Hydronephrosis - Causes, Symptoms and Treatment .MF .
hydronephrosis - kidney disease characterized by progressive expansion of the renal pelvis system in connection with the violation of the outflow of urine and an increase in hydrostatic pressure in the renal pelvis system atrophy and progressive deterioration in parenchymal renal function key.
If urine formed in the kidney tissue, the renal pelvis system (consists of several cups, united in the pelvis), it builds up and goes to the next urinary tract - the ureters.He empties the bladder.
The disease is more common in women, mainly aged 25-35 years;prevailing unilateral renal damage.
Symptoms of hydronephrosis
hydronephrosis often develops without symptoms manifested at the outbreak of infection, injury or accident is detected by palpation of the abdomen.Symptoms unique to hydronephrosis , no.The most frequently reported pain in the lumbar region of varying intensity, constant aching, and in the early stages - as a pristupov_pochechnoy colic.Pain in hydronephrosis , can occur both day and night, no matter on which side of the patient sleeps.
attacks accompanied by nausea, vomiting, abdominal distention, and increased blood pressure.Most patients notice a decrease in the number of incontinence episodes before and during them and after the increase in its number of attack.In advanced stages of hydronephrosis severe pain is uncommon.
increase in temperature during attacks of pain is possible only when the infected hydronephrosis .
important symptom when a large hydronephrosis is detectable in the upper quadrant tumor formation.
Sometimes the only simptom- hematuria (micro- and macroscopic), often observed in the initial stages of hydronephrosis.Macroscopic hematuria is observed in 20% of patients with hydronephrosis, microhematuria - much more often.
in end-stage kidney disease function is greatly disturbed.Signs of renal failure occur mainly in the bilateral process.
hydronephrosis hydronephrosis may be congenital or acquired.
Causes of congenital hydronephrosis are disteneziya urinary tract;Congenital malformation of renal artery location (or its branches), compressing the ureter;valves and congenital ureteral stricture;retrokavalnoe location of the ureter;ureterocele, congenital obstruction of the lower urinary tract.
Reasons acquired hydronephrosis are some urological diseases: nephrolithiasis, inflammatory changes in the urinary system, traumatic narrowing of the urinary tract, urinary tract tumors, prostate tumors, and cervical tumors, malignant infiltration of the retroperitoneal fat and fiber pelvic tumor metastasis in the retroperitoneallymph nodes, finally, various traumatic and other injuries of the spinal cord, leading to violations of the outflow of urine.
anatomical obstacles are divided into five groups:
- being in the urethra and bladder;
- located along the ureter, but outside the lumen;
- caused by a deviation in the position and course of the ureter;
- existing in the lumen of the ureter or in the cavity of the pelvis;
- which are located in the wall of the ureter and renal pelvis.
One of the common causes of hydronephrosis is the so-called additional vessel going to the lower pole of the kidney and ureter in place compressing a discharge from his pelvis.The role of the additional vessel in hydronephrosis development is expressed in mechanical compression, as well as in its impact on the neuro-muscular system UPJ.As a result of constant vzaimodavleniya and therefore the inflammatory reaction around the extension of the vessel and the ureter and scars are formed, creating creases or fixed compression UPJ, and pressure on the ureter place it occurs, scar tissue, causing constriction of its lumen.Barriers to the flow of urine, located in the lumen of the ureter and renal pelvis can be valves and spurs on their mucosa, narrowing of the ureter, tumor pelvis and ureter stones, diverticula.
Complications hydronephrosis hydronephrosis
Dangerous occurrence of renal failure.The kidney stops working in connection with which death can occur from toxic products of metabolism - build-up of residual nitrogen in the blood and other disorders of homeostasis, which normally appear in the urine.
When hydronephrosis may urolithiasis, as well as join the infection (pyelonephritis), which in turn may aggravate the disease.
dangerous complications hydronephrosis is a spontaneous rupture of the pelvis or calyx.In this condition, the urine is poured directly into the retroperitoneal space.
At the slightest suspicion of hydronephrosis is necessary to apply methods of diagnosis, confirming the diagnosis, determine the cause of hydronephrosis, ascertain their stage of development;
- must be carried out a comprehensive survey: blood, urine.
- Ultrasonography - allows you to define and increase the size of the pelvis and kidney cups, the degree of expansion, the thickness of the kidney tissue.
- X-ray study of the kidneys - the main method of diagnosis of hydronephrosis.Panoramic X-ray allows us to determine the size of kidney stones and discover if they are available.In a series of intravenous urogram may be noted slow accumulation of contrast solution into the dilated renal pelvis (pelvis) and cups.On urograms seen extended, rounded pelvis, dilated calyx.With a significant violation of kidney function contrast fluid may accumulate in sufficient concentration only in 1 or 2 hours does not stand a sick kidney.
- To determine the degree of renal impairment is performed radioisotope study and kidney scan.
- To clarify the diagnosis may angiography, computed tomography and magnetic resonance.
Treatment of hydronephrosis
Treatment should be aimed at removing the cause of the development of hydronephrosis, if necessary - reducing the size of the pelvis and kidney preservation.
Conservative treatment is usually ineffective and only applied when inflammation in the kidney, for pain relief, for lowering blood pressure, renal failure symptoms and used as a preparation for an operation.
Among the various surgical treatment methods are most common reconstructive, organ operation.Reconstruction method a lot, and the type and scope of the operation depends on which disease is caused hydronephrosis, from the same depends on the outlook for the future life of the patient.
indication for plastic surgery are those one-stage and bilateral hydronephrosis , in which the parenchyma function adequately maintained and cause of the disease can be eliminated.
to kidney removal recourse when kidney function is almost lost, and the preservation of the kidney is dangerous because of possible complications.In most cases this operation is performed in elderly patients.