Causes of kidney hydronephrosis and pathology diagnostics. Methods of treatment and degree of hydronephrosis of the right kidney Chronic hydronephrosis of the left kidney

Hydronephrosis is one of those pathologies that doctors call the "silent killer". The disease affects the kidneys, causing them to enlarge and then die. In most cases, the patient does not experience severe pain, so he does not even attach importance to some of the symptoms characteristic of the disease. Meanwhile, the lack of timely and proper treatment can lead to the development of serious consequences, and sometimes even death.

What is hydronephrosis

Hydronephrosis is a progressive pathology in which the kidney gradually expands as a result of a disturbed outflow of urine. The disease, in the absence of adequate treatment, leads to the death of the organ.

Hydronephrosis is a condition in which urine accumulates in the renal pelvis.

The kidney consists of a parenchyma that produces urine, and a pelvicalyceal apparatus that ensures the excretion of this fluid through the ureters into the bladder. This is how a healthy organ functions. If there is a narrowing of the ureter, then the outflow of urine is reduced. Fluid begins to accumulate in the pelvis. This leads to the expansion of the kidney, or, in the words of physicians, to hydronephrosis.

With this pathology, pressure increases in the pelvis, blood supply and nutrition of the organ worsens. Gradually begin to develop functional disorders. The kidney loses its ability to produce urine and turns into a "sack" filled with urine. An infection can easily penetrate into such an organ, leading to purulent inflammation. Neither immunity nor antibiotics act on the affected kidney, so the only way to save the patient's life is surgical excision of the organ.

Hydronephrosis is also called hydrocalicosis, uronephrosis, or hydronephrotic transformation.

Classification of pathology

In urology, several classifications of hydronephrosis are used.. Depending on the origin, the pathology can be:

• Primary (or congenital). Hydronephrosis is provoked by anomalies of the urinary system. Such a pathology is most often laid down during fetal development and is diagnosed in childhood.
• Secondary (acquired). The disease develops against the background of ailments occurring in the body. Such hydronephrosis serves as a complication of pathologies (for example, urolithiasis).

In accordance with the localization, hydronephrosis can be:

• unilateral (right-sided or left-sided) - only one kidney (right or left) is affected;
• bilateral - this is a rather rare type of hydronephrosis (diagnosed in approximately 5–8% of all cases), with this pathology, there is a violation of the outflow of urine in both kidneys.

Depending on the nature of the process, hydronephrosis occurs:

• closed - the pathology is characterized by complete obstruction of the urinary tract;
• open - urine output is partially preserved;
• intermittent - the outflow of urine is preserved only in certain postures of the body.

According to the type of course, pathology can be:

• acute - develops within a few days, has vivid symptoms, with such hydronephrosis, the kidneys can be restored;
• chronic - associated with the gradual destruction of the organ, the disease develops over several months, the lost functionality of the kidneys most often is not restored.

Depending on the presence or absence of an infectious process, hydronephrosis occurs:

• infected - the pathology is complicated by a bacterial infection;
• aseptic - there is no infectious and inflammatory process in the urinary system.

Quite often, calculous hydronephrosis is diagnosed. This is a pathology in which stones are found in the kidneys.

Degrees of disease

During hydronephrosis, doctors distinguish 3 stages:

1. The first degree is considered the easiest. The renal pelvis is slightly distended. It accumulates about 10 ml of urine. Despite the enlargement of the kidney, the organ still copes with its functions. Symptoms at this stage are little or completely absent.
2. Hydronephrosis of the second degree is characterized by the accumulation of more fluid in the pelvis. The pressure on the tissue increases. The kidney begins to atrophy. Healthy tissues are replaced by fibrous ones. Kidney function is reduced by up to 40%. It is still possible to save the organ at this stage.
3. Hydronephrosis of the third degree is accompanied by severe structural and functional disorders of the kidneys. Such changes are already irreversible. The kidney is enlarged by 1.5–2 times, the tissues are almost completely atrophied. At this stage, organ death is inevitable.

Hydronephrosis in its development goes through 3 stages, each subsequent one is characterized by a sharp decrease in the functioning of the organ

The causes of congenital hydronephrosis are associated with the anatomical features of the child's body and are in the following anomalies:

• urinary tract dyskinesia (urination disorder caused by atony or spasm of the ureter);
• pathological localization of the ureter;
• incorrect position of the arteries of the kidneys, providing pressure on the ureter;
• obstruction of the urinary tract (difficulty in the outflow of urine), provoked by narrowing of the ureter.

An experienced specialist can notice pathological disorders of the kidneys even during fetal development during an ultrasound examination.

Hydronephrosis has several causes, either congenital or acquired.

The causes of acquired hydronephrosis are varied. Pathological disorders can affect the ureter, bladder and even the urethra. The following factors leading to the development of hydronephrosis are known:

• Obstruction (obstruction or narrowing) in the area of ​​the ureters. This pathology can be caused by the following groups of reasons:
  
• Bladder obstruction. The following groups of reasons can impede the outflow of urine:
  • Internal problems. Hydronephrosis can provoke the following pathologies of the bladder:
    • neoplasms;
    • the presence of stones;
    • bladder diverticula;
    • cystocele (bladder prolapse);
    • fibrosis of the neck of the organ.
  • external reasons. Difficulty in the outflow of urine can be triggered by pelvic lipomatosis (a pathology in which many lipomas form in fatty tissue).
• Obstruction of the urethra (urethra). The following reasons can cause a violation of the outflow of urine:
  

At-risk groups

The following categories of people are most susceptible to the development of hydronephrosis:

• elderly people;
• children;
• the population living in the radioactive zone;
• workers in contact with heavy metals and pesticides;
• people leading a sedentary lifestyle.

According to statistics, hydronephrosis is more often diagnosed in women than in men. This is due to the structure of the genitourinary system and the bearing of a child.

Video: causes and manifestations of pathology

Symptoms of hydronephrosis

The clinical picture of hydronephrosis depends on the rate of development of the pathological process, the site of obstruction and the stage of the course.

It seems to me that it is almost impossible to independently determine renal pathologies. One day my friend decided to sign up for a pool. Naturally, she had to go to the doctor for help. The therapist carefully looked at my friend, who, probably, did not appear in the hospital for 5 years, gave her a whole list of referrals for laboratory and instrumental studies. The unfortunate was indignant, but still went to undergo a medical examination. The results showed that one of her kidneys was enlarged. The doctor referred her with suspicion of hydronephrosis to a urologist. Surprisingly, a friend never complained of discomfort in the lower back.

Signs of chronic pathology

With a slow blockage (chronic course), the patient may complain of the following symptoms:

• periodic aching pain in the lower back on the affected side;
• increased discomfort after physical activity;
• gradual decrease in working capacity, the appearance of chronic fatigue;
• causeless increase in pressure;
• the appearance of blood in the urine.

In chronic hydronephrosis, pain in the lower back may occur periodically

Acute manifestations

If the process of obstruction develops rapidly, then a person may experience the following symptoms:

• severe pain - discomfort is localized in the lower back, sometimes it can radiate to the groin, genitals, leg, the pain is very sharp, acute, in its strength resembles renal colic;
• increased urge - the patient is faced with an urgent desire to often run to the toilet, while the urge to urinate may be false;
• the presence of blood in the urine - sometimes streaks of blood are visible in urine, but most often they are invisible to the human eye, and hematuria (blood in the urine) is determined only in the laboratory;
• nausea - such discomfort often occurs when stones move along the ureter, as a result of which the outflow of urine is disturbed, nausea can turn into vomiting, which does not bring relief;
• manifestations of intoxication - if an infection joins, then the patient is faced with a sharp increase in temperature (sometimes even up to 40 ° C), severe headache, chills;
• jumps in pressure - such hypertensive crises are very poorly stopped by medications, patients may complain of increased heart rate;
• a feeling of weakness - the skin gradually turns pale, sweat increases, the patient complains of severe weakness.

The following symptoms are characteristic of the last stage of hydronephrosis:

• swelling of the legs and face;
• the appearance of shortness of breath;
• a sharp decrease in pressure;
• loss of consciousness;
• cessation of urine output.

Swelling of the legs can signal progressive hydronephrosis

If hydronephrosis has affected both kidneys, then the patient's risk of developing renal failure is very high. Failure of both organs can be fatal. This patient requires urgent hospitalization.

Diagnostic methods

If you suspect renal pathology, the patient should contact a urologist or nephrologist. The doctor will initially examine the patient, ask him about the disturbing symptoms. During palpation (palpation), the doctor can detect bladder distension or kidney enlargement, but such data is not enough to make a diagnosis, so doctors prescribe a comprehensive examination.

