Pathologies of the urinary system are quite common and occupy a significant place among all somatic diseases. Many diseases are asymptomatic. If an ultrasound scan reveals an increase in kidneys, the causes of this pathological phenomenon should be clarified.
The kidneys participate in the processes of homeostasis and play an important role: they control the composition of the blood, remove from the body the decomposition products of many chemical compounds, toxic substances and excess water. The main indicator of the state of this organ is size. Healthy kidneys function continuously. If a specific pathological process develops, this immediately affects the functionality of this paired organ, and, as a result, an increase in kidney size occurs.
Norm
During life, the size of the kidneys changes: this urinary organ is formed until about 50-55 years, and later on, the mechanisms of irreversible atrophic processes are triggered.
In an adult, a healthy kidney has the following parameters:
- length in women - 8-10 cm, in men -10-12 cm;
- width - 4-5 cm and 5-6 cm.
There are a number of aspects that must be taken into account for the correct assessment of parameters:
- Individual characteristics of the body, in which a change in the size of the kidneys up to 15-20% is permissible.
- Elderly people are characterized by the disappearance of the fat layer of this organ, whose width in healthy people is approximately 12 mm.
- One kidney may be slightly larger than another.
With an asymptomatic course of pathology, an increase in the kidney helps to detect palpation and ultrasound.
Kidney size in children
In newborns, the weight of the kidney is approximately 10–12 g. During the first year of life, the weight of the paired organ reaches 35 g, and the size increases by 1.5–2 times. The main difference in the structure of the kidneys in infants and children up to 1 year old is the immaturity of the cortical layer, where the filtering part is located - the Bowman capsule, as well as the descending and ascending loops. The thickness of the cortical layer is not more than 2 mm, while the cerebral layer is 8 mm. As the child grows and grows up, the cortical layer increases by 4–5 times.
Below are the norms of the size of the kidneys for children of different ages:
- 1 month: length - 4.2 mm, width - 2.2 mm;
- 6 months: length - 5.5 mm, width - 3.1 mm;
- 1 year: length - 7.0 mm, width - 3.7 mm;
- 6 years: length - 7.9 mm, width - 4.3 mm;
- 10 years: length - 9.8 mm, width - 5.2 mm;
- 15 years: length - 10.7 mm, width - 5.3 mm.
Symptoms of kidney enlargement
If at the initial stage of the disease the increased size of the organ does not cause concern, then with the advanced form, the pathology is accompanied by many symptoms. It is at this stage that the diagnosis of disorders in the work of the genitourinary system is most often carried out.
Symptoms of kidney enlargement:
- pain in the lumbar region, aching nature of pain;
- frequent, painful urination, there is blood in the urine;
- an increase in body temperature, which is typical for kidney infiltration;
- puffiness resulting from a violation of urination.
Causes of pathology
The main cause of kidney enlargement is serious diseases of the urinary system. The exception is a congenital pathology or a situation where the patient has only one kidney that performs double work.
A common cause of acute symptoms of an enlarged kidney is pyelonephritis. In the inflammatory process, which has an infectious nature of origin, aching pains, fever, painful urination, nausea occur. The disease occurs as a result of infection of the urinary canal by various pathogenic bacteria. Untreated inflammation becomes chronic and is characterized by periodic exacerbations.
In addition, a pathology such as hydronephrosis leads to an increase in kidney in adults. This is a progressive disease in which urine accumulates in the renal pelvis. Over time, its abnormal amount leads to a change in the size of the cups, and subsequently to a direct increase in the kidney.
Hydronephrosis is a severe form of complications provoked by a number of serious acquired or congenital pathologies. This disease is fraught with the development of irreversible pathological processes in the renal tissues.
Symptoms and causes of hydronephrosis
This chronic disease can lead to oncological degeneration of the kidney. Women are more susceptible to the disease, in men this disease is much less common. In 95% of cases, it affects only one kidney. The main cause of the primary type of hydronephrosis are congenital anomalies of the urinary canal. The secondary type of disease occurs as a result of acquired pathologies. The reasons for the development of secondary type hydronephrosis can be:
- urolithiasis disease;
- diseases of the genitourinary system;
- narrowing of the urethra, provoked by injuries;
- malignant tumors of the genitourinary system, abdominal cavity, pelvis, spinal cord.
