflux is fraught with the development of various kinds of complications. A high risk is that in the initial stages of the pathology does not manifest itself.
Complications that occur most often with reflux:
- pyelonephritis;
- hydronephrosis;
- chronic renal failure;
- hypertension of the kidneys.
Despite the fact that such pathologies, both in symptomatology and in the course of diseases, are different, one common factor can provoke them - incorrect urine outflow. Also, a stagnant urethra in the ureter is an excellent medium for the development and propagation of infections.
Diagnostics
If urine is thrown into the kidneys during reflux, it means that the pathology has already passed to the third stage and began to manifest certain symptoms. The first and second degree of the disease can only be noticed by chance at a routine examination in the presence of other complaints or pathologies in the patient.
In order to accurately diagnose and determine the degree of development of the disease, a number of diagnostic procedures are performed:
- a patient’s history is being collected - the doctor should find out if there have been cases of pathologies associated with the patient’s urinary system in the past;
- visual examination and pressure measurement, which excludes or confirms renal hypertension;
- laboratory methods - a general analysis of urine (elevated ESR and white blood cells indicate inflammation in the body), blood biochemistry helps to evaluate kidney function;
- excretory urography - an x-ray with contrast shows which channel the urethra passes from accumulation to exit (are there any abnormalities or bends in the structure of the organ);
- Ultrasound - done on a full bladder and immediately after urination, this allows you to assess how full the urine is and how it is then emptied, as well as to reveal the structure of tissues and possible abnormalities of the development of the urinary system;
- mixed cystography - diagnoses whether there is a return flow of urine to the ureter and to what extent it is carried out using a contrast medium, which subsequently appears in the pictures.
Treatment
A specialist will talk about the symptoms and treatment of kidney reflux. Therapy primarily depends on what caused the pathology, on the age of the patient and the severity of the disease. In the initial stages, conservative treatment is performed. This period is characterized by inflammatory processes of the lower parts of the ureter and does not affect the region of the kidneys, so you can limit yourself to drug therapy.
When contacting a urologist for help in the first three stages of development, the percentage of the patient’s full recovery is up to 70%.
Conservative therapy is as follows:
- Diet. It is important in pathology to reduce salt intake to a minimum, refuse smoked meats, fatty foods, switch to vegetables, fruits and cereals. Taboo for alcohol, soda and strong coffee.
Medications. It can be antibiotics, anti-inflammatory drugs, antispasmodics, depending on the degree of spread of the inflammatory process and infection. If the pressure is increased, drugs are prescribed to reduce it.
Physiotherapy. Therapeutic baths, magnetotherapy, electrophoresis reduce the inflammatory process, remove cramps and restore the physiological current of the urethra.
Kidney reflux surgery in adults
As a rule, conservative therapy is carried out for six months. If there are no improvements during this time, moreover, complications arise in the form of recurrent pyelonephritis and a decrease in kidney function, surgical intervention is indicated.
At the initial stages of the development of pathology, with the 1st and 2nd degree of reflux, endoscopic correction is performed. By injection, volume-forming implants are introduced into the area of the mouth of the ureter. They perform a strengthening function. The basis of implanted implants is collagen, Teflon or silicone. These materials are hypoallergenic, durable, have good compatibility with human organs.
With kidney reflux, surgery is also performed if the pathology has gone into a high degree of severity. Laparoscopic laureterocystoneostomy is indicated for the 3rd or 5th degree of pathology. At this stage of the development of the disease, the walls of the ureter have already changed significantly, therefore, the removal of pathological sites is quickly carried out, as well as the creation of an artificial connection of the ureter with the ureter. This operation can be performed with resection of a part of the ureter or with a kidney transplant.
Forecast and Prevention
With kidney reflux, it is important to diagnose in a timely manner. Only in this case can pathology be stopped or treated with conservative therapy. If complications or the disease is accompanied by pathological changes in the kidneys, then surgery can not be avoided.
There are no special preventive measures, except for preventive diagnostics. It is worth protecting the back and pelvic organs from injuries, hypothermia, treating any inflammatory processes of the urinary system in a timely manner and reducing salt intake.
Output
Kidney reflux, depending on the type (congenital or acquired), as well as on the degree, is a treatable disease. Often, pathology can be eliminated by conservative methods, but if the disease is neglected, surgical intervention is indicated. It is important to undergo timely diagnosis, as the disease develops for a long time and does not manifest itself in any way. At the initial stage, it can be detected by chance when examining the pelvic organs.