Hydronephrosis of the kidneys, what is it? This pathological process, which can lead to disruption of urine outflow due to stretching of the collecting system.

The disease leads to damage to the kidney (left or right) or transformation. The outflow of urine is disrupted, compression of blood vessels occurs, atrophy of the renal tissues and deterioration in functionality as a result of excessive pressure in the calyces.

Often only one kidney is affected. The disease happens:

congenital with incorrect location of the urinary canal or obstruction;
acquired against the background of development inflammatory processes in the genitourinary system, tumor localization in the uterus, urinary tract, in the peritoneal cavity.

With congenital hydronephrosis, the natural outflow of urine is impaired due to anatomical features or abnormalities. Hydronephrosis has a three-stage course:

during the first stage, the renal pelvis is slightly dilated, but functions stably;
at the second stage, an increase in the diameter of the kidneys and thinning of the walls are observed;
during the third stage - excessive kidney enlargement by 2 times, when it is already diagnosed renal failure.

Why does pathology develop?

Hydronephrotic transformation of the kidney is observed when the passage in one of the segments of the urinary system narrows. There are many reasons for this. Provoking factors include:

urolithiasis, when the flow of urine is impaired due to the accumulation of kidney stones or urinary tract;
lymphoma, lymphadenopathy, prostate adenoma, which can lead to inflammation in the urethra, changes in structures;
tuberculosis;

abdominal trauma when the ureter is involved in the process;
congenital anomalies in the structure of the ureter when the diameter deviates from the norm;
localization in neighboring organs, leading to compression of the urinary organs and disruption of the outflow of urine.

Timely detection and treatment of pathology is required, since otherwise complications are inevitable.

How does it manifest?

Chronic hydronephrosis initial stage practically does not manifest itself in any way, and there are no symptoms. At times it is observed:

a feeling of heaviness in the ureter, incomplete emptying of the bladder even after urination;
tingling;
dull aching pain in the lower back;
signs of flatulence;

nausea is rapid;
fatigue;
temperature increase;
promotion blood pressure.

With hydronephrosis or hydrocele of the kidney, the main symptom is pain in the lumbar region, depending on the location of hydronephrosis and the characteristics of the pathology.

Hydronephrosis of the right kidney is more often diagnosed in people who abuse alcohol, as well as in the elderly. With pathology of the left kidney, blockage of the outflow tract is observed due to the accumulation of stones in the urinary canal. Hydronephrosis of the left kidney is more common in childhood.

In this case, the following symptoms are observed:

left lower back pain radiating to the left leg;
disturbance of urine outflow;
discharge of a cloudy color in case of injury to the mucous membrane.

Hydronephrosis occurs in a special way in pregnant women and children. This is a common occurrence with abnormal development of the urinary tract, when the kidneys begin to work harder during pregnancy and fetal growth. The body begins to compensate for the work of the kidneys, symptoms appear following symptoms among women:

blood pressure surges;
swelling;
an increase in the size of the kidney, which can lead to compression in the uterus with the development of late gestosis;
disruption of blood supply and blood flow to the fetus, which can lead to delay intrauterine development, the birth of a child already with a congenital pathology.

Consequences

Hydronephrotic transformation of the right kidney prevents the development of pyelonephritis. When conducting diagnostics, the level of urea and creatinine in the blood is increased.

The disease poses a threat to the lives of women; sometimes doctors, when diagnosing bilateral hydronephrosis even before conception (when only one kidney is functioning and the disease cannot be treated), suggest an abortion.

In childhood, congenital hydronephrosis is observed in 90% of cases and against the background of developmental defects genitourinary system. If the cause of the pathology is a hereditary predisposition when a special antigen appears in the genotype, then the symptoms of hydronephrosis in a child appear more pronounced.

If possible, the doctor will definitely try to restore the functionality of the organ. In this case, the following methods are applicable for reconstruction of the affected kidney:

ureteropyelectasia;

flap surgery;

endothermic by cutting strictures;

through plastic manipulation.

With hydronephrotic transformation of the left kidney, removal is performed in cases where recovery is no longer possible. To restore the patency of the urinary tract, during the operation the doctor will try to normalize the size of the renal pelvis or perform plastic surgery if the walls are excessively widened.

If the cause of hydronephrosis is the development malignant tumor, then the tumor is first removed, then a course of chemotherapy is prescribed. On third - last stage Hydronephrosis, most likely, the kidney can no longer be restored.

Maintenance therapy is required. Diet for hydronephrosis plays a predetermining role when the renal pelvis is excessively dilated. You need to exclude salt and coffee from your diet and drink less liquid (up to 1.5 liters). It is advisable to steam dishes.

Consequences

When renal hydronephrosis appears, all patients want to understand what it is. This is dropsy and it is dangerous because excessive disruption of the outflow of urine leads to the accumulation of stones. Their accumulation clogs the ducts, leading to severe poisoning body and kidney rupture often occurs if the contents escape into the retroperitoneal space.

