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Hydronephrosis

Hydronephrosis

Hydronephrosis of the kidney is a hydronephrotic transformation of the kidney. The disease is an expansion of the renal pelvis system (which unites several renal cups that open into the renal pelvis) of the organ.

In its initial stage, hydronephrosis leads to a slight increase in pressure in the renal-pelvic system, but as the disease progresses, the pressure increases and, ultimately, leads to an effect on the entire organ and to damage to the renal tissue.

In hydronephrosis, the following symptoms are often encountered: hematuria, pain and the ability to palpate the kidney, but their combination is not sufficient to make a diagnosis of hydronephrosis (since similar symptoms are present in other diseases of the urinary system). Therefore, a complete examination is necessary, in particular, the passage of the patient by an ultrasound examination (ultrasound).

Also in medical practice, to diagnose hydronephrotic transformation of the kidney and determine the degree of progression of this disease, X-ray of the urinary tract and intravenous urography are used, with the help of which it is possible to assess the state of the organ and its functionality. The clarification of the patient's complaints and the data of laboratory tests are also important.

Treatment of hydronephrosis is aimed at eliminating the causes that led to the development of this disease. Surgical treatment is possible (conservatively, hydronephrosis is treated at its initial stage) - the prognosis is usually favorable.

Compliance with a certain diet is required (content of essential amino acids in food, consumption of berries, vegetables and fruits, limiting the addition of table salt to food, etc.) for patients with hydronephrosis.

Renal hydronephrosis is an expansion of the renal calyx and pelvis. Generally speaking, the kidney functions as follows: urine is constantly formed in the tissue of this organ, which is collected in the renal calyx-pelvis system, and then enters the ureter, which opens into the bladder. With hydronephrosis, urine accumulates in this system in large quantities, as a result of which expansion occurs.

Hydronephrosis is a polyetiologic disease. This means that many reasons can influence the development of hydronephrosis. All of them are combined according to the principle that lead to the occurrence of hydronephrosis of the kidney.

Impaired urine outflow is a prerequisite for the development of renal hydronephrosis. This is true. An obstacle to the outflow of urine can, for example, be anomalies in the development of the urinary tract, urolithiasis, damage to the urinary tract due to trauma, etc.

Hydronephrosis is divided into primary and secondary. The cause of primary hydronephrosis, or, as it is called, congenital, is an abnormality in the development of the renal tissue or urinary tract. The congenital form of the disease can also occur if additional blood vessels are available.
Secondary hydronephrosis can develop as a result of tumors of the ureter, kidney, renal pelvis. Also, the causes of hydronephrotic transformation of the kidney (hydronephrosis) include urolithiasis (which, nevertheless, can be not only the cause of this disease, but also its consequence) and the consequences of injuries.

The onset of hydronephrosis is marked by an increase in urine pressure in the calyx and renal pelvis. The consequence of such an increase in pressure is the development of muscle and elastic fibers in stretched structures (in the renal pelvic system of the kidney).
At first, due to the developed elasticity with increased pressure, the renal-pelvic system successfully fights and counteracts it, but to a certain degree of its increase. With the development of hydronephrosis, the pressure tends to increase more and more, therefore, it begins to act not only on the calyx and pelvis of the kidney, but also on it itself, thereby making it difficult for urine to drain from the organ.
If a similar situation persists for a long period of time, then the disease can provoke damage to the kidney tissue, as a result of which the renal tubules and glomeruli are not immune from atrophy - they shrink, thereby reducing the layer of the organ in which primary and secondary urine is formed.
If the cause of hydronephrosis in a person is not clarified and, accordingly, is not eliminated, then the process of damage continues and leads to a thinning of the kidney tissue. In this case, the calyx of the organ and the pelvis reach enormous sizes, the action of gravity often leads to the fact that the kidney cannot be kept in its own bed - it sinks down.

Hydronephrosis leads to the development of renal failure, which is inevitable if the disease is not detected and eliminated in time. If hydronephrosis is started, then it even threatens that the kidney will completely stop working, death may occur, since substances that are normally excreted in the urine will no longer be excreted from the human body, that is, the body will be intoxicated with metabolic products.

Hydronephrosis can lead to the development of urolithiasis. As noted earlier, urolithiasis can be both the cause of hydronephrosis and its consequence. Urolithiasis as a result of hydronephrotic transformation of the kidney can aggravate the course of hydronephrosis. Pyelonephritis, inflammation of the renal tissue, can also join urolithiasis (as a result of which the normal flow of urine is also disrupted). A very serious and dangerous complication of hydronephrotic transformation of the kidney is an unexpected rupture of the calyx or pelvis, as a result of which urine enters the retroperitoneal space.

The manifestations of hydronephrotic transformation of the kidney are numerous. This is due to many reasons that can lead to the development of hydronephrosis. However, there are three main symptoms of this disease, which are most common in the presence of hydronephrosis. These include the following: the ability to palpate the kidney, the appearance of pain and hematuria.

