Hydronephrosis of the kidney in children: what parents should know. Hydronephrosis in children at various stages of development. Diagnosis and treatment of the disease, its possible consequences Hydronephrosis of the left kidney in a 4-month-old child

The kidneys are one of the most important organs in the human body, many vital functions. - a serious problem, a dangerous condition that can cause serious harm to health.

Hydronephrosis is one such pathology. In children, this disease occurs quite often(mainly in boys), accompanied by a violation of the outflow of urine, can lead to kidney atrophy. Pathology can be both unilateral and bilateral (more complex form).

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general information

Hydronephrosis is a disease caused by increase in urine pressure on the structures of the kidneys.

In the event that this situation is of a protracted nature, there is a change in the structures of the kidney (renal pelvis, calyx).

They expand, increasing in size. This leads to further violation of the process of outflow of urine, an even greater increase in the hydrostatic pressure of urine, organ atrophy. Moreover, the greater the pressure, the more extensive the deformation processes become, the more the kidney functionality is impaired.

Often the disease is caused congenital anomalies development of the urinary system, which develop during the period of intrauterine development of the fetus. In this case, the pathology, which manifests itself after the birth of the baby, can be unilateral or bilateral.

The kidneys are a paired organ, therefore, with unilateral hydronephrosis, the symptoms of the pathology may be absent for some time, since the healthy organ takes over the functions of the affected kidney.

At bilateral form of the disease, the clinical picture is more vivid and pronounced.

Reasons for development

Hydronephrosis is most often congenital, therefore, the main cause of its appearance is considered anomalies of intrauterine development of the urinary tract child's body:

1. Narrowing of the lumen of the urinary canals.
2. A change in the position of the ureters, as a result of which there is a reverse outflow of urine (reflux effect).
3. Violations of the structure of the vascular system of the kidneys, as a result of which extra vessels are formed that wrap around the ureter, thereby reducing its patency.

If we are talking about an acquired form of pathology, the following can lead to its development: unfavorable factors:

1. Injuries in the lumbar region.
2. Metabolic disorders in the body, which provoked the development of urolithiasis.
3. Inflammatory processes in the ureter, leading to scarring in the tissues of the organ.
4. Unsuccessful surgeries during which the ureter was damaged.

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Disease classification

The development of hydronephrosis occurs in several stages. There are the following stages:

• initial. The functions of the kidneys are preserved, there is a slight expansion of the renal pelvis while maintaining the integrity of this structural element;
• at the second stage kidney function is gradually lost, the walls of the renal pelvis become thinner, it increases even more in size. There is an increase in the size of the kidney as a whole;
• third the stage is characterized by a significant (or complete) loss of kidney functionality, a strong increase in the size of the organ, and atrophy of the renal parenchyma.

According to the degree of damage, hydronephrosis is unilateral (more often the right kidney is affected, and not the left kidney), or bilateral (a rare phenomenon diagnosed in only 10% of cases).

The disease has a congenital form (most common) and acquired.

Pathogenesis

As a result of disturbances in the development of the urinary system, the outflow of urine from the body slows down. This is due, most often, to anomalies in the structure of the urinary canals, which, in this case, unable to fully perform their function.

As a result of such disorders, the pressure exerted by the accumulated urine on the structural elements of the kidneys increases. This leads to the development of inflammatory processes, an increase in the size of the organ and its elements, and impaired renal function.

This, in turn, exacerbates the problem even more, since the hydrostatic pressure of the urine in this case only increases.

Symptoms and signs

It is important to remember that with a unilateral form of pathology, its symptoms can do not appear for a long period of time.

At the initial stage of the development of the disease, it can also occur asymptomatically. However, over time, the clinical picture becomes more pronounced, there are such signs how:

The third stage is characterized by the appearance of the following symptoms:

• dryness and pallor of the skin;
• an increase in blood in the urine;
• decrease in the volume of urine excreted (almost complete absence of urination);
• hyperthermia;
• lack of appetite, severe weakness;
• nausea.

Complications and consequences

Hydronephrosis in children is a disease that doesn't go away on its own, which means that a small patient needs special treatment.

