In modern pediatrics, quite often there are various pathologies of the excretory system. And sometimes during a preventive check, doctors note that the pelvis of the kidney is enlarged in the newborn. Naturally, such a diagnosis makes parents panic and look for more information about this pathology. So how dangerous is it? Is it possible to notice symptoms of pyeloectasia on my own? What treatment will the baby need? What are the complications of the disease? Answers to these questions will be useful to many parents.
Renal pelvis: what is it? A brief digression into anatomy
It's no secret that the kidneys are an important excretory organ. And in order to understand what pyeloectasia is, you need to briefly familiarize yourself with the anatomical features of the human body.
Kidneys are paired organs located behind the parietal sheet of the peritoneum in the lumbar region. Each kidney is covered with a dense fibrous capsule, directly under which there is a parenchyma consisting of cortical and brain substance - this is the internal part of the organ, in the thickness of which there is a system of accumulation and excretion of urine.
The smallest elements of the system are the renal calyxes, which merge together to form larger cups. In turn, the so-called renal pelvis is formed from the complex of cups. What it is? This is the structure in which urine is collected and delivered to the ureter. The right and left ureters carry it directly into the bladder.
When can we say that the renal pelvis is expanded? Norm and pathology
Naturally, in order to determine whether a child has a pathology, it is necessary to compare the parameters with acceptable values. So what size should the pelvis be normal? Here a lot depends on the age of the child:
- for the fetus up to 32 weeks of pregnancy, the norm is 4-5 mm;
- in a fetus 32-36 weeks, these indicators should be equal to 7-8 mm;
- the size of the pelvis of the newborn baby should not exceed 7 mm.
So what is pyeloectasia? This is a pathology that is characterized by enlargement of the renal pelvis. It is immediately worth noting that this is not an independent disease - it appears as a result of existing abnormalities of the urinary system. By the way, this pathology can manifest itself both before and after the birth of the baby.
Pathology classification
There are several ways to classify a disease. For example, pyeloectasia in a child can be right-sided, left-sided, and bilateral. In addition, take into account the reasons and the moment of expansion of the pelvis, dividing the ailment into:
- congenital organic expansion (is the result of abnormal intrauterine development of the urinary system);
- congenital dynamic expansion - associated with impaired urine outflow, usually diagnosed in newborns;
- acquired pyeloectasia of a kidney in a child - develops after birth as a result of an injury to the organs of urination or an inflammatory process in the excretory system;
- acquired dynamic expansion - is recorded with urolithiasis or the presence of tumors.
The main causes of the development of pathology
If during the examination it was found that the pelvis of the kidney is enlarged in the newborn, then it is important to determine the cause. As a rule, a change in size is associated with a violation of the outflow of urine - fluid accumulates in the pyelocaliceal system of the kidney, causing its expansion. In turn, a violation of the outflow of fluid can be associated with various pathologies.
The causes include narrowing of the ureter or its inflection. Sometimes, for one reason or another, the valvular apparatus of the ureteropelvic junction forms incorrectly, as a result of which urine begins to accumulate in the kidney. Pioelectasia in a child may be associated with muscle weakness - this is observed among premature babies.
Sometimes the ureters are compressed by vessels or other nearby organs, especially if there are various abnormalities in the development of the fetus. Risk factors include the presence of tumors (including benign), as well as urolithiasis, since organic or mineral formations can clog the lumen of the ureters, disrupting the normal outflow of fluid.
It is proved that there is a certain genetic predisposition. Risk factors include severe pregnancy (the presence of preeclampsia, eclampsia), as well as acute inflammatory lesions of the mother's kidneys during gestation.
What are the symptoms of the disease?
Pielectasis in a child, as a rule, proceeds without any symptoms. Sometimes some non-specific signs can be noted - the baby often cries, from time to time loses his appetite, becomes restless.
Older children sometimes complain of discomfort in the lower abdomen and in the lower back. Painful syndrome and difficulty urinating are also possible, but they are usually associated with complications of pyeloectasia, including the formation of kidney stones or the development of inflammatory diseases.
Why is pyeloectasia dangerous? Possible consequences
In most cases, a child’s pyeloectasia is benign. Nevertheless, there is a likelihood of developing complications, so their list should be familiarized with:
- Due to increased pressure in the bladder, a rapid increase in the ureters (megaureter) is possible, followed by their stenosis.
- In boys, valve damage to the back of the urethra is sometimes observed.
- Complications include vesicoureteral reflux, in which there is a reverse flow of urine into the renal structures.
- Bloating of the ureters (urethrocele), the result of which is a violation of normal urination.
- If the pelvis of the kidney is enlarged, then this creates the conditions for the development of urolithiasis in a child.
- Hydronephrosis is a pathology in which there is a sharp expansion of the pelvis, while the ureter remains normal.
- The ureter can flow into the urethra or vagina (ectopia).
- Violation of the normal outflow of urine can lead to the development of pyelonephritis and sclerosis of the kidney tissue.
Methods for the diagnosis of pathology
How to find out that the pelvis of the kidney is enlarged in the newborn? This can be done using ultrasound examination of the kidneys and abdominal cavity. By the way, according to statistics, the right kidney is affected more often than the left. There is another regularity - due to physiological characteristics, boys are more prone to pyeloectasia. On the other hand, they are usually diagnosed with a mild degree of pathology, which quickly passes by itself.
Additionally, x-ray studies are carried out, including cysto and urography. Normally, the size of the pelvis after urination should not change - this is another sign of pathology that can be detected during the tests.
This violation can be noticed even before the birth of the baby. Starting from the 17th week of pregnancy during an ultrasound examination, an experienced doctor may notice changes in the size of the renal pelvis.
Are there effective treatments?
Intrauterine treatment of the fetus is not carried out. Quite often, with growth and intrauterine development, the problem disappears by itself even before childbirth. If the pelvis of the kidney is enlarged in the newborn, then the doctor after conducting the studies can draw up an effective treatment regimen.
Naturally, it is impossible to reduce the size of the pelvis with the help of drugs. And therefore, drug therapy is reduced to taking drugs that facilitate the outflow of urine. Treatment depends on the presence of complications. With inflammation, anti-inflammatory drugs are prescribed, with urolithiasis - drugs that can dissolve small mineral formations and accelerate their excretion.
Every three months it is necessary to undergo ultrasound diagnostics. So the doctor has the opportunity to track the dynamics of the development of the disease. According to statistics, in most cases, pyeloectasia passes by itself, the size of the pelvis comes back to normal as the child grows.
In the most severe cases, surgical intervention is required. The operation is indicated in cases where the pathology continues to progress, in connection with which the functioning of the kidneys is impaired. The indication is the presence of complications, including vesicoureteral reflux, ectopy, urolithiasis. As a rule, endoscopic surgical methods are used to avoid abdominal surgery and a long rehabilitation period.
Prevention of Complications
Unfortunately, there are no specific preventive measures. Naturally, it is recommended that a pregnant mother carefully monitor the state of health, immediately undergo treatment for various inflammatory diseases and do not forget about planned ultrasound examinations of the fetus. If the pathology is diagnosed during the period of intrauterine development, the doctor will carefully monitor the condition of the newborn, which will help to avoid the development of complications.
The same rules must be followed after the birth of the baby - every 3-6 months it is necessary to do an ultrasound of the genitourinary system.