Hydronephrosis of the right, left kidney: causes,treatment, complications

Update: December 2018

Hydronephrosis (or hydronephrotic transformation) is
expansion of the renal pelvic system due to impairment
outflow of urine and organ blood supply. Disease occurs
mostly on the one hand, both kidney disease
extremely rare.

The disease is one of the most common in
pediatric urological practice. Among adults, hydronephrosis is more common.
occurs in young people under 35 years old, and mostly in
women.

Classification of hydronephrosis

By origin:

  • primary – arises due to congenital anomalies
    urinary system (primary megaureter, additional vessel
    kidneys);
  • secondary – develops as a complication of another disease,
    for example, prostate cancer, urolithiasis.

By infection:

  • aseptic, that is, clean, without bacteria;
  • infected – more formidable option when pathology
    accompanied by purulent complications.

By stages:

  • 1 initial – only the pelvis (pyeloectasia) expands,
    renal function is not impaired;
  • 2 early – pelvis and calyx expand, thinning
    parenchyma, kidney function is significantly reduced;
  • 3 terminal – kidney parenchyma sharply atrophied, function
    completely lost.

Causes of hydronephrosis

The main reason for the development of pathology is the appearance
obstacles to urine outflow. Depending on what level
urinary system is a block, emit such
the reasons:

Where is the obstacle What leads to his appearance
Urethra (urethra) and bladder
  • urolithiasis disease;
  • tumors, strictures, diverticula, foreign bodies in
    the urethra and bladder;
  • atony of the bladder due to innervation disorders;
  • injuries of the perineum, external genitalia, pelvic
    hematoma;
  • phimosis of the penis;
  • vesicoureteral reflux;
  • benign hyperplasia, tumors, tuberculosis
    prostate
Ureter (crushing it outside)
  • chronic cystitis with inflammation of the paravesical tissues;
  • parapelvic cyst of the kidney;
  • intestinal tumors;
  • carcinomatosis of the peritoneum;
  • enlarged lymph nodes of the abdominal cavity;
  • Crohn’s disease, ulcerative colitis;
  • adhesive disease of the abdominal cavity and small pelvis;
  • accessory renal artery;
  • neoplasms of the ovaries, uterus.
Ureter (change in its course or excesses)
  • abnormal development of the ureters (change of course, their curvature
    and twist along the axis);
  • intrauterine stenosis;
  • its high discharge from the kidney;
  • retrocaval location (behind the inferior vena cava)
The lumen of the ureter or pelvis
  • congenital and inflammatory strictures;
  • tumors, foreign bodies, stones in the lumen;
  • cystic ureteritis;
  • congenital true and false valves of the ureter;
  • diverticula of the ureter.
Ureter (change in functional activity)
  • hypo- or atony of the ureter;
  • neuromuscular dysplasia of the ureter;
  • primary megaureter.

Symptoms

Hydronephrosis of the first degree is asymptomatic and detected
most often by chance (during an ultrasound or palpation of the abdomen). In the second
stages may appear such symptoms:

  • constant aching pain in the lower back or navel on the side
    lesions;
  • bouts of renal colic;
  • decrease in the number or complete absence of urine;
  • hematuria (the appearance of a small amount of blood in the urine).

Accession of the infection to the disease is manifested by fever, a common
weakness, nausea and vomiting, lack of appetite, the appearance of pus in
urine

When the disease goes into a third stage, terminal,
the pain disappears, the general condition of the patients deteriorates sharply, increases
nitrogenous wastes in the blood, toxic encephalopathy occurs.

It is characteristic of this pathology that even with a pronounced block,
the affected kidney maintains its working capacity for a long time.

Hydronephrosis of the right or left kidney does not differ in clinical
picture, all manifestations are exactly the same. Very dangerous when
both kidneys are affected simultaneously. Then pathology is fast
progresses and, without proper treatment, leads to the death of the patient
from uremia.

Complications

  • acute or chronic pyelonephritis;
  • kidney rupture;
  • chronic renal failure;
  • malignant increase in blood pressure (not stopable
    antihypertensive drugs).

Diagnostics

To confirm the diagnosis and identify the cause of the pathology, and
also definitions of treatment tactics use a number of special
survey methods. With hydronephrosis of the kidney in pregnant women
use of radiological and
radioisotope research methods that can cause mutations
fetus.

Method name What is used
  • Palpation of the abdomen
In the abdominal cavity an enlarged formation is palpated, with
smooth surface, soft-elastic consistency, at level 12
Thoracic – 2 lumbar vertebrae.
  • General analysis and biochemical examination of blood and urine

In the analysis of blood revealed an increase in the products of nitrogen
exchange (urea, creatinine), anemia (reducing the number
erythrocytes and hemoglobin), leukocytosis (if attached
secondary infection).

With urine examination can detect a decrease in relative
density, the secretion of bacteria, white blood cells and red blood cells (especially
if pyelonephritis joins).

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  • Ultrasound (two-dimensional sonography and
    Doppler or duplex ultrasound)

Gives the opportunity to determine the size of the pelvis and cups, thickening
cortical and medulla, reveal stones, diverticula, foreign
body, neoplasms of the urinary system, condition
renal blood flow, additional renal vessels.

Modern technologies allow ultrasound research
urinary system from the inside. This is called endoluminal
ultrasonography. It is performed through the introduction through the urethra
special microscopic ultrasonic sensor, which is carried out right up to
affected kidney.

  • Radioisotope study (renography or scintigraphy)

A special technique based on the reception of radiopharmaceuticals –
radioisotopes absorbed exclusively by renal tissue. Through
for some time the patient is placed in a gamma camera that registers
radioactive radiation in the pictures.

Thus, this examination shows whether the kidney is working.
or its function is completely lost.