Otherwise, it is possible to develop serious complications, such as pyelonephritis, renal failure, significant intoxication of the body, fever to dangerous values.

These phenomena are considered very dangerous, especially for children of the first year of life, can lead to death.

Diagnostics

It helps the doctor to make a diagnosis by questioning the patient, assessing the clinical manifestations of the pathology, as well as a number of laboratory studies:

1. Blood tests for the presence of inflammatory processes in the body, blood levels of urea, creatinine.
2. Urinalysis for the content of blood elements.
3. Determination of the functionality of the kidneys by the Rehberg test.
4. Ultrasound of the organs of the excretory system to determine the stage of development of pathology.
5. MRI, CT to identify the causes of the development of the disease.

Treatment Methods

As a rule, at the initial stage of the development of the disease, no therapy is required, however, the child should be under medical supervision.

The second and third stages require adequate therapy.

Conservative treatment is used, in some cases, if drug therapy has not given the expected effect, the child needs surgical intervention.

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Medical therapy

For the treatment of hydronephrosis, the doctor prescribes the patient the following groups of drugs:

1. Anti-inflammatory funds allow you to eliminate inflammatory processes, relieve swelling.
2. Antibacterial drugs needed if an infection has joined the underlying disease. Antibiotics prevent the spread of pathogenic microflora throughout the body.
3. Enterosorbents to eliminate the manifestations of intoxication of the body.
4. Since an increase in blood pressure occurs with hydronephrosis, it is necessary to take drugs that lower blood pressure.

Dieting

A proper diet is a prerequisite for a successful cure. The patient is prescribed special diet, characterized by high caloric content, nutrient content.

At the same time, salt intake should be significantly reduced.

It is important to observe the liquid regime, the child is recommended drink as much pure water as possible. This helps to cleanse the body, restore the process of outflow of urine.

Surgical intervention

Radical Methods treatment (surgery) is prescribed in the presence of the following indications:

• significant violations of the process of outflow of urine;
• extensive inflammatory processes in the kidney area;
• severe pain;
• significant impairment of kidney function;
• kidney failure.

Surgical operations can be different:

1. open operation. It is carried out under general anesthesia. The doctor makes an incision in the hypochondrium, through this incision, access to the affected organ is provided. During the operation, damaged kidney tissue is removed, and the renal pelvis is also excised. Healthy areas of the body are connected with sutures. It is necessary to check the tightness of the urinary canals to prevent leakage of urine.
2. Endoscopy. It is used in the event that there is a narrowing of the urinary canal. Special rods and tubes are inserted into the ureter through the urethra, which are necessary to increase the lumen of the canal. If the tissue of the organ is affected by scars, endotomy is used - laser removal of scar tissue.
3. Laparoscopy is the most efficient method. The operation is performed under general anesthesia. 5 punctures are made in the hypochondrium. An endoscope is inserted into one of them, which is connected to a video camera. This allows the doctor to see the whole picture in detail. Through another puncture, carbon monoxide is injected into the patient's body. This is necessary to increase the internal space in the patient's body, which facilitates the work of the surgeon. Then the doctor, using special tools, removes all the affected parts of the organ, connects the renal tub with a healthy part of the ureter. As a rule, subsequent suturing is not required, however, a sterile dressing treated with an antiseptic should be applied to the puncture area.
4. Nephrectomy- complete removal of the affected organ. It is prescribed only if the disease has a unilateral course. Currently, it is used extremely rarely, only in emergency cases, when there is a complete death of the organ. If at least 10% of the kidney is preserved, this method of treatment is not used.

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Forecast

The chances of a successful recovery depend on the form of the disease (with unilateral hydronephrosis, the prognosis is more favorable), as well as on how timely treatment was started.

Hydronephrosis at an early stage of development responds well to treatment, in 90% of cases the child recovers returns to full life. If the pathology has moved to the 2nd or 3rd stage of development, the prognosis, alas, is ambiguous. In the absence of therapy, death can occur.

Hydronephrosis is a kidney disease that interferes with the flow of urine. Pathology can be both congenital and acquired, its development is influenced by many factors.