Diagnostics includes the following studies:

• Analysis of urine. Such a study reveals typical signs of impaired renal function. In the urine, streaks of blood, leukocytes, and purulent discharge can be detected.
• Blood analysis. An increase in ESR and leukocytes in the blood indicates the development of an inflammatory process in the body.
• Biochemistry of blood. This analysis in the case of the development of hydronephrosis will show an increased level of creatinine, urea.
• Ultrasound examination of the kidneys. Diagnosis is carried out in different positions (on the back, side, abdomen). Ultrasound determines the size of the kidneys, assesses the condition of the parenchyma, cups, pelvis. The study gives an idea of ​​the patency of the ureter and the presence of stones in the kidneys.

  The doctor can see the pathological expansion of the kidney with the help of ultrasound

• X-ray contrast studies. With the help of a contrast fluid injected into the urethra or into a vein, the rate of accumulation of urine in the kidneys is determined, the narrowing of the ureter is detected, and the place of blockage with stones is identified.
• Endoscopy. An endoscope is used to examine the condition of the urinary tract.

  Endoscopic research method helps to determine the condition of the urethra, bladder and lower ureters

• Dynamic nephroscintigraphy. This is a radioisotope method that allows you to assess the degree of impaired renal blood flow.
• Magnetic resonance or computed tomography. MRI and CT are recognized as the most accurate diagnostic methods. Such studies allow you to determine the causes of obstruction, to clarify the degree of damage to the kidneys.

Hydronephrosis causes symptoms similar to some other ailments. Therefore, the urologist necessarily conducts a differential diagnosis with urolithiasis, nephroptosis (prolapse of the kidney), and polycystic disease.

Treatment of hydronephrosis

Methods of treatment of hydronephrosis in each case are selected individually. The tactics of dealing with pathology depends on the cause of the disease, the severity of obstruction of the urinary system, the individual characteristics of the patient.

The patient is prescribed complex treatment, which may include the following areas:

• drug therapy;
• dieting;
• physiotherapy methods;
• folk remedies.

In case of failure of conservative treatment, urologists recommend surgical intervention.

Medical therapy

For the treatment of hydronephrosis, the following groups of drugs can be prescribed:

• Painkillers. Such drugs are prescribed during the acute form of hydronephrosis. These drugs effectively relieve pain. The following medications may be included in therapy:
• Tempalgin;
• ibuprofen;
• Ketoprofen.

Photo gallery: medications for hydronephrosis

Baralgin reduces pain No-shpa relieves spasms Ceftriaxone helps fight bacterial infection Kanefron reduces the severity of the inflammatory process Trental restores renal blood flow

Diet food

The diet is selected by the doctor individually for each patient. The choice of therapeutic nutrition depends on the cause, nature and stage of the course of the disease.

The basic principles of nutrition for hydronephrosis are based on the following recommendations:

• Fluid intake should be moderate. During the day, doctors advise drinking about 1.5-2 liters of water.
• You need to eat 5-6 times a day. In this case, all portions should be small.
• Preference is given to boiled, stewed, baked dishes. It is advisable to give up fried foods, which increase the burden on the kidneys.
• Salt should not be abused. Nutritionists advise limiting the intake of this spice to 2–2.5 g per day.

Table: useful and harmful products

Photo gallery: useful products for hydronephrosis

With hydronephrosis, it is useful to eat fresh vegetables Doctors recommend including walnuts in the menu The diet for hydronephrosis is enriched with low-fat dairy products Nutritionists advise eating cereals The diet must include fruits, berries as a source of vitamins and minerals

Surgery

Surgery is the main method of dealing with hydronephrosis. Surgical measures allow you to quickly restore the outflow of urine from the damaged kidney, protect the parenchyma (kidney tissue) from further destruction.

With hydronephrosis, the following types of operations are performed:

• Temporary drainage. This event normalizes the outflow of urine and enables the kidney to restore functioning. The operation is temporary. In the future, doctors assess the degree of damage to the organ and perform another intervention (reconstructive or organ-removal).
• Reconstructive surgery. Such an intervention is designed to completely normalize the functioning of the urinary system.
• organ removal surgery. Such interventions are resorted to in extreme cases, when it is impossible to save the kidney.

If both kidneys are affected in a patient, the presence of purulent discharge is confirmed, renal colic progresses, then surgery is performed without delay.

Temporary drainage

To save a person's life, surgeons can resort to the following measures:

Restoring the outflow of urine causes the kidney to function normally. And if the organ has not yet been destroyed, then it quickly returns to its normal work.

The main types of operations for hydronephrosis

The tactics of surgical intervention depends on the site of obstruction and the degree of restoration of the kidney. Most often, doctors resort to the following operations:

After the operation, the patient is prescribed antibiotic therapy, dietary nutrition is recommended, and physiotherapy may be advised. Rehabilitation depends on the extent of the operation. With sparing surgical techniques, the patient recovers in 4-6 days. For open, major surgeries, 2-4 weeks may be required.

Physiotherapy methods

To speed up the recovery of the patient after the operation, the patient may be prescribed the following types of physiotherapy:

Folk remedies

Along with drug therapy, folk remedies can be used. Before using sorcerer's prescriptions, it is necessary to consult a doctor. It should be understood that such funds are not able to replace the treatment prescribed by the doctor, they act only as additional therapy.

kidney tea

Kidney tea has a diuretic effect. In addition, it provides pain relief and eliminates spasms.

Components:

• stamen orthosiphon - 2 tbsp. l.;
• boiling water - 100 ml.

Cooking method:

1. Pour boiling water over dry grass.
2. Cover the container with a lid, insist for 20 minutes.
3. Strain the drink, carefully wring out the grass.
4. Drink 50 ml of kidney tea twice a day 20 minutes before meals.
5. The duration of tea treatment is discussed individually with the doctor. One course can last 2-4 weeks.

Bearberry infusion

With hydronephrosis, bearberry leaves will help. They can reduce pain, have an anti-inflammatory effect and provide a diuretic effect.

Components:

• bearberry leaves - 1 tbsp. l.;
• water - 1 tbsp.

Cooking method:

1. Pour boiling water over dry grass.
2. Wrap the container with the infusion and keep it warm for half an hour.
3. Strain the medicine.
4. Use the drug for 1 tbsp. l. 30 minutes after eating 5 times a day.
5. The duration of treatment is 7-10 days.

Healing infusion

With hydronephrosis, a medicinal collection is very useful, combining birch buds, dandelion roots and juniper fruits. This remedy has a diuretic, anti-inflammatory effect. In addition, the infusion can lower blood pressure.

Components:

• birch buds - 2 tbsp. l.;
• juniper fruits (chopped) - 2 tbsp. l.;
• dandelion roots - 2 tbsp. l.;
• water - 0.3 l.

Cooking method:

1. Grind all dry ingredients and mix.
2. Pour dry raw materials (a quarter of a glass) with boiling water.
3. Infuse the drink in a thermos for 6 hours.
4. Strain the finished drink.
5. Take an infusion of 50 ml before meals 3-4 times a day.
6. Continue treatment for 7-10 days.

Photo gallery: components of folk recipes

Staminal orthosiphon relieves spasms, relieves pain Bearberry leaves have diuretic and anti-inflammatory effects Birch buds reduce inflammation Juniper fruits serve as an effective antiseptic Dandelion roots effectively stop inflammatory processes

Prognosis and possible complications

Hydronephrosis is a very serious pathology. But with timely access to doctors, according to statistics, 95 out of 100 patients recover.. With bilateral kidney damage, the prognosis is not so favorable, but even in this case, doctors find an opportunity to save the patient by prescribing regular hemodialysis.

With a late appeal to doctors, the prognosis is disappointing. Running hydronephrosis can lead to:

• urolithiasis (prolonged stagnation of urine leads to the formation of kidney stones);
• nephrogenic hypertension (against the background of renal dysfunction, hypertension (high blood pressure) develops, which is difficult to treat with medication);
• pyelonephritis (inflammation occurring in the kidneys);
• sepsis (infection can spread throughout the body);
• renal failure (against the background of prolonged stagnation of urine, the kidney may lose the ability to produce it);
• death (prolonged stagnation of urine can lead to rupture of the kidneys and outflow of contents into the abdominal cavity, resulting in the development of a uremic coma, and subsequently death may occur).

Hydronephrosis, which has not received adequate treatment, can lead to the development of pyelonephritis.

It is useful for patients who have undergone hydronephrosis to play sports, but only sparing types. Heavy physical activity (for example, weightlifting) is strictly prohibited. Yoga classes are very helpful. In each case, the recommended amount of physical activity is discussed with the doctor individually.