As a result, pyelonephritis will begin to develop as a complication, urolithiasis disease. In case of stagnation of urine, it will develop.

How is kidney hydronephrosis treated? Only identification and treatment at the initial stage gives quite favorable prognoses. Is it worth delaying or refusing treatment at the initial stage or surgery? The outcome of the disease is that if you do not delay, doctors guarantee a complete cure for the disease.

Afer Dima

Hydronephrosis of the kidney: symptoms and treatment depending on the stage

Hydronephrosis of the kidney is specific disease, characterized by a pathological increase in the internal size of the pyelocaliceal region of the kidneys due to strong pressure a large volume of fluid (urine excreted by the kidneys) onto its walls. In this case, the accumulation and stagnation of urine is associated with a complete or partial disruption of its outflow through the urinary system. This leads to inflammation of the renal tissue - parenchyma, followed by its atrophy and deterioration of the filtering and excretory function of the kidney. As a result of this, partial, and then, as the disease progresses, complete renal failure may occur.

To prevent poisoning of the body by waste products, in such cases it is recommended to remove one, and when there is bilateral hydronephrosis, both damaged kidneys. In the future, such patients are advised to undergo regular hemodialysis sessions using an artificial kidney machine or undergo a donor organ transplant.

Depending on the causes of the development of the disease, its forms are distinguished:

Congenital – hydronephrosis develops in utero or immediately after birth.
Acquired – hydronephrosis appears as a result of damage to a previously healthy kidney.

Let us highlight the main degrees of hydronephrosis or, as they say, stages:

Stage I - there is an expansion of only the pelvic system without disruption of the functions of the organ.
Stage II – significant expansion of the pelvis, accompanied by thinning of its walls and impaired renal function up to 20%.
Stage III - the kidney is represented by a large multi-chamber cavity filled with urine. Functions are reduced to less than 80%.

Causes of occurrence and development of hydronephrosis

Congenital or acquired form of hydronephrosis of the right or left kidney can occur as a result of deterioration or complete cessation of the movement of urine from the pelvic region through the ureter to the bladder and urethra. The causes of this disorder can be both anatomical and physiological factors.

Congenital hydronephrosis in children manifests itself as a result of existing defects in the shape and structure of the kidney, ureter and lower urinary system. Also, congenital or acquired hydronephrosis of the kidney in children can occur due to developmental pathology blood vessels during the prenatal period or the first year of life. Congenital causes:

Pathological narrowing of the internal lumen (dysthenesia) of the urinary tract at the level of the kidney, ureter, bladder sphincters or urethra.
A congenital anomaly of the renal artery itself or its branch, in which the vessel has the shape of a ring that compresses the ureter and prevents the normal outflow of urine.
Abnormal shape, kinking, or malposition of the ureter.
Congenital pathology of the development of the lower urinary tract (obstruction; ureterocele, etc.).
Immaturity or underdevelopment of the urinary system in premature infants.

The acquired form of hydronephrosis can have both anatomical causes of impaired urine outflow from the renal pelvis, and physiological ones (arising against the background of diseases of the central and peripheral nervous system). There are five main groups in total pathological conditions, creating mechanical obstacles of an anatomical nature in the urinary system:

Thickening of the walls of the ureter or pelvis as a result of tumors.
The presence of tumors in surrounding organs and tissues that compress the ureter, kidney or urethra.
Violation of the normal location of the ureter or kidney (prolapse of the kidney, bending or torsion of the ureter).
Blocking of the internal lumen of the ureter and pelvis with formed kidney stones.
Compression or damage to the lower organs of the urinary system as a result of cancer and other diseases or injuries.

Quite often, women experience hydronephrosis during pregnancy. Its cause is mechanical compression of the ureter and other organs of the urinary system by the enlarged uterus.

Hydronephrosis, uncomplicated in the first stages of development, has virtually no symptoms and clinical manifestations. The patient feels only a slight deterioration in health, increased fatigue. Therefore, it is possible to suspect mild degrees of hydronephrosis at this stage only with a random examination for other diseases. An enlarged renal pelvis can be determined, for example, by palpation or diagnostic ultrasound.

If associated inflammatory diseases, one can already suspect unilateral or bilateral hydronephrosis based on the following symptoms, which are also characteristic of other kidney diseases:

Constant or intermittent aching pain in the lumbar region.
Frequent or severe renal colic.
Nausea, vomiting, bloating and increased blood pressure during attacks of renal colic.
Initially, a decrease and then a significant increase in the amount of urine during urination.
A tumor-like formation palpable on palpation in the area of the right or left hypochondrium (or on both sides).
The appearance of blood in the urine (at the same time its color becomes brownish or reddish).

For more late stages As the disease progresses, the symptoms of kidney hydronephrosis become more obvious.