Depending on the stage of development the disease manifests itself in different ways, if at the first stage there may be no symptoms, then at stages 2 and 3 the clinical picture is very noticeable. Hydronephrosis needs mandatory treatment. It can be drug therapy, or radical methods of treatment.

About the causes and treatment of hydronephrosis in children in this video:

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Hydronephrosis of the kidneys in children is a pathological condition that most often refers to a variety of congenital developmental anomalies. This disease is characterized by a pronounced expansion of the renal pelvis as a result of difficulty or complete cessation of the outflow of urine into the cavity of the ureters.

Acquired pathology occurs as a result of injury to the lower back, the anatomy of the organ is disturbed, inflammation appears in the urinary system, scars and the process of decay are formed, which prevents full urination.

In children, this pathology is more common than in adults, in infants, symptoms may not be observed, the disease progresses with age. But at present, it is possible to diagnose the pathology of the child with an ultrasound examination of the mother during pregnancy. In this case, it is better to start treatment immediately after the birth of the baby.

Causes of hydronephrosis in newborns

The reason for the development of this condition can be the anatomical narrowing of the lumen of the ureter in the area of ​​​​its departure from the pelvis, as well as insufficient contractility of the muscle fibers in their membranes. The most common cause of hydronephrosis is considered to be anatomical defects.

Anatomical factors:

• The presence of valves in the cavity of the ureter
• Abnormal divergence of the choroid plexuses and accessory vascular branches
• Anomalies in the location of the ureters in relation to the renal parenchyma
• The presence of strands of embryonic origin, which provokes compression and bending of the ureters

If a child has congenital hydronephrosis, its cause lies in a structural disorder of the kidney. Even in the fetal period, during the formation of the internal organ, the urinary tubules can be incorrectly positioned, twisted, or narrowed, which will cause a delay in the outflow of urine.

Numerous studies say that the main cause of the pathology in most cases is the mother’s wrong lifestyle when carrying a child, namely smoking and alcohol. Another cause of congenital hydronephrosis is genetics. The disease is inherited.

What is dangerous hydronephrosis

Prolonged retention of urine outflow leads to ischemic damage to the renal parenchyma with subsequent atrophic changes. The rate of formation of the pathological process depends entirely on how obturated the urinary duct is.

With a pronounced violation of the urinary outflow, the pelvis of the kidneys still cope with the urinary function for a short amount of time, but after a certain period of time, hypertrophy of the muscle fibers begins to develop.

Increased pressure in the renal pelvis and ureters can lead to rupture of their membranes, while urine is poured into the retroperitoneal cavity. Due to prolonged stagnation of urine in the upper parts of the urinary system, infectious and inflammatory processes can develop.

Hydronephrosis of the kidneys in children. Symptoms

Symptoms depend on the degree of the disease; in the initial stages, hydronephrosis of the kidneys in children goes unnoticed.

Hydronephrosis of the first degree in a child.

At this stage, there are no violations of the kidneys, the internal organs work normally, the pathology does not make itself felt, but internal changes occur. When conducting an ultrasound, you can notice a slight expansion of the pelvis of the kidney. A thin child may develop a tummy, which parents should pay attention to.

Hydronephrosis of the second degree in a child

During this period, the disease makes itself felt. On ultrasound, you can notice a significant expansion of the pelvis and calyces of the kidney. The second stage of hydronephrosis entails compression of the renal parenchyma, due to the large amount of urine. Following is the atrophy of the renal tissue, which further reduces the function of the diseased kidney.

The main symptom at this stage is severe pain with localization in the lumbar region, irradiation can spread to the umbilical region. The severity and duration of the pain syndrome depend on whether the inflammatory process of the urinary system has joined the underlying disease.

Hydronephrosis of the second degree is also characterized by a change in laboratory tests in favor of a violation of the filtration capacity of the renal parenchyma. The child's urine becomes cloudy, and the results of laboratory tests show that the urine contains a large number of white blood cells and red blood cells. In infectious diseases, there is an increased temperature.

Frequent urinary tract infections in children may signal the presence of hydronephrosis.

During palpation, a tumor-like formation can be palpated, which is well palpable even through the anterior wall of the abdomen. There is also increased blood pressure.