Hydronephrosis in pregnancy

Sometimes hydronephrosis can develop during pregnancy. This pathology appears as a result of compression of the growing uterus of the ureters. This disease is completely reversible and disappears after childbirth. But hydronephrosis is dangerous for both the pregnant woman and the fetus. The disease can lead to the following unpleasant complications:

• Fetal pathologies. Violation of the outflow of urine can provoke the development of functional disorders, as a result of which the blood supply to the placenta will significantly worsen. Against the background of malnutrition, the infant may develop various pathologies.
• Infection. Hydronephrosis creates favorable conditions for infection in the body. It is very dangerous during pregnancy. The infection can cross the placenta and cause congenital ailments in the fetus.

Treatment of hydronephrosis during pregnancy is carried out only by a doctor. Usually a woman is recommended to take a knee-elbow position 4-5 times a day. This position relieves the burden on the ureters, and urine flows freely from the kidney.

Hydronephrosis can develop during pregnancy as a result of compression of the ureter by the growing uterus.

If hydronephrosis developed in a woman long before childbirth and managed to acquire a chronic form, then the patient may need serious treatment. Sometimes doctors even resort to placing a stent (ureteral catheter) to ensure the outflow of urine.

If hydronephrosis in a woman is provoked by pathological congenital strictures, then the risk of such anomalies in the fetus is high.

Prevention

Preventive measures include the following recommendations:

• stick to proper nutrition, completely abandon junk food (fried, spicy foods, alcohol, fast food);
• wear clothes according to the season, many kidney pathologies develop (or worsen) against the background of hypothermia;
• treat all infections of the genitourinary system in a timely and correct manner;
• visit your gynecologist and urologist regularly.

Hydronephrosis is an extremely unpleasant disease that can have unpredictable consequences. Despite the complexity of the disease, doctors know how to deal with it and almost always win, of course, if the patient seeks help in a timely manner.

Hydronephrosis is Greek for “water in the kidneys.” Hydronephrosis is a common congenital disease or condition that affects about 1 in 500 babies. However, hydronephrosis can also appear later in life in both children and adults. Hydronephrosis is a disease in which the outflow of urine into the bladder is slower than it should be, and as a result, this leads to the fact that urine accumulates in the renal pelvis in a larger amount than it should and thereby disrupts the normal functioning of the kidney.Hydronephrosis can affect one kidney (unilateral) or both kidneys (bilateral) Hydronephrosis can be "prenatal" or "antenatal" or postnatal The term "prenatal" or "antenatal" means that the hydronephrosis was detected in the baby before birth Postnatal means that the hydronephrosis was detected after birth .

Obstruction or blockage is the most common cause of hydronephrosis. This may be due to problems that occur during pregnancy, the fetus (prenatal) or may be a physiological response to pregnancy. Approximately 80% of pregnant women develop hydronephrosis or hydroureter. According to experts, this occurs, in particular, due to the effect of progesterone on the ureters, which in turn reduces their tone.

Today, hydronephrosis is usually first diagnosed on a prenatal ultrasound. The detection of hydronephrosis while the baby is in the womb has become more common due to advances in prenatal ultrasound. Before the development of this technology, children born with hydronephrosis could not be accurately diagnosed until they began to show symptoms of kidney disease, and often hydronephrosis could not be detected at all. Many children diagnosed with prenatal hydronephrosis have the ability to recover on their own at a very early age, without medical intervention.

Facts about hydronephrosis

• Hydronephrosis is swelling of the kidneys with partial or complete obstruction of the outflow of urine from the kidney to the bladder.
• A hydroureter is a swelling of the ureter, the canal that connects the kidney to the bladder.
• Obstruction (obstruction or blockage) can occur at any level.
• Depending on the level of the cause, hydronephrosis can be unilateral (in which one kidney is affected) or bilateral (in which both kidneys are affected).
• The increased pressure caused by hydronephrosis can potentially compromise kidney function if not reduced in time.
• The symptoms of hydronephrosis depend on whether the swelling occurs acutely or progresses gradually. If it is an acute obstruction, symptoms may include severe pain, nausea, and vomiting.
• Treatment for hydronephrosis and hydroureter is aimed at restoring the flow of urine from the affected kidney.

Kidney anatomy

Ureters are a pair of tubes or channels that carry urine from the kidneys to the bladder. The length of the ureters is approximately 10-12 cm and runs along the left and right sides of the body parallel to the spinal column. Gravity and peristalsis of smooth muscle tissue in the walls of the ureters move urine towards the bladder. The ends of the ureters closer to the bladder are slightly expanded and sealed at the point of entry into the bladder itself, forming the so-called valves. These valves prevent urine from flowing back to the kidneys.

Bladder is a hollow, sac-shaped organ used by the body to collect and hold urine. The bladder is located along the midline of the body at the bottom of the pelvis. Urine from the ureters slowly fills the cavity of the bladder, stretching its elastic walls, which allows it to hold 600 to 800 milliliters of urine.

Urine produced by the kidneys is transported through the ureters to the bladder. The bladder fills with urine and stores it until the body is ready to expel it. When the volume of the bladder reaches about 150 to 400 milliliters, its walls begin to stretch, affecting their receptors, which in turn send signals to the brain and spinal cord. These signals lead to involuntary relaxation of the internal urethral sphincter, and the person feels the need to urinate. Urination may be delayed until the bladder exceeds its maximum capacity, but the increased nerve signals can lead to great discomfort and a desire to urinate.

Hydronephrosis in children

Causes of hydronephrosis in children

While there are many conditions that lead to hydronephrosis, the most common causes are obstructions (blockages) that reduce the ability of urine to pass from the kidney to the bladder. These obstructions may include:

• ureteropelvic obstruction is a blockage or blockage at the point where the kidney meets the ureter (the tube that carries urine to the bladder).
• ureterovesical segment obstruction is a blockage or blockage at the point where the ureter meets and joins the bladder.
• posterior urethral valve is a congenital condition found only in boys. It is a pathological tissue valve in the urethra (the channel that carries urine out of the body to the outside), preventing the free exit of urine from the bladder.
• ureterocele - occurs when the ureter does not develop properly and a small sac forms in the bladder.

• Vesicoureteropelvic reflux occurs when urine from the bladder backs up into the ureters and often back into the kidneys. When the sphincter muscles at the junction of the ureter and bladder do not work properly, the urine backflows and moves back up to the kidney.
• ectopic ureter - a congenital anomaly in which the ureter secretes urine not into the bladder.

• urinary tract infections.

Acute hydronephrosis

Chronic hydronephrosis

• no symptoms at all.

Diagnosis of hydronephrosis in children

Ultrasound procedure

Miction cystourethrography
This is a specific x-ray examination that examines the urinary tract and allows specialists to see a direct image of the bladder and vesicoureteral reflux, if present. A catheter (hollow tube) is placed in the urethra and the bladder is filled with liquid dye. X-rays are taken as the bladder fills and empties. The images show if there is a backflow of urine into the ureters and/or kidneys. They also show the size and shape of the bladder and urethra.

Cystourethrography is a common procedure, but some children and their parents find inserting a catheter uncomfortable. In such cases, it is recommended to use an anesthetic gel to ease the discomfort. By talking softly to the child before the procedure about possible discomfort, adults can help ease the child's anxiety. The calmer the child during the procedure, the less discomfort he will feel.

Measurement of urine flow rate
This method is often performed in children who have urinary incontinence, the need to urinate frequently, urinary tract infections, hypospadias, vesicoureteral reflux , vesicoureteral reflux, meatal stenosis.

The child will be asked to drink water before the procedure so that the bladder is comfortably filled with urine. The child will urinate into a special toilet that has a small bowl at the base to collect the urine. This bowl is connected to a computer and a measuring scale is applied to it (like a kitchen measuring cup). The computer is able to analyze information about the flow of urination. This study is non-invasive and the patient will urinate normally.

Residual urine measurement
Residual urine volume measurement can be done to determine if the patient is able to empty the bladder. This is usually done immediately after measurement of residual urine volume. After the patient urinates, a small scan of the bladder is performed using ultrasound. This allows you to see how much urine is left in your bladder after urinating. This method is non-invasive.

X-ray of the kidneys, ureters and bladder
X-rays may be taken to identify the causes of abdominal pain, to evaluate the organs and structure of the genitourinary system and / or the gastrointestinal tract (GIT). An x-ray of the kidneys, ureters, and bladder may be a diagnostic procedure used to evaluate the urinary system or bowel.
X-rays use invisible electromagnetic beams used to produce images of internal tissues, bones, and organs on a special film or computer monitor. X-rays are produced using external radiation to produce images of the body, its organs, and other internal structures for diagnostic purposes. X-rays pass through the tissues of the body onto specially treated plates (similar to a film camera) and a "negative" picture is taken (the harder and denser the structure, the more it appears on the film).

