Incomplete duplication of both kidneys. Kidney duplication is a common congenital pathology.

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This video is about a man who was found to have double kidneys by doctors:

In most cases, complete or incomplete duplication of the kidney is not dangerous to health. Patients are diagnosed by chance. Pathology can provoke some diseases that are treated with conservative methods or with the help of surgical intervention. Pregnancy with an anomaly is possible, but not for girls with kidney failure. The disease is asymptomatic and positive. The patient can live for a long time without going to the doctor for help.

Double kidney is the most common congenital disorder. In children, doubling of the kidneys is often detected completely by accident when diagnosing another pathology and performing an ultrasound scan. Double kidney - what is it? Doubling of the organ occurs in the prenatal period. The kidneys are a paired organ. Doubling is more often observed on the one hand. Medical practice shows that this pathology is most common on the left, and girls are more susceptible to it.

Bilateral doubling, according to statistics, occurs in only 10% of cases of this pathology. The kidney may be fully or partially doubled. The pathological kidney is much larger than the normal one.

Each of the parts of such a kidney has a separate blood supply system, but most often a single pelvicalyceal system. The pathological structure of the kidney physically and functionally does not create any problems, and often people learn about this fact by accident. However, during life, such features of the body can provoke a number of diseases.

What is renal PLS? The pelvicalyceal system performs the main function of the urinary system - the accumulation of urine and its excretion into the bladder. With partial doubling, a single PCS develops. If the organ doubles completely, a separate PCS is formed in each of the lobules. But the complete separation of the organ does not occur, it is covered with a single fibrous membrane. Each of the PCLs has a separate ureter - an outlet to the bladder.

In a doubled organ, it either connects to the main one, or has a separate entrance to the bladder. The first option for this pathology is more preferable from a physiological point of view, since the second one can provoke a violation of urine output and a persistent expansion of the pelvis, or hydronephrosis. These were general information about what CHLS is, then we will talk about the factors that can provoke the development of a double kidney, and what it threatens.

Causes of duplication of the kidney

Double kidney - what is it and what are the main causes of such a pathology? This anomaly is exclusively congenital and is laid only during the intrauterine development of the fetus. The genetic factor plays a major role in this. If one of the relatives of the mother or father had a similar anomaly, then there is a risk of having a child with the same pathology.

In addition, there are some factors that can negatively affect a woman's body during pregnancy and have a pathogenic effect on embryogenesis, as a result of which an abnormal kidney is formed in the fetus. Such a congenital defect can be provoked by the following circumstances:

• exposure (X-ray or radioactive);
• harmful factors at work;
• medications;
• drugs;
• smoking and alcohol;
• radiation therapy;
• violation of metabolic processes;
• severe avitaminosis;
• taking hormonal drugs;
• infections.

These teratogenic factors can lead to the pathology of kidney development. The development of two points of growth of this organ is formed. The child has a doubling of the kidneys, and a double PCS is formed. Sometimes doubling of the organ does not occur completely, which happens much more often than complete doubling. Doubling of the right or left kidney can be detected in a baby before birth with ultrasound.

Incomplete renal duplication often does not manifest itself throughout life and is detected in the diagnosis of other pathologies, while complete duplication provokes hydronephrosis and stagnation of urine in a separate pelvis. This contributes to the development of diseases such as:

• urolithiasis disease;
• pyelonephritis;
• nephroptosis;
• tumor;
• kidney tuberculosis.

If a newborn child has problems with the urinary system, an examination is carried out to identify the cause of the violations, often this is a complete doubling of the renal pelvis.

Kinds

There is complete and incomplete doubling of the kidney. Let us consider this anomaly in detail.

Full doubling - instead of one kidney, two organs develop. This phenomenon is observed extremely rarely, only in 10-15% of cases of the total number of anomalies. Each of the bifurcated organs has a separate pyelocaliceal system, equipped with its own ureter. The ureter is sometimes connected to the main one and forms a single mouth, and sometimes it is isolated and connected to the bladder.

Each bifurcated kidney has its own PCS and ureter, and they are able to independently filter urine. The lower parts of such organs are more functional. Sometimes an additional ureter has an additional branch in the form of an end in the diverticulum of the bladder (a depression connected to the main cavity by a channel). It is extremely rare with this pathology that the branched end of the ureter has an outlet to the urethra or vagina, then the baby may leak urine and be diagnosed as incontinence.

Incomplete duplication of the kidney is much more common than complete (80-90% of cases). In this case, the kidney is markedly enlarged. Each part of such an organ is fed by a separate renal artery, but its CLS is single. Sometimes PCS develops two, and one artery feeds them.