Hydronephrotic transformation of the kidney can give various pains. If we are talking about the very beginning of the disease, then recurrent renal colic is a frequent manifestation of hydronephrosis. Their periodic appearance is associated with pressure surges in the calyx-pelvis system. Renal colic can also occur with the movement of stones in the event that the hydronephrotic transformation of the organ is accompanied by urolithiasis. Moreover, the resulting pain can be very pronounced.
In the lumbar region and abdomen with hydronephrosis, dull pain often occurs. In the late afternoon, the pain may tend to increase significantly, but at night the intensity of the pain syndrome decreases. In addition, an attack of pain can occur immediately after physical exertion on the patient's body.
It is known that as the disease progresses, the arising pains become less and less pronounced. Often they give, and speaking in a more scientific language, they radiate to the lower limb and groin.

Hematuria is a characteristic sign of hydronephrotic transformation of the kidney. Actually hematuria is a condition when blood elements are found in the patient's urine. The cause of hematuria in the case of hydronephrosis is strongly different from the normal (upward) pressure in the renal pyelocaliceal system, as well as irritation of the renal tissue. Hematuria can be observed during the movement of stones (if any), and microtrauma. In addition, hematuria in itself can provoke the formation of stones, that is, urolithiasis.

The ability to probe the kidney is characteristic of the hydronephrotic transformation of the kidney. It is important to understand that the kidney is greatly enlarged due to the increase in its constituent parts - the calyx and pelvis. However, it is not always possible to probe the kidney through the abdominal wall. Basically, this symptom occurs in people with a lean physique, but in the case of a very strong enlargement of the kidney, it can also be felt in people who are not very thin.

Pain, hematuria and the ability to palpate the kidney are symptoms that are insufficient to diagnose hydronephrosis. The reason for this is simple - the listed symptoms are often expressed in other diseases, that is, they are not characteristic only of hydronephrotic transformation of the kidney. In this regard, for the diagnosis of hydronephrosis, it is necessary to examine the patient and conduct laboratory and instrumental studies. Based on their data, a correct diagnosis can be made.

Ultrasound examination is a mandatory step in the diagnosis of hydronephrosis. Ultrasound examination (ultrasound) is not only a simple method for obtaining important data on the state of the kidney, but also a reliable method. The presence of stones and the size of the kidney can be assessed by plain radiography of the urinary tract.

Intravenous urography allows you to assess the functionality of the kidney. This is very important for determining the presence of hydronephrosis and the degree of its progression, since ultrasound and radiography data are often not enough to compile a complete picture of the disease.
Intravenous urography is carried out as follows: a certain substance is introduced into the patient's body. It accumulates in the kidneys and is then excreted in the urine. The essence of this method is that a specialist takes pictures after a certain period of time after the introduction of the substance. These images allow you to judge the degree of damage to the kidney tissue.

In the treatment of hydronephrotic transformation of the kidney, it is necessary to eliminate the cause that led to the development of the disease. This is an important and main stage in the treatment, which determines its effectiveness. If urolithiasis has led to hydronephrosis, then the treatment will consist in getting rid of this ailment. This can be stone crushing or surgery (stone removal).

Hydronephrosis is treated with surgery. In modern medicine, several methods are known to get rid of this disease. Thus, with hydronephrotic transformation of the kidney, several types of operations are possible. Firstly, this is the execution of the fistula between the pelvis and the ureter, the essence of this operation is to create an additional pathway for the outflow of urine from the kidney. As a result, an objective prerequisite is created for the normalization of pressure in the calyx and renal pelvis.
The second possible operation for hydronephrosis is associated with the elimination of the narrowing of the pyelocaliceal complex - a longitudinal dissection of tissues and their stitching is carried out. Sewing is done already in the transverse direction. Thus, one of the fairly common reasons leading to hydronephrotic transformation of the organ is eliminated.
The moment of surgical treatment is important: the earlier the corresponding operation is performed, the sooner the recovery and the greater the likelihood of recovery of kidney function.
One of the goals of surgical treatment is to prevent the spread of infection and the development of kidney failure. The prognosis is generally good.

Hydronephrosis can be successfully treated with conservative methods. Unfortunately, they can be dispensed with only in the initial stages of the disease, when hydronephrosis has not yet created problems with impaired human performance and has not led to a sharp decrease in kidney functionality. Therefore, if signs of hydronephrotic transformation of the kidney are detected, prompt hospitalization and examination are required.

Hydronephrosis requires a specific diet. The patient should eat a lot of fresh vegetables and fruits. The patient is recommended to drink at least two liters of fluid per day. In addition, the food included in the diet should be high in calories (the daily requirement is approximately three thousand kilocalories). Food should include essential amino acids (amino acids that cannot be synthesized in the human body, but must come into it ready-made) - in this regard, it is recommended to follow the potato and egg diet. Limit the amount of salt added to food.

Watch the video: Renal Ultrasound - Hydronephrosis - SonoSite, Inc. (December 2020).