Magnetic resonance imaging ( MRI)
MRI is one of the most informative diagnostic procedures. MRI allows you to create three-dimensional and two-dimensional images of organs, which in the case of hydronephrosis, allows you to accurately determine the cause of the development of the disease, the stage of the disease, as well as changes in the tissues of the kidney. One of the positive aspects of using MRI is that it does not use ionizing radiation, contrast agents that can be used during the study do not cause allergies, there is no need to change the position of the patient's body to obtain an image of one or another organ or another angle. In addition to the positive aspects, there are also negative ones - for examination, the patient is introduced into a large closed hollow tube - this can cause an attack of claustrophobia (fear of closed spaces), if you have metal objects in your body (tooth crowns, plates for osteosynthesis, screws in the bones), you will not be allowed to perform this study (due to the fact that the basis of the MRI is a very powerful magnet, it can pull out metal objects from the body, so always inform the doctor about the presence of metal objects in your body). The procedure takes from 20 to 80-90 minutes.

Video urodynamic and urodynamic study.
A urodynamic study is done to measure the pressure inside the bladder when it is empty, full, and during emptying. This research method uses two thin catheters. One catheter is inserted into the patient's bladder through the urethra, the other catheter into the rectum. The bladder then fills with water. The pressure inside the bladder, rectum and abdomen is constantly monitored. This study measures pressure, muscle contraction, and bladder potential. A video urodynamic study is performed during a urodynamic procedure to visualize the urethra, bladder, and ureters.

Renal scan
This is a nuclear medicine test performed to provide an image of the kidney that will help determine the presence and area of ​​damage to the kidney. Neither before nor after this study, patients are not subject to any restrictions in diet or activity. This procedure can take several hours, and therefore parents are advised to bring toys and books for the child from home.

Radioisotope kidney scan
Radioisotope Renal Scanning is a nuclear medicine imaging technique that provides more detailed information about kidney function, size, shape, position, and urinary obstruction by imaging the kidneys. The patient is injected intravenously labeled with radioisotopes (usually radioisotopes of Technetium or Iodine) drug and visualize its accumulation in the kidneys and the rate of release. MAG 3 (Mercaptoacetyltriglycerin) is currently considered the best drug. In this study, there are no restrictions on food intake and activity.

Bacteriological examination of urine
Bacteriological analysis of a sterile urine sample taken from a child is performed in the office. If the child is toilet trained and urinates in the latrine on a regular basis, the urine sample will be placed in a small sterile bowl. If the child does not yet use the toilet on his own, a catheter or small bag is placed over the genitals and used to collect urine. This urine is then examined in the office for the presence of pathological impurities that normally should not be in the urine, such as blood or protein.

Microscopic analysis of urine
Using the same urine collection technology as in the bacteriological method, the sample is sent to the laboratory for more in-depth analysis. A microscope is used to look for certain abnormalities in the urine. This test is done when a urinary tract infection is suspected.

Urine culture
If a urine sample shows the presence of bacteria, a urine culture is usually performed. Bacteria cultures are grown in the laboratory for 24 hours to determine what type of bacteria it is and what drugs are most effective in treatment.

Analysis of daily urine
Daily urine analysis is often performed in children with kidney and bladder stones. Urine is collected in a special container for a full 24-hour period. In the urine collection for this study, the child's first daytime urination is not included. Then the urine is collected during the rest of the day and night, and the first urination of the next morning. The entire amount of urine received is sent to the laboratory, where a urine test is performed to identify the causes of the formation of stones in the human body.

Creatinine level
A study on the level of creatinine is carried out in children with severe symptoms of kidney disease. Creatinine is filtered from the blood through the kidneys. If the kidneys do not filter well, the level of creatinine in the blood will rise.

Treatment of hydronephrosis in children

What is the treatment for hydronephrosis?

If a child's hydronephrosis worsens over time, or if a severe form was initially diagnosed, medical intervention may be necessary. The operation is usually performed by a pediatric urologist. The most common procedure performed to correct hydronephrosis is pyeloplasty. Pyeloplasty involves removing narrowed or obstructed parts of the ureter and then reattaching it to a healthy part of the drainage system. The success and outcome of pyeloplasty is about 95%. There are times when other surgeries may be necessary.

Fetal Surgery
There are rare cases when prenatal hydronephrosis is so severe that it puts the life of the fetus in danger. This usually means that there is an increased risk of low amniotic fluid (a condition called oligohydramnios), blockage of the baby's ureter, blockage of the drainage of the bladder and both kidneys.

The most reliable surgical intervention in the body of the fetus is a procedure similar to the procedure for amniocentesis. Guided by ultrasound, surgeons pass a shunt (small tube) through a large needle inserted through the mother's abdomen and directly into the baby's enlarged bladder. The shunt allows urine that has accumulated in the bladder to drain into the amniotic cavity.

Even after a fetal intervention, the baby will most likely still need some kind of surgical treatment after birth to ensure normal bladder drainage and protection of kidney function.

Surgery
Surgery is usually needed only for severe hydronephrosis, but sometimes it may be an option for some children with moderate hydronephrosis. The goal of surgery is to reduce swelling and pressure in the kidney by restoring the free flow of urine.

When talking about the surgical procedure, the most commonly mentioned is pyeloplasty, which removes the most common type of blockage that causes hydronephrosis in the ureteral- pelvis segment. After surgery, children usually stay in the hospital for about three days and complete recovery occurs in about two to three weeks; the success rate is about 95%.

Surgical treatment using robotics
Robotic pyeloplasty is a laparoscopic (minimally invasive) procedure in which surgeons operate with a tiny camera and very thin instruments inserted into three to four small incisions. Although it takes longer to perform than open surgery, robotic pyeloplasty accomplishes the same goal: removing the diseased portion of the ureter and reattaching the healthy part to the kidney. Robotic surgery also offers a number of benefits, including:

• Less postoperative discomfort.
• Fewer scars and their small size.
• Shorter postoperative hospital stay (usually 24 to 48 hours)
• Faster recovery and the ability to return to full activity earlier

Hydronephrosis in adults

Causes of hydronephrosis

Common Causes

Kidney stones are a common cause of hydronephrosis in men and women. Sometimes the passage of a stone from the kidney into the ureter can block the normal flow of urine.

Causes in men

In men, there are two most common causes of hydronephrosis:

• noncancerous tumor of the prostate gland (benign prostatic hyperplasia)
• prostate cancer

Causes in women

In women, the most common causes of hydronephrosis are:

• pregnancy – during pregnancy, an enlarged uterus (uterus) can sometimes put pressure on the ureters
• cancers that develop inside the urinary tract, such as bladder or kidney cancer
• cancers that develop inside the reproductive system, such as cervical, ovarian, or uterine cancer

Other reasons

• a blood clot (embolism) - which develops inside the urinary tract (the cause may be injury to the walls of these tracts)
• endometriosis is a disease where tissues that should only grow in the uterus begin to grow outside of it. This abnormal growth can sometimes disrupt the urinary tract.
• tuberculosis is a bacterial infection that usually develops in the lungs, but in some cases it can also spread to the bladder.
• damage to the nerves that control the bladder (neurogenic bladder)
• ovarian cysts are fluid-filled sacs that develop inside the ovaries. Enlarged ovaries can sometimes put pressure on the bladder or ureters.
• narrowing of the ureter due to trauma, infection, or surgery.

Symptoms of hydronephrosis in children and adults

Most newborns with hydronephrosis have no symptoms at all. Older children also may not have any symptoms, and the condition may disappear without any treatment.

The symptoms are almost the same for both children and adults..
If a child has a more severe form of hydronephrosis, one or more of the following symptoms may appear:

• abdominal pain, nausea and/or vomiting, especially after large fluid intake.
• pain in the side (just above the pelvic bone) slightly radiating to the back.
• hematuria (blood in the urine) is a change in the color of the urine.
• urinary tract infections.

If the forms of blockage are rapid - for example, as a result of a kidney stone - symptoms will develop within a few hours. If the block develops gradually over several weeks or months, there may be few or no symptoms.

Symptoms may be more severe and depend on the location of the problem, the length of time the urine is blocked, and how much the kidney has been distended.

Acute hydronephrosis

The most common symptom of acute hydronephrosis is severe pain in the back or side, between the ribs and thigh. The pain will be on the side of the affected kidney, or on both sides if both kidneys are affected. In some cases, the pain may radiate to the testicles (in men) or the vagina (in women).
The pain usually comes and goes, but often the symptom worsens after drinking liquids. In addition to pain, nausea and vomiting may also occur.

If the urine inside the kidney becomes infected, symptoms of a kidney infection may also occur:

• high temperature (fever) of 38 ° C or higher.
• uncontrollable shivering (chills).

