The functioning of the urinary system depends on the correct excretion of the fluid. If its outflow is disturbed, stagnation occurs, as a result of which the renal pelvis and calyx extend. This leads to progressive tissue atrophy and organ death.
Hydronephrosis of the kidney - what is it?
When the urine is delayed in the excretory system, its volume is constantly increasing. A large amount of fluid provokes stretching of the kidney cavities and accompanying pathologies, explaining what is hydronephrosis:
- increased pressure in the ureter;
- deterioration of glomerular filtration;
- disturbance of pyelovenous, pyelolymphatic and pyeloarterial current;
- lowering the permeability of the tubules;
- atrophy of interstitial tissue, parenchyma;
- death of nephrons.
What is dangerous hydronephrosis?
Progressive ailment causes a slow dying off of the structural units of the kidney. First, the disease of hydronephrosis is accompanied by a mild violation of the functions of the organ and does not noticeably affect the overall condition of the urinary system. Later, there is partial failure, which can occur with rare relapses. If there is no effective treatment, the right kidney hydronephrosis will pass into a severe stage with absolute disruption or disabling of the organ functions. This is fraught with complete insufficiency and poisoning with products of vital activity.
Hydronephrosis of the kidneys - causes
Urologists call acquired and congenital factors predisposing to the development of the described disease. Hydronephrosis - causes of the first group:
- fast-growing tumor, pressing on the ureters;
- posttraumatic or postoperative narrowing of tubules with formation of scar tissue;
- embolism of the vessel;
- spinal cord injury;
- cancer of the right, left kidney or bladder;
- presence of stones, sand;
- endometriosis ;
- ovarian cyst;
- inflammatory diseases of the genitourinary system;
- tuberculosis;
- metastases and others.
Congenital hydronephrosis
Sometimes the outflow of urine is disturbed against the background of different anomalies in the structure of the outflow tracts. Hydronephrosis on the right and left is diagnosed with the following congenital pathologies:
- obstruction of urinary tubules;
- additional structures, septa and valves in the urinary tract;
- diverticula;
- anatomical obstructions located in the bladder, urethra, wall and ureteral lumen, pelvis;
- dyskinesia and distension;
- ureterocele.
Hydronephrosis of the right kidney often arises from the incorrect structure of the main systemic artery or its large branches. An abnormally formed blood vessel has the shape of a ring that is squeezed by the ureter. This "clamp" prevents the normal current and the removal of excess fluid, leads to the expansion of cups and lohanok left or right kidney.
Hydronephrosis in Pregnancy
The considered problem is considered a typical phenomenon during pregnancy, especially from the 2nd trimester. Hydronephrosis of the kidney during pregnancy develops as a result of a significant increase in the size of the uterus. Its walls begin to bulge into the peritoneal space and press on the ureter. The more stretched the uterus, the more fluid is retained in the kidney.
Degrees of hydronephrosis
Depending on the severity of the pathology and the severity of its symptoms, three stages of the course of the disease are distinguished:
- Hydronephrosis 1 degree (compensated) is characterized by complete preservation of the functions of the right kidney. In the pelvis a small amount of urine accumulates, so the walls and calyx of the organ do not practically stretch.
- Hydronephrosis of the 2nd degree (partially compensated) is accompanied by transformation of the tissues of the damaged kidney and a decrease in its functions by 40-45%. In order for the excretory system to function normally, the work of a healthy paired organ increases.
- Hydronephrosis of 3 degrees (terminal) is a failure of the right kidney. Because of excessive workload, a healthy body can not cope with the excretion of excess urine, and severe insufficiency progresses. In the absence of therapy, a fatal outcome is likely.
Hydronephrosis of the kidney - symptoms
The described pathology is extremely rarely accompanied by significant clinical signs. The severity and specificity of the symptoms depends on the stage of hydronephrosis, the causes and duration of its progression, the localization of obstruction of the urinary tract. In the early period, it is almost impossible to detect the disease, there are no signs of disruption of the excretory system and the right kidney.
Hydronephrosis - symptoms of severe disease severity:
- discomfort in the lower back;
- chronic fatigue;
- arterial hypertension;
- decreased ability to work;
- nausea;
- renal colic;
- fever;
- vomiting;
- chills;
- rare and less abundant urination;
- pain in the back and lower back;
- swelling;
- anemia.
Hydronephrosis - Diagnosis
To suspect the considered illness the urologist can at physical examination, during a palpation, percussion, auscultation. To confirm hydronephrosis of the right or left kidney, a number of laboratory tests are required:
- blood (biochemistry, electrolytes);
- urine (general, unfolded, bakpos);
- Samples from Nechiporenko, Reberga, Zimnitskiy, Addis-Kakovsky.
Finally, to establish the diagnosis of "hydronephrosis of the right kidney" instrumental studies help:
- magnetic resonance imaging or computed tomography;
- retrograde ureteropyelography;
- excretory urography ;
- ultrasound diagnostics;
- dopplerography;
- endoluminal echography;
- chromocystoscopy;
- Renoangiography;
- percutaneous antegrade pyelography;
- radioisotope dynamic nephroscintigraphy and others.
Treatment of kidney hydronephrosis
Therapy of the presented pathology is developed individually for each patient. Ways how to treat hydronephrosis are selected by the urologist in accordance with the nature of the course of the disease, the severity of the symptoms, the cause of the accumulation of urine. The main tasks of therapeutic measures:
- elimination of excess fluid from the urinary system;
- prevention of stretching of the right kidney and atrophy of its tissues;
- normalization of urine outflow;
- elimination of factors provoking disorders of renal activity.
Hydronephrosis - treatment without surgery
Conservative therapy is practiced exclusively in the early stages of the disease, when the activity of the urinary system is still compensated. Kidney disease "hydronephrosis" involves the use of symptomatic medicines of several groups:
- anti-inflammatory - ketoprofen, Ibuprofen, Tenoxicam;
- anesthetics - Ketorolac, Naproxen, Indomethacin ;
- antibiotics - Sumamed , Flemoxin Solutab, Clindamycin;
- hypotensive - Metoprolol, Physiotens, Albarel and others.
The use of pharmacological agents is not an effective method of treating the right kidney. Medication is often prescribed on the eve of surgery to stabilize the condition, improve the patient's well-being and prevent infection of the urinary system. Without surgical procedures, pathology will progress.
Hydronephrosis - operation
The choice of radical therapeutic approach is carried out only after careful diagnosis. First, it is important to find out why hydronephrosis has occurred - the treatment is developed depending on the provoking factor. In the presence of stones or sand in the right kidney, their remote crushing (lithotripsy) is recommended. Manipulation is performed using ultrasonic and radio wave influences.
If the hydronephrosis of the right (left) kidney is caused by the tumor, a decision is made on the resection of the tumor. In addition, radiation and chemical therapy can be carried out. Often, it is not possible to remove only the tumor and metastases, so the surgeon recommends partial or complete excision of the organ in which the growth is found, with simultaneous drainage of the right kidney.
With congenital anomalies in the development of the urinary system, plastic is performed. Such operations are aimed at restoring the normal current of the liquid. In severe cases, when hydronephrosis leads to complete rejection of the right kidney, there is a danger of complications in the form of acute intoxication with products of urine disintegration, the organ must be removed (nephrectomy).