Often people with such a pathology do not even suspect the existence of an anomaly and live happily with it for many years.

Symptoms

Doubling of the kidneys is not manifested by any special symptoms. People with such a diagnosis can live their whole lives and not be aware of the anomaly or detect pathology in various studies for other diseases.

Problems arise only with difficulties with emptying the pelvis. More often it happens at full doubling. Patients experience lower back pain on the side of the abnormal organ, Pasternatsky's symptom (pain on tapping) is also positive on the same side. In addition, you may experience:

• general weakness;
• hyperthermia (with the addition of a bacterial infection);
• symptomatic hypertension;
• pain during urination;
• regular inflammation;
• renal colic.

Complete duplication of the kidney often provokes diseases of the upper urinary tract, which are severe, and their treatment brings the patient only temporary relief.

Incomplete duplication of the organ, as a rule, does not cause any problems with emptying the pelvis, and therefore is asymptomatic.

Possible consequences

What is the danger of doubling the kidneys? Incomplete doubling does not interfere with the excretory function and does not cause any pathologies in either the child or the adult. However, complete doubling can cause complications associated with urinary stagnation and provoke a number of pathologies:

• pyelonephritis;
• urolithiasis (urolithiasis);
• hydronephrosis;
• tuberculosis;
• nephroptosis;
• polycystic;
• ureterocele (narrowing of the ureteral canal, causing the appearance of a rounded cystic formation in the intravesical region);
• tumors and other diseases.

Diagnostics

It is not difficult to detect such a pathology. To do this, it is enough to conduct a kidney examination using:

• cystoscopy;
• excretory urography;
• magnetic resonance urography;
• radiography.

In addition, standard tests are prescribed, such as a general blood and urine test.

Often one hardware study is not enough. So, X-ray does not make it possible to see whether this doubling is complete or not. Then additional studies are ordered.

During ultrasound, the specialist often makes an unambiguous conclusion and reveals two separate PCS of both kidneys or one. This makes it possible to suspect a complete bifurcation of the organ.

Cystoscopic examination allows you to see the mouth of the ureters. With a complete doubling of one or both kidneys, there will be more than two of them. For example, when a child's right kidney is doubled, a pair of ureters will enter the bladder on the right, and one on the left.

Ascending urography involves the use of a contrast agent, which is clearly visible on x-rays.

All these research methods allow you to accurately diagnose.

Treatment

Incomplete duplication of the kidneys has no negative consequences, and therefore does not require therapy. Manifestations of signs of pyelonephritis, urolithiasis or hydronephrosis suggest symptomatic treatment. First of all, the patient needs to pay attention to his diet and lifestyle and, if necessary, adjust them.

With bifurcated PCLS of the kidney, treatment is symptomatic, which includes:

• dietary modification (reducing fat intake);
• antibiotic therapy (with the addition of an infection);
• antispasmodic drugs;
• painkillers;
• herbal medicinal preparations.

With the development of severe hydronephrosis, the doctor's task is to preserve the function of the abnormal organ as long as possible. To do this, doctors select the most effective methods in order to properly treat the pathology and maintain the correct functioning of the organ for quite a long time. If this fails, resort to surgical treatment. There are several types of surgery:

• nephrectomy - part of the kidney (one or more segments) is removed;
• pyelo-pyeloanastomosis or uretero-ureteroanastomosis - an anastomosis is applied during the reverse throwing of urine (reflux);
• antireflux surgical treatment - a lumen is created for the outflow of urine (tunnelization of the ureter);
• excision of the ureterocele and suturing of the ureters into the wall of the bladder.

Finally

Kidney duplication is usually not harmful to health and is often discovered incidentally during physical examinations or diagnostic procedures for other diseases. With this anomaly of the kidneys, complications arise as a result of difficulty in the outflow of urine from the pelvis of the pathological organ. It is important to know that with such an anomaly, a healthy lifestyle should be followed:

• nutrition should be rational, fried and heavy foods should be excluded from the diet;
• give up alcohol and tobacco;
• do not self-medicate.

Following these simple rules, many people with a similar pathology live for many years and feel great.

By the term "doubling of the kidney" doctors understand a congenital malformation in the development of the kidneys, when the organ completely or partially doubles. Each kidney has its own blood supply and often pelvicalyceal system. More often, a doubling of one kidney is diagnosed, although it happens that a mutation of both occurs. Pathology is dangerous with possible complications from the urinary system. Treatment is usually aimed at stopping secondary diseases. In rare cases, there is a need for surgical treatment of the anomaly.

Abnormal bifurcation in the kidneys can be harmful to human health, but also not cause obvious harm.