Chronic hydronephrosis

If hydronephrosis is due to blockade that develops over a long period of time, there may be:

• the same symptoms as in acute hydronephrosis (see above).
• no symptoms at all.
• dull back pain that comes and goes.
• the patient may urinate less frequently than usual.

Always see a doctor if you have:

• severe and persistent pain
• have symptoms, such as a high fever, suggesting a possible infection
• noticeable uncharacteristic changes in the frequency of urination

Diagnosis of hydronephrosis in adults

If an acute onset of symptoms is noted, a physical examination may reveal tenderness in the side or where the kidneys are located. Examination of the abdomen may reveal an enlarged bladder. In men, a rectal examination is usually done to assess the size of the prostate. In women, a pelvic exam may be performed to evaluate the condition of the uterus and ovaries.

Laboratory tests
Depending on which potential diagnosis is currently being considered, the following laboratory tests may be performed:

Analysis of urine
Detects the presence of blood, infection, or abnormal cells.
This is a very common test that can be performed in many medical settings, including doctors' offices, laboratories, and hospitals.

It is carried out by collecting a urine sample from the patient's body in a special container. Usually, a small amount (30-60 ml) of urine may be required for analysis. The sample is examined in a medical clinic, and can also be sent to a laboratory. Urine is visually assessed by its appearance (color, turbidity, odor, transparency), as well as by macroscopic analysis. An analysis can also be performed based on the chemical and molecular properties of the urine and their microscopic evaluation.

General blood analysis
May reveal anemia or potential infection.

The CBC is one of the most commonly ordered blood tests. A complete blood count is a calculation of blood cells. These calculations are usually determined on special machines that analyze various blood components in less than a minute.

The main part of a complete blood count is to measure the concentration of white blood cells, red blood cells and platelets in the blood.

How is a complete blood count performed?
A complete blood count is performed by obtaining a few milliliters of a blood sample directly from the patient. This procedure is carried out in many places, including clinics, laboratories, hospitals. The skin is wiped with an alcohol wipe and a needle is inserted through the area of ​​cleansed skin into the patient's vein. The blood is drawn out with a syringe through a needle on the syringe or with a special vacuum tube (which serves as a container for the blood) that is attached to the needle. The sample is then sent to a laboratory for analysis.

Blood electrolyte analysis
May be useful in chronic hydronephrosis as the kidneys are responsible for maintaining and balancing their blood levels.

Blood test for creatinine
Blood tests - which help evaluate kidney function.

Approximately 2% of the creatine in the human body is converted to creatinine each day. Creatinine is transported through the blood to the kidneys. The kidneys filter out most of the creatinine and dispose of it in the urine. Since muscle mass in the body is a relatively constant value from day to day, creatinine production usually stays pretty much the same on a daily basis.

Instrumental Research

CT scan
Computed tomography of the abdominal cavity may be performed to assess the condition of the kidneys and make a diagnosis of hydronephrosis. It may also allow the doctor to find underlying causes of the disease, including kidney stones or other structures that put pressure on the urinary system and prevent the normal flow of urine. Depending on the situation, a CT scan can be done with a contrast agent that is injected into a vein, or with an oral contrast agent that the patient takes by mouth before the examination, which allows the bowel to be further depicted. But most often, with kidney stones, neither oral nor intravenous contrast is needed.

Ultrasound procedure
An ultrasound is another test that is performed to detect hydronephrosis. The quality of the results of the study depends on the professional experience of the doctor performing the study, which must correctly assess the structures of the abdominal cavity and retroperitoneal space. Ultrasound can also be used in the examination of pregnant women, as it excludes the effect of radiation rays on the fetus.

Degrees of Hydronephrosis

1. Mild degree - in which there will be minor reversible changes in the structure of the kidney, a slight expansion of the pelvis, normal kidney function.
2. Medium degree - at which there will be relatively significant changes in the structure of the kidney, a fairly strong expansion of the pelvis, thinning of the walls of the kidney, and an increase in the size of the kidney by 15-25%. Kidney function is significantly reduced, in comparison with the function of a healthy kidney by about 25-40%.
3. Severe degree - in which severe, sometimes irreversible changes in the structure and function of the kidney appear. The kidney greatly increases in size - up to 2 times. The pelvis of the kidney is very much dilated, the function of the kidney is critically reduced or absent.

Treatment adults

• remove urine buildup and relieve pressure on the kidneys
• prevent irreversible kidney damage
• treating the underlying cause of hydronephrosis

The timing of the patient's treatment will depend on whether he has an infection, because there is a risk of the infection spreading into the blood, causing blood poisoning or sepsis, and this can be very life-threatening for the patient. In these circumstances, experts often recommend surgery on the same day when the diagnosis is fully confirmed.
Immediate surgery may also be recommended if both kidneys are affected, or if the patient has symptoms such as severe pain, vomiting, and nausea that cannot be relieved with medication.
If the patient does not have these symptoms, then his condition can be considered conditionally safe for delaying surgery for several days.

Medical treatment

Medical treatment for hydronephrosis is limited, and is used in the treatment of pain, as well as in the prevention or treatment of infection (antibiotic therapy). However, there are 2 exceptions - oral alkalizing therapy for urolithiasis, and steroid therapy for retroperitoneal fibrosis.

Any medical treatment for hydronephrosis should be agreed and prescribed by a specialist doctor.
Urine diversion
The first step in the treatment of hydronephrosis is the removal of urine from the kidneys. This helps relieve the patient's pain and prevents kidney damage.

A catheter (thin tube) is inserted into the bladder through the urethra or directly into the kidneys through a small incision in the skin. This allows urine to flow freely and relieves pressure on the kidneys.

Treating the underlying cause

As soon as the pressure on the kidneys is relieved or disappears completely, the cause of the accumulation of urine should be eliminated. This usually involves removing the cause of the tissue blockage.

Blockage of the ureter (a common cause of hydronephrosis) is treated with an operation called ureteral stenting. It involves placing a small tube inside the ureter to "bypass" the blockage. The stent can be placed in the ureter without the patient having to make large incisions in the body.
Once the urine has been drained and the ureter is unblocked, the underlying cause of the disease must be treated to prevent the hydronephrosis from returning.

Some possible causes and their treatment are described below.

• kidney stones - can be broken up with sound waves or a laser.
• Enlargement (swelling) of the prostate - may be treated with medication or, in rarer cases, surgery to remove some or all of the prostate.
• Cancers – Some cancers, such as cervical cancer, prostate cancer, that are associated with hydronephrosis can be treated with a combination of chemotherapy, radiation therapy, and surgery to remove the affected tissue.

With hydronephrosis, the diet will be based on the requirements prescribed for the disease or cause that caused hydronephrosis, that is, it will be specific to each case individually. However, there are a number of unified rules for nutrition in hydronephrosis, which should be followed:

• Moderate water consumption - up to 2 liters per day
• The maximum reduction in the use of table salt, no more than 2 grams per day, it is better to refuse salt altogether, if possible, replace it with lemon juice.
• Fresh vegetables should be consumed in the form of salads.
• It is recommended to exclude such foods from the diet as: fatty meat, sea fish, legumes, smoked meats, sausages, meat sauces, chocolate and coffee.

Forecast at hydronephrosis

How to treat hydronephrosis during pregnancy?

What is fetal hydronephrosis?

• A blockage can occur at the junction of the kidney and ureter, at the junction of the bladder and ureter, or in the urethra (urethra). If there is a blockage, surgery is likely to be required.
• Vesicoureteral reflux - This condition is a malfunction of the valve between the ureter and the bladder, which normally prevents urine from the bladder from flowing back into the ureter and kidney. Approximately 70-80% of children born with this diagnosis grow up and this disorder resolves itself, but constant monitoring by a doctor is usually necessary and antibiotics may be used so that if urine gets back into the ureter and kidney, infection does not occur. Surgery may be required if infection does occur or if the reflux problem does not go away on its own.

What is neonatal hydronephrosis?

After childbirth, usually on the third day, an ultrasound examination of the newborn is performed to determine the condition of the internal organs, as well as to determine the presence of hydronephrosis. If hydronephrosis persists after birth, a cystourethrogram or kidney scan will be required to determine the cause of the hydronephrosis. A kidney scan is preferred as it gives more accurate results. As already mentioned, the main causes of hydronephrosis are blockage of the urinary canals or vesicoureteral reflux. In the case of vesicoureteral reflux, treatment is limited to antibiotic therapy (to prevent infection of the kidneys by diverting urine from the bladder back into the ureter and kidney) and regular follow-up with a doctor with periodic ultrasound examinations to monitor the condition of the reflux. In most cases, as the child grows older, vesicoureteral reflux goes away on its own. In the event of a blockage, surgical treatment will most often be required. In some cases, when the blockage is minor, it is possible to observe for 6 months and then re-examine, in the case of a favorable course, it is possible to avoid surgical intervention.