Hydronephrosis of the third degree in a child

This is the last stage of the pathology, in which all the symptoms appear brighter. Protein ceases to be processed normally due to a violation of the water and electrolyte balance. The kidney parenchyma is affected, swelling of the extremities, a strong increase in the abdomen, bloody discharge during urination are added to the symptoms of the second degree.

How to treat?

Treatment of hydronephrosis in children is carried out by surgical methods, the only way to return the normal outflow of urine. If the functional ability of the affected kidney is still preserved, patients are shown an operation to restore the normal patency of the ureters. If the kidney has completely stopped its ability to function normally, such children are shown a radical surgical technique. The prognosis for further life depends entirely on the severity and neglect of the child's underlying condition.

There are cases when in newborns hydronephrosis can go away on its own up to a year. The baby is examined every three months, with the first and second degree of hydronephrosis, if the disease has reached stage 3, it is necessary to urgently treat the child. The operation for hydronephrosis in children in most cases is carried out by the endoscopic method. This technique is less traumatic for children than the abdominal one.

During the operation, two small incisions are made through which the endoscope and the necessary devices are inserted. If the violation of the patency of urine is caused by the ureter, it is plastic. If a large amount of urine has accumulated in the kidney, it will be removed using a catheter. The efficiency of the operation is very high.

Modern technologies make it possible to perform an operation on a child still in the womb, but the risks of this technique are very high, it can lead to miscarriage.

rehabilitation period

At the end of the operation, the surgeon puts an internal or external drainage system on the child. With the internal system, the baby can be discharged from the hospital in a week. But from the outside, you will have to spend about a month in the hospital. In the rehabilitation period after hydronephrosis, antibiotics and uroseptics are prescribed. The child is placed on dispensary registration with a urologist. For six months, it is necessary to take a general urine test once every two weeks. Even if 6 months have passed since the operation, leukocytosis can be detected in the urine, do not worry about this, this is normal.

Hydronephrosis of the kidneys in children is a serious disease, the treatment of which is urgent. If you suspect that your child's kidney function is impaired, be sure to share your suspicions with the doctor.

• Classifications and stages of the disease

Hydronephrosis is a kidney disease. Its appearance is due to an exceptionally significant increase in the size of the renal calyces and pelvis. Hydronephrosis in children occurs with much greater regularity and frequency.

The disease is provoked by disturbances in the structure of this organ, which interfere with the natural flow of fluid inside the kidneys. As a result, the following picture takes place: hydroscopic pressure in the cavities of the pelvis and calyces grows at a rapid pace, their walls are stretched, which subsequently leads to impaired functioning of the kidney and pain in the patient.

Hydronephrosis is a multistage pathological process, with the lesion occurring predominantly in the left kidney.

From the point of view of the causes of the disease, the following groups of the disease are distinguished:

• congenital;
• acquired.

Congenital hydronephrosis in children is a consequence of disorders that have arisen in the structure of the kidneys, namely: narrowing of the urinary tubules, changes in their course, twisting. In some cases, the disease carries a hereditary factor.

Acquired nephrosis occurs against the background of any inflammatory diseases of the urinary system. Absolutely any injuries associated with the lumbar region, which subsequently lead to a violation of urine conductivity, can provoke such an ailment. Depending on the location of the sore spot, the following classification is distinguished:

• unilateral;
• bilateral.

This disease is quite serious and has its own stages of development:

1. Function of a kidney is practically not subject to changes. There is an expansion of the renal pelvis.
2. Significant change in the size of the pelvis. Its walls are very thin. The kidney itself is increased in size by at least 20%. There is a significant decrease in kidney function.
3. The kidney takes the form of a multi-chamber cavity. There is a complete (or significant - up to 80%) loss of the excretory function by this organ. After a certain period of time, the process of decay begins in this organ, which carries a serious threat to the child's body.

