The word "hydronephrosis" consists of two parts: "hydro" - water "nephrotoxicity" - Kidney. That is hydronephrosis is the high content of fluid in the kidney when disrupt the normal flow of urine. This is a serious disease, as if untreated hydronephrosis affected kidney may lose its function, which is a life-threatening condition.
Types and causes of hydronephrosis
Hydronephrosis is innate, or primary and acquired or secondary. Hydronephrosis in children, as a rule, is innate in adults - acquired.
The most common causes of hydronephrosis in children are congenital anomalies of the structure of the kidney or its vessels. Hydronephrosis secondary is a consequence of changes in the structure of the kidney or urinary tract (ureter, urethra, and sometimes the bladder) due to any disease. It can be an inflammation of the renal pelvis or ureter, prostate adenoma, cysts and stricture (narrowing) of the urinary tract, etc.
Hydronephrosis may be unilateral, affects only one kidney or bilateral. Bilateral hydronephrosis occurs when disrupted the flow of urine in the lower urinary tract - the bladder and urethra, resulting from increased fluid content affects both kidneys. Hydronephrosis in children, as a rule, is one-sided.
In the case where the abnormal expansion under pressure not only urine underwent renal pelvis and ureter, say about ureterohydronephrosis.
The degree of hydronephrosis
There are three degrees of hydronephrosis:
- Hydronephrosis in the first degree. There is a stretching of the renal pelvis (pyelectasia) due to increased pressure of urine. At this stage, the kidney function is still intact, but the kidney have increased in size;
- Hydronephrosis in the second degree. There is a further, more significant expansion of the renal pelvis and renal calyx (gidrokalikoz). As a result, the liquid contained in the tubules, compresses the renal parenchyma, which is under pressure thins (atrophy). At this stage, the kidney function is significantly impaired;
- Hydronephrosis in the third degree. Atrophy of kidney tissue, taking irreversible. Kidney function gradually lost in the final stage of hydronephrosis kidney dies. The kidney that has lost its function, in this case represents a significant threat to health.
Symptoms of hydronephrosis
Severity of symptoms depends on the degree of hydronephrosis, which is a disease. Early symptoms of hydronephrosis are not expressed, so the disease is sometimes found in the state of neglect.
Hydronephrosis in infants, and generally hydronephrosis in children usually does not manifest itself until the third degree of the disease, unless it can attract the attention of high anxiety baby, sometimes with hydronephrosis in infants found in the urine admixture of blood. Hydronephrosis in infants is usually known in advance, as is found even during the prenatal ultrasound diagnosis of the fetus. Hydronephrosis in children later in life, as adults, can be detected by chance during examination for another reason.
Sometimes an early sign of hydronephrosis is renal colic, especially characteristic of hydronephrosis caused by urolithiasis. When the disease reaches a significant level of development, the main symptoms of hydronephrosis are aching dull and constant pain in the kidney area and signs of declining renal function: edema, hypertension due to impaired water metabolism. One of the most frequent symptoms of hydronephrosis is the appearance of blood in the urine (hematuria).
Diagnosis of hydronephrosis
The leading method for the diagnosis of hydronephrosis is an ultrasound of the kidneys and urinary tract. As a supplement using color Doppler mapping (CFM), radioisotope renography, and sometimes the computer or magnetic resonance imaging. Also, in some cases, hydronephrosis can be used endoscopy - uretrotsistoskopiya or ureteroscopy. All these methods aim at rendering the inner structure of the kidney, ureter, and supplying them to receptacles.
Since the accession of infection contributes to hydronephrosis, urine culture is performed. Functional tests of urine (sample of Zimnitsky, the sample for Nechiporenko) is carried out to study the function of the kidneys.
Treatment of hydronephrosis
Treatment of hydronephrosis is carried out only with surgery. Conservative treatment of hydronephrosis applies only to eliminate the inflammation, if there has been the accession of secondary infection, or as a therapy to alleviate the symptoms of hydronephrosis surgery.
Operation treatment of hydronephrosis is to eliminate the obstacles that disrupt the normal flow of urine. Each case requires an individual approach, therefore the choice of surgical treatment of hydronephrosis remains of a surgeon. Currently, surgical treatment of hydronephrosis performed endoscopic method that does not require a large incision and traumatic access to the surgical site.
The endoscope is inserted into the abdominal cavity through the two small puncture, all manipulations are performed delicate surgical instruments under the control of what is happening on the screen. This method of treatment of hydronephrosis at times allows to reduce trauma surgery, the risk of postoperative complications and almost beskroven.
Hydronephrosis in infants in the low stage may not require medical intervention. In such cases, dynamic monitoring by ultrasound from two to four times a year. Hydronephrosis in children of the first and second degree, even sometimes in the first year of life passes alone, surgical treatment of hydronephrosis is not required. However, the disease in the third degree, and the exacerbation of symptoms hydronephrosis in infants require immediate surgical intervention.
When hydronephrosis in the terminal stage, in case of death of the kidneys, it is removed. Usually, this operation is performed in the elderly, when the regenerative functions of the body are significantly reduced.