- this is a progressive expansion of the pyelocaliceal complex with subsequent atrophy of the renal parenchyma, which develops as a result of a violation of the outflow of urine from the kidney. It is manifested by pain in the lower back (aching or by the type of renal colic), hematuria, painful frequent urination, arterial hypertension. Diagnosis may require ultrasound of the bladder and kidneys, bladder catheterization, intravenous urography, cystourethrography, CT or MRI of the kidneys, pyelography, renal scintigraphy, nephroscopy. Treatment of hydronephrosis involves the elimination of the cause of the violation of the passage of urine; The emergency treatment is nephrostomy.

General information

Hydronephrosis or hydronephrotic transformation of the kidney is a consequence of a violation of the physiological passage of urine, which leads to a pathological expansion of the kidney cavities, changes in the interstitial renal tissue and atrophy of the parenchyma. Between the ages of 20 and 60 years, the incidence of hydronephrosis is higher in women, due to reasons associated with pregnancy and gynecological cancers. After 60 years, hydronephrosis often develops in men, mainly against the background of prostate adenoma or prostate cancer.

Causes of hydronephrosis

The causes of the disease are variable, but can be divided into two groups: caused by obstruction or obstruction in any part of the urinary system (ureters, bladder, urethra) or reverse flow of urine due to bladder valve failure. By localization and nature, the causes of hydronephrosis can be internal, external and functional.

1. At the level of the urethra. Among the internal lesions of the urethra, diverticula, urethral strictures, and urethral atresia contribute to the development of hydronephrosis. External obstacles, as a rule, are hyperplasia and prostate cancer.
2. At the level of the bladder. From the side of the bladder, internal factors in the development of hydronephrosis can be urolithiasis, cystocele, carcinoma, bladder diverticulum, contracture of the bladder neck. An external obstruction to the outflow of urine from the bladder can occur with pelvic lipomatosis.
3. At the level of the ureters. Tumors, fibroepithelial polyps, blood clots, calculi, fungal lesions of the urethra (aspergilemma, mycetoma), ureterocele, tuberculosis, endometriosis, etc. are more often internal causes of the development of hydronephrosis. An external obstruction to the passage of urine in the ureteral segment can be created by retroperitoneal lymphoma or sarcoma, pregnancy, cervical cancer, uterine prolapse, ovarian cysts, tubal-ovarian abscess, prostate tumors, abdominal aortic aneurysm, lymphocele, an abnormally located renal artery that compresses the ureter.

With hydronephrosis, damage to the urinary tract at various levels can also be caused by congenital dyskinesia and obstruction of the urinary tract, their injuries, inflammation (urethritis, cystitis), spinal cord injuries. When the obstruction to the outflow of urine is located below the ureteropelvic segment, not only the pelvis, but also the ureter expands, which leads to hydroureteronephrosis. Functional disorders include the presence of a neurogenic bladder and vesicoureteral reflux.

Pathogenesis

Violation of the flow of urine leads to an increase in pressure inside the ureter and pelvis, which is accompanied by noticeable violations of glomerular filtration, the function of the tubules of the kidney, pyelolymphatic flow, pyeloarterial and pyelovenous blood flow. The outcome of hydronephrosis is atrophy of the renal tubules and the death of the structural units of the kidney - nephrons.

Classification

By the time of development, hydronephrosis can be primary (congenital) or acquired (dynamic). According to the severity of the course, mild, moderate and severe hydronephrosis is distinguished; according to localization - one-sided and two-sided. In practical urology, hydronephrosis of the right and left kidneys occurs with the same frequency; bilateral hydronephrotic transformation is observed in 5-9% of cases.

The course of hydronephrosis can be acute and chronic. In the first case, with timely correction, complete restoration of renal functions is possible; in the second, kidney function is lost irreversibly. Depending on the presence of infection, hydronephrosis can develop aseptic or infected type.

Symptoms of hydronephrosis

Manifestations of pathology depend on the location, rate of development and duration of obstruction of the urinary tract segment. The severity of symptoms is determined by the degree of expansion of the pyelocaliceal complexes of the kidney. Acute hydronephrosis develops rapidly, with pronounced paroxysmal pain in the lower back, like renal colic, spreading along the ureter, into the thigh, groin, perineum, and genital area. There may be frequent urge to urinate, pain, nausea and vomiting. With hydronephrosis, blood appears in the urine, visible to the eye (gross hematuria) or determined by the laboratory (microhematuria).

Unilateral aseptic chronic hydronephrosis is latent for a long time. In most cases, there is discomfort in the region of the lumbocostal angle, periodic dull pain in the lower back, which intensifies after physical exertion or ingestion of large amounts of fluid. Over time, chronic fatigue and decreased ability to work progress, transient arterial hypertension occurs, and hematuria appears.

With an increase in body temperature, as a rule, one should think of infected hydronephrosis and acute purulent obstructive pyelonephritis. In this case, pus (pyuria) appears in the urine. A symptom that is pathognomonic for hydronephrosis is the patient's preference to sleep on his stomach, since this position leads to a change in intra-abdominal pressure and an improvement in the outflow of urine from the affected kidney.

Complications

Chronic hydronephrosis often contributes to the occurrence of urolithiasis and pyelonephritis, hypertension, which further aggravate the clinic of hydronephrotic transformation of the kidney. Against the background of infected hydronephrosis, sepsis sometimes develops. The course of hydronephrosis can be complicated by the development of renal failure. In this case, especially with bilateral hydronephrosis, the death of the patient occurs from intoxication with nitrogen metabolism products and disturbances in water and electrolyte balance. A life-threatening complication of hydronephrosis can be spontaneous rupture of the hydronephrotic sac, resulting in the outflow of urine into the retroperitoneal space.

Diagnostics

With hydronephrosis, the diagnostic algorithm consists of collecting anamnestic data, conducting a physical examination, laboratory and instrumental studies. In the process of studying the anamnesis, the nephrologist finds out the presence of causes that may contribute to the development of hydronephrosis. Physical data are uninformative and nonspecific.

With deep palpation of the abdomen, a distended bladder can be determined, in children and thin adults - an enlarged kidney. Percussion of the abdomen in the area of ​​the altered kidney, even with a slight hydronephrosis, reveals tympanitis. With renal colic, tension and bloating, bladder catheterization is often resorted to. The release of a large volume of urine through the catheter may indicate an obstruction at the level of the urethra or bladder outlet. The determining methods for diagnosing hydronephrosis are x-ray and ultrasound studies.

• Echography. Ultrasound of the kidneys is performed polypositionally, examining longitudinal, transverse, oblique projections in the position of the patient on the abdomen and on the side. With echography, an assessment is made of the size of the kidneys, the condition of the pyelocaliceal complexes, the presence of additional shadows, the condition of the ureters. If necessary, an ultrasound of the bladder is additionally performed with the determination of the amount of urine, ultrasound of the vessels of the kidneys. To identify changes in the area of ​​the pelvic-ureteral segment, and periureteral tissue allows the implementation of endoluminal echography.
• Radio diagnostics. Priority for the detection of hydronephrosis are radiopaque studies, primarily excretory urography and retrograde ureteropyelography, which make it possible to judge the excretory function of the kidney. In some cases, to determine the causes of kidney obstruction in hydronephrosis, they resort to chromocystoscopy, renal angiography, percutaneous antegrade pyelography, MRI and CT of the kidneys. Radioisotope dynamic nephroscintigraphy and renoangiography are used to assess organ blood flow.

To visualize obstructions to the outflow of urine in hydronephrosis, endoscopic methods can be used - ureteroscopy, cystoscopy, ureteroscopy, nephroscopy. Signs of impaired renal function in hydronephrosis can reveal blood and urine tests. Biochemical parameters of blood are characterized by an increase in the level of creatinine, urea, a change in the electrolyte balance (sodium, potassium). In the general analysis of urine, leukocyturia, pyuria, hematuria are determined. If necessary, a sample of Reberg, Zimnitsky, Nechiporenko, Addis-Kakovsky, urine culture is examined.

Hydronephrosis should be distinguished from conditions similar in symptoms, not complicated by hydronephrotic transformation of the kidney - nephrolithiasis, nephroptosis, polycystosis, kidney cancer.

Treatment of hydronephrosis

Conservative therapy is ineffective. It can be aimed at pain relief, prevention and suppression of infection, lowering blood pressure, correction of renal failure in the preoperative period. The emergency treatment for acute hydronephrosis is percutaneous (percutaneous) nephrostomy, which removes accumulated urine and reduces pressure in the kidney.

