Without the excretory system, it is impossible to imagine the work of the human body. One of its components is the kidneys. This is a paired organ, the main task of which is to remove liquid and water-soluble elements. He also takes a direct part in the metabolism and regulation of acid-base balance. In the body of an absolutely healthy person, both kidneys are present. 2.5% of newborns have defects. And although rare, an abnormal absence of a kidney is found.
What is aplasia (agenesis) of the kidney?
The causes, symptoms and treatment methods of such rare diseases will be discussed below. First you need to understand what these terms mean.
In various medical guides you can find a mixture of the two concepts “aplasia” and “agenesis”. Is there a difference between them? Agenesis is the complete absence of one or two kidneys at the same time. This pathology is congenital in nature. In place of the missing organ, there are not even the rudiments of the kidney tissue. Aplasia is a phenomenon in which only a bundle of connective tissue remains in the retroperitoneal cavity. In other words, it is an underdeveloped kidney that is not able to fulfill its function.
In clinical practice, it does not matter which form of the disease is found in the child. In both cases, a full-fledged organ is missing. Unified disease statistics are also not presented. It is known that renal abnormalities make up about 7-11% of all pathologies of the genitourinary system.
History reference
Agenesis of the kidney has been known to mankind since ancient times. Even Aristotle mentioned this ailment in his writings. He argued that if an animal cannot exist without a heart, then without a kidney or a spleen - completely. In the Renaissance, a scientist from Belgium, Andreas Vesalius, became interested in this problem . In 1928, the Soviet doctor Sokolov set about identifying its prevalence among the population. Since then, scientists have identified several forms of aplasia (agenesis), each of which has its own clinical picture and prognosis.
Types of agenesis
There are several classifications of this pathology. The main distinguishes the disease by the number of organs.
- Right-sided renal agenesis (ICD-10 code - Q60.0). This form of the disorder is most often diagnosed in women. Usually, the right kidney is especially vulnerable from birth. It is located below the left and is considered less mobile. In most cases, the paired organ takes over all the functions, and the person does not feel any particular discomfort.
- Left-sided agenesis of the kidney. This form of pathology is rare and difficult to tolerate. The right kidney is less functional. She is not adapted to compensatory work.
Separately, it is worth considering bilateral agenesis. For this kind of ailment, the absence of two organs simultaneously is characteristic. With him, babies rarely survive. After birth, they immediately need a transplant operation. What is bilateral kidney agenesis code? ICD-10 includes this pathology under the code Q60.1.
Forms of aplasia
This renal abnormality is only one-sided. The pathological process can extend exclusively to the right or left organ. In this case, the kidney is usually represented by fibrous tissue in its infancy, but without the pelvis, ducts and glomeruli.
Causes of the disorder
There is no consensus on the causes of renal agenesis in newborns. Doctors have different points of view. Some see the connection of pathology with a genetic predisposition. Others deny this fact.
A long study of the disease and numerous studies have identified several factors, the presence of which increases the likelihood of its occurrence. Aplasia or renal agenesis in the fetus is possible in the following cases:
- Chronic alcoholism, drinking during pregnancy.
- Diabetes mellitus in a future mother in childbirth.
- Past viral / infectious diseases in the first trimester.
- Uncontrolled use of drugs by a woman for 9 months.
The kidneys begin to form in the fetus from the 5th week of his life in the womb. This process continues throughout pregnancy. However, the 1st and 2nd trimesters are considered the most dangerous. At this time, the likelihood of developing pathology, subject to the influence of adverse factors, is quite high.
General clinical picture
Aplasia or agenesis of the kidney may not manifest itself for a very long time. Some mothers do not go for an ultrasound during pregnancy, and after the baby is born, they neglect the tests. As a result, a person does not even know about existing health problems. He learns of an unpleasant diagnosis years later. As a rule, during a preventive examination at school or when applying for a job. In this case, a healthy kidney takes up up to 75% of the functions of a missing or poorly functioning organ. Therefore, a person does not feel any discomfort.
Sometimes a kidney anomaly begins to appear in the child in the first days of life. Among the main symptoms of pathology, doctors distinguish:
- various facial defects (puffiness, wide and flat nose);
- a large number of folds on the body;
- volume stomach;
- low location of the auricles;
- deformities of the lower extremities;
- the displacement of the position of some internal organs.
When it is precisely the agenesis of the kidney in a child that is diagnosed, the ailment is usually accompanied by abnormalities in the development of the genital organs. For example, in girls, a two-horned uterus, vaginal atresia, are detected. In boys, the absence of the vas deferens is detected. In the future, such problems may be complicated by impotence and even infertility.
Diagnostic Methods
An adult is always diagnosed with a renal agenesis disability. However, you must first undergo a comprehensive examination. During its conduct, the doctor collects the patient's history, examines his hereditary predisposition. To confirm the preliminary diagnosis, additional research methods may be required:
- Ultrasound
- Urography using a contrast agent;
- Renal angiography;
- CT
Determine the absence or underdevelopment of the kidneys in the fetus by ultrasound. Already at the first screening study, which is scheduled for the 12-14th week, a specialist can confirm the pathology. After that, a woman is additionally prescribed an additional examination for concomitant malformations.
Therapeutic measures
The only form of the disease that actually poses a danger to life is bilateral renal agenesis. Quite often, a fetus with such a diagnosis dies in the womb or at the time of birth. Also, the likelihood of death in the first few days of life is quite high due to renal failure.
Thanks to the development of perinatal medicine, today it is possible to save a child with this pathology. For this, it is necessary to conduct an organ transplant operation in the first hours after delivery , and then hemodialysis should be done regularly. This method of treating the disease is quite real and is used in practice in large medical centers. However, initially it is necessary to organize a quick differential diagnosis and exclude other malformations of the urinary system.
Unilateral renal agenesis has a favorable prognosis. If the patient’s pathology is not complicated by unpleasant symptoms, it is enough to undergo a routine examination once a year and take the necessary tests. It is also necessary to protect a healthy kidney. Detailed recommendations should be given by the attending physician. As a rule, they include following a diet with the exception of spicy and salty foods, rejection of addictions.
Aplasia is not specifically treated. However, preventive recommendations to strengthen the immune system can not do. It is necessary to eat properly, to avoid infectious and viral diseases. It is also recommended to abandon serious physical exertion.
With a severe form of the pathological process, hemodialysis and even organ transplantation may be required. In all other cases, therapy is prescribed individually, taking into account the nature of the disease and the overall clinical picture.
Prevention Methods
Aplasia and renal agenesis are different according to ICD-10. However, both of these pathologies cause concern for future parents. Is it possible to prevent their occurrence?
If we exclude a genetic predisposition to the disease, then preventive measures are quite simple. Even at the planning stage, the expectant mother should begin to monitor her health (eat right, give up addictions, engage in feasible sports). Such recommendations should be followed after the successful conception of the baby.
If the development of pathology could not be avoided, measures must be taken to eliminate it. With bilateral agenesis, there is a symmetric fetal developmental retardation, oligohydramnios. If an abnormality is detected before the 22nd week of pregnancy, it is recommended that it be interrupted for medical reasons. When a woman refuses her, conservative obstetric tactics are used. It is worth noting that with a unilateral absence of a kidney, a full life is possible. It is only necessary to undergo preventive examinations and examinations from time to time.