General information

Kidney duplication is a disease that is characterized by abnormal development of an organ, when one or two lobes of an organ double, forming three or four kidneys. Despite the fact that additional organs often have their own pyelocaliceal system and ureter, the lower kidneys are more functional. With complete doubling of the organ, each lobule has its own outlet for the ureter in the bladder. The growth of an additional organ is due to congenital or acquired anomalies. Dual organs are quite common. Pathology develops during fetal development. The defect occurs in every 150 children. In this case, the disease is more typical for girls. Unilateral doubling accounts for more than 80% of cases.

Anatomical picture

The organ is visualized as two kidneys fused together, each of which has its own blood flow (blood supply is provided by separate arteries). The size of such an organ is much larger than usual. More often, the upper and lower parts are visualized, which are separated by a furrow. The lower lobule of the bifurcated kidney is more functional, despite the fact that there is a separation of the parenchyma and blood supply. In this case, the upper part of the organ is sometimes large, more often symmetrical. With absolute doubling, each of the kidneys is provided with an ureter and a pelvicalyceal system. The accessory ureter may have its own entrance to the bladder or be connected to the main ureter, which is physiologically safer, since it does not lead to hydronephrosis.

Doubling types

Doubling of the kidney is of 2 types:

• complete;
• incomplete.

Complete splitting is a defect when two lobules are formed from one organ, while the pelvis of one of them is underdeveloped. The pelvis is equipped with separate ureters that flow into the bladder at different levels. Abnormal development of CHLS is possible when the ureter is excreted into the urethra (urine leaks in children), vagina, urinary diverticulum. Each lobe is capable of filtering urine.

Incomplete duplication of the kidney is a congenital anomaly that is much more common. In this case, doubling of the left kidney and doubling of the right kidney occur with the same frequency. The size of the body is larger than usual. Each lobe has its own blood supply, but the PCS is one. It happens that two pelvises are formed, but the blood supply is common.

Causes of the anomaly

A double abnormal kidney can be formed by such factors:

• congenital;
• acquired.

An additional kidney of congenital etiology is laid genetically during the period of intrauterine development of the fetus. Abnormal genes are inherited from one or both parents. Acquired causes occur when genes are mutated, which are caused by the influence of chemical, biological or physical factors on the fetus during pregnancy.

The physical reason is the radiation treatment that the child succumbed to in the womb. Chemical provocateurs are determined by the behavior of the mother. These include the use of alcohol by a pregnant woman, drugs, smoking, drug addiction. Biological causes include viruses that can cause cell mutation in the fetus. Acquired anomalies can be prevented, since they all depend on the behavior of the pregnant woman.

In addition, a bifurcated abnormal kidney may result from exposure to the following factors during pregnancy:

• bacterial infections;
• lack of vitamins;
• environmentally dangerous situation;
• the use of hormonal drugs;
• viruses.

With complete duplication with double PCS and a bifurcated ureter, symptoms are usually absent until the development of pathologies of adjacent organs or kidney disease. If one of the ureters is excreted into the vagina (into the urethra, into the urinary diverticulum), the patient will be disturbed by various symptoms, for example, urine leakage, which occurs not only in a child, but also in an adult. With other ureteral defects, hydronephrosis often develops (urine accumulates in the PCS). Possible signs of a divided kidney:

• swelling;
• prostration;
• pain in the kidney area;
• cloudy urine;
• elevated temperature indicators;
• pain when urinating;
• nausea;
• vomit;
• high blood pressure;
• renal colic.

Diagnostics

Diagnosis in an adult usually occurs by chance during a routine examination, as there are no symptoms of kidney separation. The following diagnostic procedures are performed for a child and an adult:

• magnetic resonance urography.
• CT scan;
• dopplerography;
• radiography;
• Analysis of urine;
• ascending urography;
• excretory urography;
• cystoscopy;
• bacteriological examination of urine sediment.

Ultrasound (ultrasound diagnostics)

Usually, an accidental diagnosis occurs during an ultrasound scan. The information content of ultrasound is especially high in dilatation of the upper urinary tract. It is impossible to see the character of doubling with the help of this procedure. After the diagnosis is made, ultrasound is used to monitor the course of pathological changes during pregnancy or for other follow-up examinations.

The most common congenital anomaly of the urinary system is a duplication of the kidney. Such a pathology does not pose a particular danger to a person, but it can initiate the development of more dangerous health conditions.

In modern medicine, duplication of the kidney is understood as a complete or partial duplication of the renal system as a result of congenital pathology of the kidneys.