Types of surgical treatment of hydronephrosis can be different and are determined by the cause of this condition. All methods of surgical treatment of hydronephrosis are divided into reconstructive, organ-preserving and organ-removing. The indications for reconstructive plastic surgery are the preservation of the parenchyma function and the possibility of radical elimination of the cause of hydronephrosis. With strictures of the urethra or strictures of the ureters, balloon dilatation, bougienage, endotomy, and stenting of the ureters are performed.

In case of obstruction caused by prostate hyperplasia or cancer, prostate resection, urethral dilatation, prostatectomy, or hormone therapy may be performed. In the case of urolithiasis, lithotripsy or surgical removal of stones from the obstruction zone is indicated. Open surgery is performed for retroperitoneal tumors, aortic aneurysm, the impossibility of endoscopic stenting or shock wave lithotripsy. Nephrectomy - removal of the altered kidney - is resorted to with the loss of its function and the risk of complications.

Forecast and prevention

The rapid elimination of the causes of hydronephrosis allows the kidney to restore its functions due to the large reserve capacity. In the case of prolonged obstruction, damage to another kidney, or infection, the prognosis of hydronephrosis is serious. To prevent the development of hydronephrosis allows the passage of a periodic examination by a urologist with an ultrasound of the kidneys, the prevention of diseases of the urinary tract.

Afer Dima

Hydronephrosis of the kidney: symptoms and treatment depending on the stage

Hydronephrosis of the kidney is a specific disease characterized by a pathological increase in the internal size of the pyelocaliceal region of the kidneys due to strong pressure on its walls of a large volume of fluid (urine excreted by the kidneys). In this case, the accumulation and stagnation of urine is associated with a complete or partial violation of its outflow through the urinary system. This leads to inflammation of the renal tissue - the parenchyma, followed by its atrophy and deterioration of the filtering and excretory function of the kidney. As a result of this, partial, and then, with the progression of the disease, complete renal failure may occur at first.

To prevent poisoning of the body with waste products in such cases, the removal of one, and when bilateral hydronephrosis and both damaged kidneys is indicated. In the future, such patients are shown regular sessions of hemodialysis on an artificial kidney machine or transplantation of a donor organ.

Depending on the causes of the development of the disease, its forms are distinguished:

• Congenital - hydronephrosis develops in utero or immediately after birth.
• Acquired - hydronephrosis appears as a result of damage to a previously healthy kidney.

Let's single out the main degrees of hydronephrosis or, as they say, stages:

• Stage I - there is an expansion of only the pelvic system without disrupting the functions of the organ.
• Stage II - a significant expansion of the pelvis, accompanied by a thinning of its walls and a violation of the functioning of the kidneys up to 20%.
• Stage III - the kidney is represented by a large multi-chamber cavity filled with urine. Functions are reduced by less than 80%.

Causes of the occurrence and development of hydronephrosis

Congenital or acquired form of hydronephrosis of the right or left kidney may occur as a result of deterioration or complete cessation of the movement of urine from the pelvis region through the ureter to the bladder and urethra. This disorder can be caused by both anatomical and physiological factors.

Congenital hydronephrosis in children is manifested as a result of existing defects in the shape and structure of the kidney, ureter and lower urinary system. Also, congenital or acquired hydronephrosis of the kidney in children can occur with the pathology of the development of blood vessels during the prenatal period or the first year of life. Congenital causes:

• Pathological narrowing of the internal lumen (dysthenesia) of the urinary tract at the level of the kidney, ureter, sphincters of the bladder or urethra.
• A congenital anomaly of the renal artery itself or its branch, in which the vessel has the shape of a ring that compresses the ureter and prevents the normal outflow of urine.
• Abnormal shape, kink, or misplacement of the ureter.
• Congenital pathology of the development of the lower urinary tract (obstruction; ureterocele, etc.).
• Immaturity or underdevelopment of the organs of the urinary system in premature babies.

The acquired form of hydronephrosis can have both anatomical causes of a violation of the outflow of urine from the renal pelvis, and physiological (arising against the background of diseases of the central and peripheral nervous system). In total, there are five main groups of pathological conditions that create mechanical obstacles of anatomical nature in the urinary system:

• Thickening of the walls of the ureter or pelvis as a result of tumors.
• The presence of tumors in surrounding organs and tissues that compress the ureter, kidney or urethra.
• Violation of the normal location of the ureter or kidney (omission of the kidney, bending or torsion of the ureter).
• Overlapping of the internal lumen of the ureter and pelvis with formed kidney stones.
• Compression or damage to the lower organs of the urinary system as a result of cancer and other diseases or injuries.

Quite often, women experience hydronephrosis during pregnancy. Its cause is mechanical compression of the ureter and other organs of the urinary system by an enlarged uterus.

Hydronephrosis, uncomplicated in the early stages of development, has practically no symptoms and clinical manifestations. The patient feels only a slight deterioration in well-being, increased fatigue. Therefore, it is possible to suspect mild degrees of hydronephrosis at this stage only with a random examination for other diseases. You can determine the expanded pelvis of the kidney, for example, with palpation or diagnostic ultrasound.

In the event of concomitant inflammatory diseases, it is already possible to suspect unilateral or bilateral hydronephrosis by the following symptoms, which are also characteristic of other kidney diseases:

• Constant or intermittent aching pain in the lumbar region.
• Frequent or severe renal colic.
• Nausea, vomiting, bloating and increased blood pressure during attacks of renal colic.
• Initially, a decrease, and then a significant increase in the amount of urine during urination.
• Palpable tumor-like formation in the region of the right or left hypochondrium (or on both sides).
• The appearance of blood in the urine (while its color becomes brownish or reddish).

In the later stages of the development of the disease, the symptoms of hydronephrosis of the kidney become more pronounced.

Methods for diagnosing hydronephrosis

Hidden developing and non-recurring hydronephrosis may not have symptoms of inflammation or a clear violation of the filtering and excretory function. This can continue until the development of the initial form of renal failure. Therefore, with a decrease in the amount of urine or a change in its color and concentration, it is urgent to conduct a comprehensive laboratory and hardware examination by a urologist.

The most accurate methods for diagnosing hydronephrosis include:

• Laboratory research: general analysis of blood and urine, biochemical blood tests, urinalysis according to Zimnitsky, Nechiporenko and others.
• Ultrasound examination of both kidneys, ureter and bladder, which, if necessary, is supplemented by an examination of other internal organs.
• X-ray examination of these organs with the use of contrast agents.
• Hardware magnetic resonance imaging (MRI).

Hardware diagnostic methods help to determine and compare on which side there is, or kidney damage predominates. So hydronephrosis of the right kidney has a larger size of the pelvic region compared to a healthy left kidney. Or vice versa, hydronephrosis of the left kidney has a large pelvis compared to the right kidney.

Treatment of hydronephrosis of the kidneys

Upon confirmation of the diagnosis, treatment of hydronephrosis of the kidney should be started immediately. Indeed, with the further development and complication of this disease, the prognosis for the patient can be extremely unfavorable. And effective therapeutic methods that allow you to fully restore kidney function do not exist today.

Drug treatment of hydronephrosis for patients with unilateral or bilateral kidney damage can be carried out only as a symptomatic therapy or in preparation for surgical treatment.

Surgery for hydronephrosis of the kidney can either completely eliminate or only reduce the manifestation of this disease. The result and prognosis of surgical treatment largely depends on the form and stage of the disease. With the complete elimination of the anatomical causes of compression of the kidney or ureter, as well as with a slight violation of its functions, it is possible to completely get rid of hydronephrosis.
Timely surgical treatment is especially important for the elimination of congenital hydronephrosis in children. In most cases, the performed operations to eliminate defects or plastic surgery of congenital pathologies in the development of the kidneys and ureter give good results and a favorable prognosis for the life and health of the child.

Treatment and dietary nutrition for hydronephrosis in pregnant women

Treatment of hydronephrosis during pregnancy is aimed at restoring the outflow of urine from the kidneys with the help of special physical and breathing exercises, physiotherapy, laxatives, long walks in the fresh air and dietary nutrition. The main objective of this therapy is the prevention of inflammatory diseases of the urogenital area. Only in very severe forms of this disease is it recommended to terminate the pregnancy.

A specially designed therapeutic diet for hydronephrosis of the kidney in pregnant women and children includes dishes with a high fiber content: black bread, a variety of boiled or steamed vegetables, low-fat boiled fish and veal, beetroot, cabbage soup and borscht with beets, etc. But from fatty, fried and salty foods should be abandoned.

Prognosis and prevention of the disease

Timely elimination of the causes of hydronephrosis contributes to the rapid restoration of all kidney functions. If the obstruction proceeds for a long time and is accompanied by a bilateral lesion or infection, then in this case the prognosis for the disease is serious and often ends with the need for hemodialysis or a donor kidney transplant.

