Kidney hydronephrosis is a pathological process of enlargement of the renal pelvis and cups. They represent a part of the collector mechanism of the kidney and are interconnected by a neck having a narrow passage. The renal pelvis itself is a special funnel-shaped cavity where the large and small cups of the kidney merge. Before entering the ureter, urine in the kidney is collected here.
The expansion of the renal pelvis and cups is the result of a violation of the outflow of urine. Hydronephrosis of the kidney ICD develops, which is characterized by a pathological increase in the internal volume of the kidney area, limited to cups and pelvis. This, in turn, is caused precisely by a disturbed urine flow. A large volume of fluid produced by the kidneys exerts strong pressure on the walls of the pyelocaliceal region.
All this leads to the inflammatory process of the parenchyma - renal tissue, as a result of which its atrophy begins, the filtering and excretory functions of the kidneys deteriorate. This is what ultimately leads to all the known diseases called renal failure, which at first is partial in nature, and as the disease progresses, go into complete renal failure.
The more neglected the nature of the disease, the greater the danger to life it poses. In the initial stages, the disease responds very well to therapy.
In everyday life and medical practice, the terms "hydronephrosis of the left kidney" and "hydronephrosis of the right kidney" are often used. It is rather descriptive constructions. Modern medical terminology offers more correct definitions: "hydronephrosis on the left" and "hydronephrosis on the right."
In advanced cases, the body is at risk of intoxication with the body's vital products. In such cases, when the kidney loses its functions, it is removed. With the development of a bilateral ailment, both are removed immediately.
What is kidney hydronephrosis? The outcome of the disease will be discussed a bit later in this article.
Types of hydronephrosis
The etiology of the disease allows us to distinguish two of its forms:
- Congenital form - hydronephrosis develops during fetal development. Or it develops at the initial stage of the neonatal period, i.e. immediately after birth.
- Acquired form - a previously healthy kidney is damaged.
Stage (degree) of hydronephrosis
- At the first degree of kidney hydronephrosis, the functions of the organ itself are not impaired, only the enlarged pelvis system is observed.
- At the second stage, the expansion of the pelvis is quite significant, its walls are thinned, and kidney function is reduced by an average of 20%.
- At the third stage, a multi-chamber cavity filled with urine is already detected in the kidney. The decrease in the functional ability of the whole organ reaches 80%.
Causes of hydronephrosis
As already noted above, the development of both congenital and acquired forms of kidney hydronephrosis can be of an investigative nature, i.e. occur not by itself, but as a result of obstructed or complete lack of movement of urine from the pelvis to the bladder through the ureter and urethra. The cause of such a disturbed movement of urine may be the anatomical features of the body and available physiological factors.
Kidney hydronephrosis in children is a fairly common pathology, as a result of which organ function is impaired. This leads to a violation of the outflow of urine with subsequent expansion of the renal pelvis. Depending on the cause of the pathology, a primary and secondary type of illness can be distinguished.
Pathology of a primary or congenital nature begins to develop even in utero in the fetus. If a child has congenital hydronephrosis, then his reason lies in the structural violation of the internal organ. In the process of formation, the urinary canaliculi can become twisted, narrowed or incorrectly positioned, which will cause an incorrect outflow of urine.
Congenital Causes
It is customary to distinguish the following congenital causes of kidney hydronephrosis:
- Anomalies in the structure or location of the ureter, its inflection.
- Urinary tract dyskinesia (narrowing of the lumen inside) at the level at which the kidney, sphincter of the bladder or urethra are located.
- Congenital pathology of the renal artery. It is characterized by the fact that the vessel (renal artery) has an annular shape, as a result of which the ureter is compressed and, as a result, the normal outflow of urine is disturbed.
- Characteristic for premature babies: underdevelopment of the urinary organs and the entire system as a whole.
- Congenital defects of the lower urinary tract (e.g., ureterocele).
Renal hydronephrosis in newborns is also diagnosed.
In children, the congenital form of hydronephrosis is the result of abnormalities in the structure of the kidney and the entire urinary system as a whole.
In addition, in children, the congenital form of hydronephrosis of the right kidney or left can be a consequence of the pathological development of the circulatory system during intrauterine development or even in the first year of life.
Diagnosis and prognosis of hydronephrosis in fetal development
Modern ultrasound machines can detect this defect in fetal development already at the 14th week of pregnancy. However, it should be remembered that moderate expansion of the pelvis of the fetus is also the norm of the intrauterine development process, and usually passes after the first urination of the child or during the first month of the life of the newborn. If normalization of the anatomical parameters of the pelvic system is absent, consultation with surgeons is required, as It was noted above that renal hydronephrosis in newborns is not susceptible to conservative treatment.
In any case, if ultrasound detects abnormalities in the development of the fetus, one should pay attention and consult with specialists. Additional ultrasound may be required.
Acquired hydronephrosis of the left kidney can have causes of impaired outflow of urine from the pelvis, both anatomical and physiological, often resulting from diseases of the central and peripheral nervous system.
It is customary to identify five main factors of anatomical origin, which contribute to disruption of the urine flow through the urinary system:
- The walls of the ureter and pelvis are thickened as a result of neoplasms (tumors).
- Neoplasms are found in neighboring organs and their tissues, resulting in mechanical compression of the ureter, kidney and urethra.
- Defects in the location of the ureter and the kidney as a whole. For example, when the kidney is lowered, the ureter is bent or twisted, adverse conditions are created for the outflow of urine.
- Kidney stones. A very common cause of impaired urination. Stones overlap the gaps of the ureter and pelvis.
- Any injuries, oncological processes can cause both damage and compression of the urinary organs.