In this case, the organ is two kidneys connected together, but each of them has its own blood supply. In most cases, this kind of anatomical disturbances appear only on one side, but there are also cases of bilateral doubling.

The reasons

• The cause of such a pathology is the harmful effects of various factors on a woman during pregnancy;
• A variant with altered, defective genes of both parents is possible.

When laying the urinary organs, exposure to harmful agents is possible - ionizing radiation, smoking and alcohol, a number of drugs, a deficiency of vitamins, and minerals that can cause developmental abnormalities.

Incomplete duplication of the kidney

The most common violation is incomplete doubling, here the organ is enlarged, and the upper and lower sections are clearly defined in it, with each section having its own renal artery. With incomplete doubling of the kidney, there is no bifurcation of the pelvicalyceal system, it works alone.

With full doubling, instead of one kidney, two are formed. With doubling of the left organ on the left, a double pyelocaliceal system of the left kidney develops, but one of the parts of this system has an underdeveloped pelvis, and each pelvis has, in turn, a separate ureter that flows into the bladder at different levels.

Diagnostics

incomplete doubling any kidneys often does not manifest itself in any symptoms, and a person can live his whole life in happy ignorance of this anomaly.

The diagnosis is usually made by chance at a routine examination in the clinic.

To clarify the diagnosis, use:

• ultrasound procedure;
• method of computed tomography;
• radiography;
• magnetic resonance urography;
• cystoscopy or ascending urography helps to clarify the diagnosis even more.

Cystoscopic examination allows the doctor to examine the mouth of the ureters.

With ascending urography dyes are introduced, visible on x-rays. The picture shows the ureters, their place of entry, and in case of incomplete doubling, the dilated pelvicalyceal system.

Treatment

Treatment of duplication of the kidney they are prescribed only with the development of any complications, and if this anomaly does not cause special concerns to a person, then they are limited to monitoring it.

Observation consists of:

• Ultrasound of the renal system;
• clinical examination of urine once a year.

Treatment of complications:

• If inflammatory complications occur, then the doctor will have to select antibiotics, usually with a broad spectrum of action;
• When the kidney is doubled, stones can often appear with all the ensuing consequences, for example, in the form. In this case, analgesics, antispasmodics and herbal remedies such as kidney tea are prescribed;
• Surgical intervention is prescribed only in severe cases of hydronephrosis, or with the development of complications that are not amenable to drug treatment, and the main task of the surgeon here is to save the organ;
• If a doubling of the kidneys is determined in a woman, then she must plan the pregnancy in advance, must undergo a complete clinical and laboratory examination, and.

Doubling of the kidneys in a child can be determined even in utero, by performing an ultrasound scan after twenty-five weeks of pregnancy.

Prevention of complications

A kidney with an abnormal development is more vulnerable, and preventive measures are urgently needed here:

• a person should stop eating excessive amounts of salty foods;
• can not be supercooled;
• It is imperative that all urinary tract infections be treated promptly.

With such a pathology, people should not forget about the rules for preventing complications and monitor their health.

Doubling of the kidney is a pathology of a congenital nature, which is characterized by complete or partial doubling of the main organ of the urinary system - the kidneys. A similar anomaly occurs in 10% of cases from other diseases of the urinary system. Doubling of the kidneys in nephrology is not considered a separate disease, but with a neglected course, persistent dysfunctions in the functioning of the urinary organs can develop. Pathology is recorded in the ICD-10 with the assignment of the code Q63-8 "Other congenital anomalies of the kidney."

The abnormal structure of the kidneys is laid in the prenatal period. According to statistics, one in 150 newborns has a double organ. In the risk group for the development of the disease - girls, in boys the diagnosis is confirmed 2 times less often. Doubling on the one hand occurs in 89% of cases, and for unclear reasons, doubling of the right kidney is more often diagnosed. Anomaly on both sides occurs in 11% of cases.

Visually, a duplicated organ differs from a healthy one and looks like two kidneys fused at the poles, each with its own blood supply. Despite the irregular structure, the doubled organ performs the main functions of purifying the blood and removing harmful substances from the body.

Classification

In addition to one- and two-sided doubling, pathology is classified according to the forms:

• complete doubling - a kind of abnormal kidney, in which the organ is presented in the form of 2 independent structures connected into one; from an anatomical position, the structure of the kidney with complete doubling is organized, as in 2 separate organs - both elements have their own blood supply system, the presence of a doubling of the renal PCS (pelvicalyceal system) is characteristic;
• incomplete duplication of the kidney - a kind of anomaly, when one renal element integrates into the tissues of another; a characteristic feature of this form is associated with the presence of a single PCS; with incomplete doubling, the organ greatly increases in size; incomplete doubling of the left kidney is more often diagnosed.