In order to prevent the development of hydronephrosis, regular medical examination is necessary with an ultrasound examination of the kidneys and a laboratory analysis of urine.

With hydronephrosis, the pelvis and calyces of the organ gradually expand, due to a disturbed outflow of urine for one reason or another.

Among the diseases of the urinary system, one of the most dangerous and complex is kidney hydronephrosis. The second name for this pathology is hydronephrotic transformation, and it partially contains a description of the disease.

With hydronephrosis, the pelvis and calyces of the organ gradually expand due to the outflow of urine that is disturbed for one reason or another.

As a result, the kidney increases in size, blood circulation in it is disturbed. Without treatment, the disease dies.

Most often, the pathology occurs in young women, but its occurrence in children, men of all ages is not excluded. The course of the disease, the tactics of therapy and the prognosis depend on the cause of the onset of hydronephrosis and the form.

Basically, hydronephrosis of the left kidney or right develops, very rarely both organs are affected. In medicine, they operate with terms such as left-sided or right-sided hydronephrosis.

Types of hydronephrosis

There are two forms of this disease: congenital and acquired. Congenital is detected in children and adults due to such pathologies:

• abnormal location of the vessels of the kidney, due to which the ureter is compressed;
• dyskinesia or abnormal position of the ureter;
• obstruction, stricture (blockage, narrowing) of the ureter.

In all these conditions, the outflow of urine is disturbed, it accumulates in the kidney, which leads to a gradual increase in its cups and pelvis.

Acquired hydronephrosis of the right or left kidney occurs as a result of an infectious process in the organ, the formation of stones, tumors or metastases, due to injuries of the ureter with the formation of a scar. Pathology also develops in some diseases of the spinal cord, as a result of which the outflow of urine is disturbed reflexively.

In all cases, hydronephrosis on the right, left, or hydronephrosis of both kidneys appears when the patency of the urinary canal of an anatomical nature is disturbed. The reasons for this pathology: the incorrect position of the urinary tract, their bending, the presence of a stone, a scar in the ureter, pelvis, bladder.

Another classification of the disease is by stages. Distinguish hydronephrosis of 1 degree, 2 and 3 degrees. In the first degree, the accumulation of urine in the kidney is insignificant, its parenchyma is stretched to a small extent, the function of the organ is not impaired. With hydronephrosis of the 2nd degree, thinning of the parenchyma begins, a greater stretching of the organ, and a decrease in its capabilities by almost half. The second kidney works in an enhanced mode, which allows you to maintain the excretory function at a normal level.

In the third degree, the kidney loses most of its functions, eventually stops working (terminal hydronephrosis). The second kidney cannot cope with the increased load, so the patient is at risk of developing renal failure. If the condition is ignored, the patient dies.

Symptoms of hydronephrosis

At the beginning of the disease, there are no specific symptoms. There are signs of the underlying disease, the causes of hydronephrosis. But with the development of the pathology of the patient, specific manifestations begin to disturb.

The main complaints include pain in the lower back of a dull, aching nature. These symptoms are constant, appear regardless of the time of day, do not disappear with a change in body position. They are localized on the affected side, but there is one feature: hydronephrotic transformation of the right kidney almost always has signs of liver disease. With right-sided hydronephrosis, pain occurs not in the back, but on the right side of the abdomen. Pain is accompanied by typical "liver" symptoms: nausea and vomiting, bloating.

But with hydronephrosis, there are also symptoms such as increased blood pressure, which distinguishes right-sided or bilateral hydronephrosis from liver disease.

Pathology is also manifested by symptoms of fever, which is a sign of infection. This complication occurs frequently, since a violation of the outflow of urine creates good conditions for the development of pathogenic bacteria.

In many cases, the disease manifests itself only by the presence of blood in the urine. In 20% of patients, gross hematuria (large blood clots) is detected, but in most cases. Mostly these signs are present if the cause of the violations are kidney stones that injure the walls.

The terminal stage of this disease is manifested by obvious symptoms. The pain does not disappear, but intensifies. They are joined by symptoms of renal failure: a decrease in the amount of urine, edema, increased blood pressure, anemia. If one kidney is affected, the manifestations are less pronounced, with pathology of both kidneys, the symptoms are more pronounced, and the patient's condition worsens faster.

Diagnosis of hydronephrosis

Among the most common research methods, ultrasound is considered the most accessible and informative. With its help, you can easily identify pathology in children and adults, assess the condition of both kidneys, and determine the stage of the disease. In some cases, the cause of the blockage in the ureters can be found, but not always.

X-ray (plain radiography), contrast intravenous and radioisotope urography helps to clarify what caused the disease. X-ray examination is prescribed to determine the size of organs, to identify stones.

When performing contrast urography, the doctor can assess the intensity of the formation and excretion of urine, which are slowed down with hydronephrosis. This research method gives a clear picture with dilated pelvises and cups, and shows the cause of blockage of the ureter.

Thanks to radioisotope urography, it is possible to assess the degree of kidney damage, to accurately determine the characteristics of dysuria.

To test the excretory function, urine tests are prescribed, including the general one, according to Nechiporenko, Zimnitsky. Additionally, blood is taken for analysis, general and biochemical. To clarify the diagnosis, an MRI or CT scan is done.

Conservative treatment

Regardless of the stage of the disease, the urologist will prescribe drug therapy. But in all cases, such treatment of hydronephrosis will be symptomatic, and it is carried out only in preparation for surgery.

Therapy is aimed at stopping pain (tablets or an injection are prescribed), normalizing blood pressure, and reducing inflammation. At accession of an infection reception of antibiotics is shown. Based on the severity of the disease and the patient's complaints, diuretics or other symptomatic treatment are prescribed.

Treatment with surgical methods

- the only way to maintain the health of the body in the event that they are carried out in the first stages of the disease. During surgery, the cause of urinary tract obstruction is eliminated, and the earlier the pathology is detected, its treatment is started, the more successful the outcome of the operation.

If end-stage hydronephrosis is detected with a still viable kidney, plastic surgery is performed to restore the size of the pelvis.

When performing an operation on the right kidney, it is necessary to take into account the proximity of the pancreas, there is a high risk of damage to it.

For a non-viable kidney, nephrectomy is the only solution. In another case, the patient will die due to progressive renal failure and associated inflammatory complications. After nephrectomy, kidney transplantation is recommended, but urology knows a lot of cases when voluntary donors, people who lost one kidney due to injury or illness, continued to lead a full, active lifestyle. Therefore, even such a radical surgical intervention should not be frightening. It is much worse if it is not carried out, then the prognosis for the patient is the most negative.

Diet for hydronephrosis

Nutrition must necessarily be complete, high-calorie. Those patients who have been prescribed diuretics, even potassium-sparing ones, need to eat foods rich in potassium: legumes, dried fruits, nuts, potatoes, sea kale. The same food helps fight swelling.

The main component is vegetables and fruits, it is recommended to consume them at least 600 grams per day. Protein food should also be present, but in a limited amount, not more than 0.5 g of protein per 1 kg of human weight. Protein should be easily absorbed by the body, the best sources are dairy products, legumes, buckwheat, lean meat and fish.

In addition to the above, patients are allowed to eat yesterday's bread, crackers, various cereals, eggs (but not more than 1 per day). From desserts kissels, jelly are allowed.

There are limits on the content of salt in food, its amount is limited to 2 grams per day. But natural spices, onions and garlic are not prohibited.

All foods must be boiled or steamed. It is allowed to add a small amount of oil to already cooked food.

Under a strict ban, fried, stews, smoked meats, pickles, canned food, exclude any sauces, mayonnaise, ketchups. Limit sweets containing fats and a large amount of sugar (pastries, chocolate, products with cream), fatty meats and fish, mushrooms. Strictly prohibited, even in minimal quantities, carbonated drinks, alcohol, fast food.

The volume of fluid consumed is calculated on the basis of daily diuresis (+ 0.5 liters to the daily volume of urine allocated for the previous day). This amount should include all liquid, including first courses, drinks, water. It is recommended to exclude tea and coffee, it is worth drinking compote or diluted juice, mineral or plain water.

Prevention

The basis for the prevention of hydronephrosis is the timely detection and treatment of pathologies of the urinary system. It is recommended to adhere to the rules of a healthy diet with a reasonable intake of protein, sugar and salt. Physical activity is welcome, a complete rejection of alcohol, strong tea and coffee.

It is necessary to monitor the work of the bladder, to prevent its overflow. Experts recommend preventing general hypothermia or overheating of the patient. Hypothermia is fraught with the development of inflammation, and when overheated, due to profuse sweating, the blood thickens, and it is more difficult for the kidneys to filter it.

Pregnant women should be especially careful, as while waiting for the baby, the kidneys experience an increased load.