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How to recognize an ailment: signs of hydronephrosis

Hydronephrosis in children occurs as a result of anatomical disorders that block or significantly reduce the outflow of fluid from the kidneys. There is no single symptomatology, since everything depends on the stage of the disease. At the very beginning, this ailment may not manifest itself in any way. However, over time, the following symptoms are observed:

• pain in the abdomen;
• violation of the process of urination;
• the presence of blood in the urine;
• visual swelling in the back in the hypochondrium from the side of the affected kidney;
• infections of the urinary system;
• a significant increase in body temperature (observed along with the infection).

It is very important to detect these symptoms in time and consult a specialist in a timely manner. Otherwise, pyelonephritis occurs. In a neglected state, there is a risk of death.

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Features of diagnosis and treatment process

In babies, this ailment in most cases is diagnosed even at the stage of intrauterine development, namely at 3-4 months of pregnancy, it has the same symptoms. Hydronephrosis of the kidney in the fetus is determined on the basis of ultrasound data. Treatment of hydronephrosis in children has specific features. At the stage of intrauterine development, the baby's body is only being formed. In this regard, all emerging changes are exclusively temporary. Quite often, the cause of hydronephrosis disappears one month after the baby is born. In a situation where the disease does not recede on its own, it is necessary to immediately begin treatment, which is precisely aimed at eliminating its cause. The treatment regimen is determined by the complexity of the disease and the timeliness of its detection. If necessary, the use of various painkillers is allowed. Anti-inflammatory, antihypertensive, and antibacterial agents are in most cases used at the stage of the first stage of hydronephrosis.

This disease has irreversible causes, so the appropriate way to cure is surgical intervention (surgery). Medical treatment provides a favorable environment in this situation. Surgery is the only way to restore kidney function. At this stage, it is very important to eliminate the causes of the disease and restore the full flow of fluid in the renal vessels. Only after that should immediately take measures for anti-inflammatory and antibacterial therapy.

The process of treating such an ailment as kidney hydronephrosis in a child should be fully coordinated with the doctor.

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 bloodstream, 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, observation for 6 months and then re-examination is possible, in the case of a favorable course, there is a possibility of avoiding surgical intervention.

Hydronephrosis is a pathology that is characterized by the expansion of the collecting cavity of the kidneys. Such changes lead to a violation of the natural outflow of urine from the body. Hydronephrosis of the kidneys in children is usually congenital. This is a serious disease that requires immediate treatment. In the case of prolonged neglect, it leads to disturbances in the functioning of the kidneys. Hydronephrosis can be detected even during fetal development.

The reasons

Statistics show that hydronephrosis most often develops in boys. Also, the pathology is mostly unilateral. Only in 20% of cases there is bilateral hydronephrosis of the kidneys in a child. The most common causes of this congenital disease include:

• Underdevelopment of the lumen of the ureter.
• Abnormal structure of blood vessels.
• Change in the structure or twisting of the ureters.
• Serious injury to the lower back.
• Inflammatory processes in the ureter, glomerulonephritis.
• The formation of calculi (stones).
• Metabolic disease.
• Unbalanced nutrition.
• Ligation of the ureters during abdominal surgery.

Classification

Doctors have long noticed that hydronephrosis of the right kidney in a child is much less common than the left. This is due to the peculiarities of blood circulation in this organ. Even less often, hydronephrosis of both kidneys in a child is diagnosed, this condition indicates a serious violation in the functioning of the organ. Doctors distinguish the following stages of the course of the disease:

1. Kidney function is not changed or changed minimally, the pelvis is expanded.
2. The pelvis is enlarged, its walls are thinned. The size of the organ exceeds the norm by 10-20%, its evacuation capacity is impaired by 20-40%.
3. The kidneys are a multi-chamber cavity, the function of which is reduced by 60-80%. The organ doubles in size, the cups and pelvis are greatly expanded.

There is also a classification according to the degree of destruction of the parenchyma:

• The first degree - the parenchyma is intact.
• Second degree - minor changes are observed in the parenchyma.
• Third degree - the parenchyma is significantly damaged.
• The fourth degree - the parenchyma is completely destroyed.