  • Survey X-ray
With специальной подготовке больного в ходе исследования можно
identify an increase in the cup and pelvis apparatus and see the stones in
his projections.
  • Excretory urography
X-ray technique that visualizes urogenital
system; also by the way the contrast stands out, one can judge
kidney work.
  • Retrograde ureteropyelography
The examination consists of the following: into the ureters through the urethra
special catheters are inserted into which the contrast is poured
substance. Then a series of x-ray images is performed. How
contrast spreads and empties the cup pelvis
system, and talks about kidney function.
  • Antegrade ureteropyelography
The technique is used mainly in newborns or children.
infancy. Its essence is transcutaneous puncturing.
the pelvis and the introduction of coloring agents into them.
  • Computed and magnetic resonance imaging
These studies allow us to evaluate the anatomy of the retroperitoneal
spaces and organs of the pelvis, to clarify the location of the stone
(tumor, foreign body, stricture, diverticulum). Modern
technology helps doctors see the affected area in three-dimensional
image.
  • Renal aortoangiography

X-ray method based on the introduction of contrast in
abdominal aorta. Received x-ray photographs show
blood supply to the urinary system, allow to identify
additional vessels.

The study has many complications, so it is prescribed with
extra care.

  • Ureteropieloscopy
With the help of the endoscopic technique, introduced directly into the kidney, the doctor
with my own eyes can see the cause of hydronephrosis, make
biopsy of a neoplasm or extract a calculus.

Treatment of renal hydronephrosis

Disease therapy should be aimed at eliminating it.
causes and maintenance of renal function. Perhaps conservative and
surgery. Drug therapy methods are applied
for the relief of pain, lower blood pressure,
elimination of uremia and destruction of secondary infection (see medications
for the treatment of kidneys).

What drugs are prescribed for hydronephrosis:

  • β2-adrenomimetic hexoprenaline (ginipral) – it reduces the tone and
    expands the lumen of the ureter;
  • broad spectrum antibacterial drugs – protected
    penicillins (augmentin), cephalosporins (cefadox), fluoroquinolones
    (levofloxacin, ciprofloxacin);
  • diuretics – often loopback (furosemide, torasemide);
  • myotropic antispasmodics – drotaverin (no-spa), papaverine;
  • painkillers – opioids (morphine, promedol) for renal colic
    or nonsteroidal anti-inflammatory substances (movalis,
    nimesil);
  • antihypertensive drugs – best manifest themselves
    ACE inhibitors (Enap, prestarium) and calcium channel blockers
    (amlodipine).

To eliminate uremia apply afferent methods of detoxification:
plasmapheresis, hemodialysis.

Surgical treatment of hydronephrosis

Indications for surgery:

  • persistent aggravation of pyelonephritis;
  • chronic renal failure;
  • reduced kidney function;
  • pronounced pain syndrome;
  • urolithiasis disease.

In the preoperative period, patients are drained.
kidney (percutaneous puncture nephrostomy or installation
ureteral stent) for its unloading and restoration of function.
If the function of the organ is not completely lost, after a week of the patient
take on surgery. In such cases, reconstructive surgery is performed.
organ preservation operations:

  • ureteropieloanastomosis with resection of the narrowed
    plot;
  • ureterocalico-anastomosis (according to the method of Nivirt);
  • �”Patchwork” plastic surgery (operation Calp-De
    Verda);
  • bougienage of the ureter;
  • баллонная дилатация суженного plot;
  • endotomy (endoscopic dissection) of a stricture;
  • laparoscopic and retroperitoneoscopic plastic
    operation.

In the third stage of the disease, when the kidney is no longer functioning,
make its removal (nephrectomy).

Features of hydronephrosis in pregnant women

The main reason for the development of this pathology in pregnant women
considered anomalies of urinary tract development. Why so
is going on? Fetal development does not occur unnoticed by maternal
organism. As the baby grows inside the uterus, the kidneys of the woman
have to work for two. If mommy before conception were
certain malformations of the urogenital system that do not bring it
discomfort, then with the advent of the child the kidneys work completely
decompensated.

How does hydronephrosis occur in pregnant women?

  • in most cases, late gestosis develops (increased
    blood pressure, the appearance of edema and protein in the urine);
  • enlarged kidney can squeeze the uterus, while disrupting
    blood supply to the fetus, which leads to intrauterine retention
    development. Also large kidney size impedes normal delivery.
    mothers;
  • can be complicated by the development of pyelonephritis and chronic
    renal failure, as well as an increase in blood nitrogen
    toxins (urea, creatinine).

The development of hydronephrosis in some cases life threatening
women, therefore, pregnancy must be terminated if:

  •  The diagnosis of “bilateral hydronephrosis” was made before
    conception;
  • mother has only one functioning kidney;
  • in case of complicated pathology;
  • the disease is not amenable to conservative and surgical
    treatment.

Pregnancy is not a contraindication to
reconstructive plastic surgery. In severe cases it is possible
kidney removal.

Hydronephrosis in children

In childhood, the disease in 90% of cases is congenital
due to malformations of the urogenital system. Anomaly can
single or may be many. Feature pathology in
children is also a genetic predisposition. AT
In recent years, scientists have identified a special antigen of the HLA system,
incorporated into the genotype. If the child has such a gene, the risk
the occurrence of hydronephrosis increases 10 times.

Hydronephrosis in a child with pronounced symptoms,
usually progresses with time. Without timely treatment
the kidney parenchyma is rapidly thinning and ceases to perform its
function. With данной патологии у детей применяют исключительно
reconstructive surgery, as a growing body is always faster
recovers, compared to adults. Only in very
neglected cases, when the kidney is no longer possible to save,
remove.

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