Stages of the disease
The initial phase of hydronephrosis is characterized by a slight increase in the size of the pelvis, proceeds without severe symptoms. Perhaps malaise, decreased performance.
At the second stage, the organ ceases to function properly due to a significant increase in the pelvis, the walls of which become thinner, the kidney itself also increases. There are constant pain in the lumbar spine, attacks of hypertension, nausea.
At the third stage of the disease, the kidney increases twice, a marked violation of its functionality is noted. Urine becomes cloudy, with impurities of blood. The disease at this stage is difficult. With a complete loss of function, the diseased kidney is removed.
Cyst
Kidney cysts often become a factor in the increase of this organ in size. The main cause of kidney cysts is the accelerated growth of epithelial structures in its tubules. Most often, this similar phenomenon occurs due to injuries, a hereditary predisposition, infectious and parasitic pathologies. Sometimes a kidney cyst is congenital and is formed as a result of the loss of communication of the urinary structures with the embryonic tubules.
In most cases, the spectrum of symptoms that occur with a kidney cyst includes:
- organ enlargement;
- recurrent urinary tract infections;
- the presence of urine in the blood due to increased pressure in the kidney and impaired vascular integrity;
- pains in the lower back or side resulting from an increase in the size of the organ, due to which nearby organs are compressed;
- fluid accumulation in the kidney;
- the presence of protein in the urine;
- increase in blood pressure.
If a concomitant infectious disease occurs against the background of the development of a kidney cyst, signs of pyelonephritis appear.
An increase in this organ in children
As a rule, an increase in the kidney in a child occurs without the presence of specific symptoms. However, an increase in temperature, back pain, and problems with urination can be observed.
Pieloectasia in children is the initial stage of kidney enlargement. This pathology is prone to rapid progression.
At subsequent stages, the disease affects the entire pyelocaliceal complex. Difficult urination is more pronounced. With more advanced forms, renal tissue is depleted, the kidneys stop working fully or become incapacitated. To high numbers, the baby's body temperature rises.
The reasons for the increase in the kidney in a child may be several:
- maternal alcohol abuse during pregnancy;
- genetic predisposition;
- vesicoureteral reflux;
- defects in the development of the kidneys;
- prematurity;
- violation of innervation;
- impaired urine flow;
- tumor process;
- excessive amount of fluid in the body;
- urinary tract infections or obstruction.
Diagnostics
A traditional plan for diagnosing a patient with renal pathologies includes:
- collection of medical history and complaints;
- clinical medical examination;
- percussion and palpation of the kidneys;
- determination of the presence of Pasternatsky's symptom;
- laboratory diagnostics: general urine and blood tests, biochemical blood tests, Zimnitsky test, urine analysis according to Nechiporenko.
The list of methods for instrumental diagnosis of the causes of kidney enlargement includes:
- Ultrasound of the kidneys;
- CT, MRI;
- excretory urography.
Treatment principles
The treatment regimen for kidney enlargement for each patient is made individually. First of all, the causes of this pathological phenomenon, the age of the patient, and concomitant diseases are taken into account. Infectious and inflammatory processes are an indication for antibacterial and supportive treatment.
If endocrine diseases became the cause of kidney enlargement, this pathology is corrected by the appointment of hormonal medications. Congenital malformations, as well as diseases accompanied by impaired urine flow or the occurrence of a pathological formation in the structure of the kidney, are treated surgically.
Modern medicine has minimally invasive and effective surgical techniques that help eliminate existing problems and practically do not cause negative complications.
With kidney hydronephrosis, conservative therapy is ineffective. It can be aimed at eliminating pain, suppressing and preventing infection, reducing blood pressure, and correcting kidney failure in the preoperative period. An emergency method for acute hydronephrosis is percutaneous nephrostomy, which allows you to remove urine accumulated in the kidney and reduce pressure in the organ.
The types of surgical therapy for hydronephrosis are different and are determined by the cause of the pathology. They are divided into organ-preserving, reconstructive and organ-removing. Treatment for kidney augmentation in adults and children should be comprehensive and timely.
In case of urolithiasis, lithotripsy or surgical removal of stones from the site of obstruction is performed. Removal of an enlarged kidney (nephrectomy) is resorted to in the absence of its functionality and the risk of complications. With intrarenal cysts, surgery is also performed.
We examined the causes and treatment of kidney enlargement in adults and children.