Pathogenesis

In medicine, there is no exact information about the causes of the onset of the disease. Equally important is the hereditary factor - if one of the parents or other close relatives has a diagnosis, the likelihood of an anomaly increases. Another significant reason is associated with the impact on the female body during pregnancy of negative factors in the form of:

• ionizing radiation;
• work in hazardous conditions;
• transferred bacterial and viral infections;
• drug intoxication, poisoning with poisons;
• taking hormonal drugs;
• alcohol and nicotine intake;
• severe forms of hypovitaminosis.

As a result, two foci of kidney growth appear in the developing embryo, and conditions are created for the development of 2 PCS. Complete separation of the PCS does not occur, the doubled kidney is covered with a common fibrous layer. Occasionally, in an abnormal organ, the vessels intertwine, penetrating from one element to another, which complicates the possibility of future operations.

Symptoms

People with kidney duplication usually don't have negative symptoms. Confirmation of the diagnosis occurs by chance, during an examination for other diseases. Negative symptoms become clinically significant only with the imposition of complications. With full doubling, the complications are more serious than with incomplete doubling. In both cases, with a long course of anomalies, there are:

• frequent inflammatory processes prone to recurrent course;
• hydronephrosis - a condition in which the renal pelvis expands and the excretion of urine is disturbed;
• backflow of urine from the ureters.

Additionally, the presence of anomalies may indicate:

• aching pain in the lumbar region;
• pain when tapping the lower back;
• rise in temperature;
• attacks of renal colic;
• difficulty urinating;
• urinary incontinence;
• weakness;
• increased blood pressure;
• swelling of the face and limbs.

Survey Tactics

To confirm the diagnosis, instrumental studies are organized:

• echography with color Doppler mapping - a method that allows you to identify the presence and assess the condition of independent PCS;
• cystoscopy - necessary to visualize the mouths of the ureters, their number and localization;
• excretory urography - a method that allows you to assess the condition of the ureters, the presence of expansions and doublings of the PCS;
• MRI - will allow you to reliably examine the pelvicalyceal system in a three-dimensional projection.

Laboratory diagnostics is carried out to identify inflammatory processes in the urinary organs and evaluate the effectiveness of their work. For this apply:

• general urine analysis;
• bacteriological culture;
• biochemical blood test with the determination of the concentration of creatinine, urea, albumin, uric acid, ions (potassium, chlorine, sodium);
• smear from the urethra for bacanalysis.

Treatment

There are no specific methods of treating pathology. But patients with duplication of the organ are subject to systematic observation and examination to monitor the functioning of the renal system. For prophylactic purposes, diuretics and phytopreparations are prescribed. With the development of complications, therapy is symptomatic:

• taking broad-spectrum antibiotics;
• antispasmodic and analgesic drugs;
• a balanced diet with limited salt, fat;
• taking special kidney teas.

Surgical intervention for anomalies of the renal system is performed for a number of indications:

• chronic recurrent pyelonephritis;
• vesicoureteral reflux;
• functional or anatomical destruction of an organ and its segments.

Types of surgical interventions:

• nephrectomy - excision of the affected renal segments; when complications are imposed in the form of a tumor, the impossibility of separating the kidneys, a complete nephrectomy is performed;
• anti-reflux operation - the creation of artificial gaps for the free flow of urine;
• excision of the ureterocele with interrupted sutures and suturing of the ureters to the walls of the bladder;
• kidney transplantation, hemodialysis are indicated in the event of acute kidney failure against the background of doubling.

The course of pregnancy in pathology

A woman with a doubling of the kidney can become a mother - pathology is not a contraindication to pregnancy. The only contraindication is the severe course of the anomaly with the need for surgical intervention, or the renal failure that has arisen against the background of doubling. Preparation for pregnancy should be thorough, with a comprehensive examination and treatment (if necessary) of detected foci of infection.

A possible risk for a pregnant woman is associated with squeezing by the growing uterus of an abnormal kidney and a violation of its filtering ability. Therefore, a woman throughout the entire gestation period should be observed not only by a gynecologist and therapist, but also by a nephrologist (at least once every 2 months). If complications from the renal system appear, the pregnant woman is subject to hospitalization in the urological department to correct the condition.

Preventive measures

There are no specific preventive measures, which is associated with the mechanism of the formation of anomalies at the genetic level. A responsible approach to pregnancy planning and a healthy lifestyle for the expectant mother can reduce the likelihood of developing pathology. Proper nutrition, taking multivitamin complexes, following medical recommendations allows you to maintain your own health and ensure adequate organ formation in the fetus.