Symptoms

Kidney disease hydronephrosis in children may not show any symptoms for a long time. Because of this, serious complications develop that are difficult to treat. Pathology can be recognized by the following manifestations:

• An increase in the size of the abdomen due to ascites - the accumulation of fluid.
• Regular paroxysmal pain in the lumbar region.
• A slight increase in body temperature.
• Lethargy of the child, lack of appetite.
• Itching associated with the accumulation of toxins.
• Nervousness, bad mood, capriciousness.

In rare cases, kidney hydronephrosis in children can be recognized by the presence of blood streaks in the urine. Also, the doctor can easily detect the tumor with the help of palpation.

Diagnostics

The most important study in the diagnosis of hydronephrosis is fetal ultrasound. Already at the 15th week of pregnancy, doctors are able to examine the formed structure of the collecting system of the kidney.

It is possible to diagnose this lesion even during the intrauterine development of the child by expanding the pelvis. If the structure of the organ has not changed after birth, the following studies are carried out:

• General and biochemical blood tests.
• General urine analysis.
• Ultrasound of the kidneys and bladder.
• Voiding cystourethrography.
• Intravenous urography.
• Nephroscintigraphy.

Only after conducting all the studies, the doctor will be able to make a correct diagnosis. An extended examination allows you to prescribe the most effective and appropriate treatment, as well as control the dynamics during therapy. Usually, congenital hydronephrosis can be diagnosed at 3-4 weeks of a child's life.

Complications

If there is no treatment for hydronephrosis of the kidneys for a long time, serious complications can occur in children. The most dangerous consequence of such a disease can be called organ failure. Due to incomplete removal of toxins and toxins, nitrogenous compounds accumulate in the blood, which slowly poison the body. Prolonged exposure can even lead to death.

In addition, hydronephrosis of the kidneys can lead to the formation of stones. If an infection enters the organ, pyelonephritis develops, which aggravates the state of the pathological process. Against the background of a rupture of the calyx or pelvis, part of the urine may enter the retroperitoneal space. This is fraught with the development of sepsis or retroperitoneal phlegmon.

Treatment

Treatment of hydronephrosis of the kidneys in children is highly effective. With timely diagnosis, this disease can be eliminated quickly and without consequences. In the initial stages, medications are used. However, they can be taken only with an uncomplicated form of pathology of the 1st degree, in which the work of the organ is not destroyed.

It is very important to undergo regular clinical and radiological examination during therapy. It allows you to evaluate the dynamics of changes.

In all other cases, an operation is performed for hydronephrosis of the kidneys in children, reviews of which you can easily find on the net. This intervention is an excellent prevention of insufficiency and infection of the urinary tract. The operation is performed under general anesthesia and takes 2-4 hours on average. It has a long recovery period.

If the child's kidney function is impaired, the organ is infected, or he is tormented by severe pain in the lower back, a percutaneous nephrostomy is performed. This procedure is designed to drain urine from the body, is carried out under the control of ultrasound. In the presence of inflammatory processes, antibiotics are prescribed. The dynamics of changes is controlled by bacteriological analysis of urine with the determination of the sensitivity of microorganisms. Depending on changes in blood counts, dialysis, plasmapheresis, or detoxification drugs may be prescribed.

To maintain the normal functioning of the whole organism, diet No. 7 according to Pevzner is prescribed. It is designed to be permanent. The essence of such nutrition is to minimize the amount of salt consumed to 2-3 grams per day and limit the daily dose of liquid to 2 liters. In some cases, osteopathy is used to treat hydronephrosis in children.

Prevention

Hydronephrosis of the kidneys in children is a congenital chronic disease. It is almost impossible to recognize its symptoms in the initial stages. Diagnosis of the disease is carried out using ultrasound when the child reaches 1 month. To minimize the development of this pathology, it is necessary:

• Avoid any injury to the lower back.
• Introduce quality food.
• Provide nutritious food.
• Eliminate foods with salt from the diet.
• Monitor temperature.
• Monitor fluid intake and urine output.

Symptoms and treatment of hydronephrosis of the kidneys in children depend on the degree of damage and the individual characteristics of the organism. The development of this disease can be affected by the bad habits of a woman, which she did not give up at the time of bearing the fetus. Its first signs appear in a child after the death of the kidney tissue occurs.

It is very important to provide effective and prompt treatment.