Pregnancy is often the physiological cause of hydronephrosis. It is easy to guess that an enlarged uterus can squeeze the ureter and other organs.
Symptoms of hydronephrosis depending on the stage of the disease
At the first stage of the disease, hydronephrosis of the kidney has practically no symptoms. Perhaps increased fatigue and a slight deterioration in well-being in general, of course, this is not a clinical symptom. In the first stages, hydronephrosis is usually diagnosed by chance when a patient comes for other diseases. Or during preventive studies, when an ultrasound of all organs is performed.
As the disease develops, concomitant inflammatory processes occur that give already more pronounced symptoms of kidney hydronephrosis:
- The patient is worried about aching pain in the lumbar. They may be periodic or permanent;
- renal colic;
- symptoms of the gastrointestinal tract in the form of vomiting, nausea, increased flatulence;
- during renal colic, blood pressure rises;
- when urinating, a decrease is first observed, and then an increase in the amount of urine excreted;
- detection of a tumor-like formation in the right or left hypochondrium during palpation;
- blood is detected in the urine, urine may acquire a brownish or reddish hue.
Methods for the diagnosis of hydronephrosis
How is kidney hydronephrosis detected in children and adults? Pathology can develop latently and not have a recurring nature, and symptoms of inflammation may be absent for quite some time. The filtering and excretory functions of the kidneys may also not be impaired. This latent course of the disease can last until the initial form of renal failure has developed. Doctor's advice: if there is a decrease in the amount of urine, its delay, color and concentration have changed, this is an alarm and an occasion to immediately contact a urologist for an examination.
In medical practice, the following methods for the diagnosis of hydronephrosis are used:
- Laboratory tests: OAC and OAM, biochemical blood analysis, urinalysis according to the method of Nechiporenko, according to the method of Zemnitsky.
- Ultrasound of the urinary system.
- X-ray of the kidneys.
- If necessary, MRI (Magnetic Resonance Imaging) is prescribed.
Hardware diagnostics allows you to determine the condition of the kidneys, the degree of their damage, which side hydronephrosis is taking place. For example, with hydronephrosis of the right side, the size of the pelvis region is larger than that of a healthy kidney, respectively, on the contrary, with hydronephrosis of the left side, the size of the pelvis region is larger than that of a healthy kidney on the right. How to treat kidney disease (hydronephrosis)?
Treatment
The treatment of hydronephrosis is urgent, as the disease has a progressive character. The more the disease is started, the less chance there is of success in treatment and the possibility of restoring lost functions. Unfortunately, medicine has not yet found a technique that would 100% restore the lost kidney functions.
Conservative treatment of unilateral or bilateral hydronephrosis with medication does not have a progressive effect. It only allows you to deal with the unpleasant and painful symptoms that accompany this disease.
Surgery is the only way, if not completely eliminated, then at least partially help the kidney. It has already been mentioned that the earlier hydronephrosis is diagnosed, the higher the chance of success of surgery. The prognosis of the further course depends on the stage of the disease. Hydronephrosis can be completely eliminated if the anatomical causes of the suppression of the kidney and ureter are eliminated, as well as if the functions of the kidney have not yet been significantly disrupted.
It is the timely conduct of a surgical operation, as a method of treating kidney hydronephrosis, is of great importance, especially in children. Currently, medicine is already coping well with the elimination and repair of congenital pathologies of the development of the genitourinary system of children. The percentage of successful operations is high, forecasts for life and good health of children are very favorable.
A bit of history and statistics
A couple of decades ago, the diagnosis of hydronephrosis sounded like a sentence. Then, several years later, medicine learned to save the lives of patients with a nephrectomy. In 1991, operations were launched to preserve this body. The essence of the operation was to remove the narrowed area of the ureter.
Nevertheless, at the dawn of the development of surgical discoveries in the field of urology, the statistics of deaths after operations was quite high. The percentage of successful outcomes and predictions among pediatric patients was approximately 37%. The reason for such a high mortality rate in the postoperative and recovery period was the lack of the necessary discoveries in the field of antibiotic therapy, namely broad-spectrum antibiotics, and effective anesthesia measures.
In the modern world, the percentage of recovery approaches 90%. The discovery of minimally invasive methods of surgical operations also played a significant role in increasing the statistics of positive results. This method allows successful operations in children under 1 year old.
Pregnant kidney hydronephrosis, prevention and treatment
Since hydronephrosis has a physiological origin during pregnancy, the goal of treatment is to restore urine outflow with the help of special exercises, physical and breathing exercises. This is due to the fact that the body of a woman is shown only minimal, with the exception of emergency cases, drug interventions. Long walks and adherence to a diet are welcome. The prevention of this unpleasant disease is very important. And only in exceptional cases, when it comes to a serious threat to the life of the mother, can it be recommended to terminate the pregnancy.
The diet of medical nutrition emphasizes the use of foods with a high fiber content, the exclusion of fried foods, boiled or steamed foods are recommended, the minimum content of fatty and salty foods.
Prediction and prevention of the disease
The article has repeatedly focused on the fact that it is the detection of the disease at an early stage that plays a key role in a favorable and effective course of treatment. Of course, better late than never, but another rule works here: the sooner the better. The longer the functioning of the kidney lasts in the regime of impaired outflow of urine, the deeper and wider the damage to the parenchyma. If it is bilateral and is accompanied by an inflammatory process, then the prognosis is extremely unfavorable. Ultimately, the dynamics of the disease leads to the fact that a serious threat to the patient’s life is created, and he needs constant hemodialysis and even a donor kidney transplant.
Knowing what it is - kidney hydronephrosis, and the outcome of the disease, it is very important to regularly undergo examinations, conduct a urinalysis to avoid adverse effects and, in general, the development of the disease.