Methods for diagnosing hydronephrosis

Hydronephrosis that develops latently and does not have relapses may not have symptoms of inflammation or obvious impairment of filtering and excretory functions. This can continue until development initial form renal failure. Therefore, if the amount of urine decreases or its color and concentration changes, it is urgent to conduct a comprehensive laboratory and hardware examination by a urologist.

The most accurate methods for diagnosing hydronephrosis include:

Laboratory research: general analysis blood and urine, biochemical blood tests, urine analysis according to Zimnitsky, Nechiporenko and others.
Ultrasound examination of both kidneys, ureter and bladder, which, if necessary, is supplemented by examination of other internal organs.
X-ray examination of these organs using contrast agents.
Hardware magnetic resonance imaging (MRI).

Hardware diagnostic methods help determine and compare on which side kidney damage is present or predominant. Thus, hydronephrosis of the right kidney has a larger size of the pelvic region compared to the healthy left kidney. Or vice versa, hydronephrosis of the left kidney has a larger pelvis compared to the right kidney.

Treatment of kidney hydronephrosis

Once the diagnosis is confirmed, treatment for kidney hydronephrosis should begin immediately. Indeed, with further development and complication of this disease, the prognosis for the patient can be extremely unfavorable. And effective therapeutic techniques There are currently no treatments that can completely restore kidney function.

Drug treatment of hydronephrosis for patients with unilateral or bilateral kidney damage can only be carried out as symptomatic therapy or in preparation for surgical treatment.

Surgery for kidney hydronephrosis can either completely eliminate or only reduce the manifestation of this disease. The result and prognosis of surgical treatment largely depends on the form and stage of the disease. With complete elimination of the anatomical causes of compression of the kidney or ureter, as well as with minor violation its functions, it is possible to completely get rid of hydronephrosis.
Timely surgical treatment is especially important for eliminating congenital hydronephrosis in children. In most cases, operations performed to eliminate defects or plastic surgery congenital pathologies development of the kidneys and ureter give good results and a favorable prognosis for the life and health of the child.

Treatment and dietary nutrition for hydronephrosis in pregnant women

Treatment of hydronephrosis during pregnancy is aimed at restoring the outflow of urine from the kidneys using special physical and breathing exercises, physiotherapeutic procedures, laxatives, long walks on fresh air And dietary nutrition. The main goal of such therapy is the prevention of inflammatory diseases of the genitourinary area. Only with very severe forms For this disease, termination of pregnancy is recommended.

Specially designed therapeutic diet for hydronephrosis of the kidney in pregnant women and children, includes dishes with a high fiber content: black bread, a variety of boiled or steamed vegetables, lean boiled fish and veal, beetroot soup, cabbage soup and borscht with beets, etc. But you should avoid fatty, fried and salty foods.

Forecast and prevention of the disease

Timely elimination of the causes of hydronephrosis contributes to the rapid restoration of all kidney functions. If the obstruction lasts a long time and is accompanied by bilateral damage or infection, then the prognosis for the disease is serious and often ends with the need for hemodialysis or a donor kidney transplant.

In order to prevent the development of hydronephrosis, regular medical examination with holding ultrasound examination kidneys and laboratory analysis urine.

With hydronephrosis, the pelvis and calyces of the organ gradually expand due to the outflow of urine being impaired for one reason or another.

Among diseases of the urinary system, kidney hydronephrosis is considered one of the most dangerous and complex. The second name of this pathology is hydronephrotic transformation, and it partially contains a description of the disease.

With hydronephrosis, the pelvis and calyces of the organ gradually expand due to impaired outflow of urine for one reason or another.

As a result, the kidney increases in size and blood circulation in it is disrupted. Without treatment of the disease, the organ dies.

The pathology most often occurs in young women, but its occurrence in children and men of all ages cannot be ruled out. The course of the disease, treatment tactics and prognosis depend on the cause of hydronephrosis and its form.

Hydronephrosis mainly develops in the left or right kidney, very rarely both organs are affected. In medicine, they operate with such terms as left-sided or right-sided hydronephrosis.

Types of hydronephrosis

There are two forms of this disease: congenital and acquired. Congenital is detected in children and adults due to the following pathologies:

abnormal arrangement of the kidney vessels, which causes compression of the ureter;
dyskinesia or abnormal position of the ureter;
obstruction, stricture (blockage, narrowing) of the ureter.

In all these conditions, the outflow of urine is impaired, it accumulates in the kidney, this leads to a gradual enlargement of its calyces and pelvis.

Acquired hydronephrosis of the right or left kidney occurs due to infectious process in the organ, the formation of stones, tumors or metastases, due to injuries of the ureter with scar formation. Pathology also develops in some diseases spinal cord, as a result of which the outflow of urine is disrupted reflexively.

In all cases, hydronephrosis on the right, left, or hydronephrosis of both kidneys appears when the patency of the urinary canal of an anatomical nature is impaired. The reasons for this pathology: incorrect position of the urinary tract, their bending, the presence of a stone, scar in the ureter, pelvis, bladder.

Another classification of the disease is by stages. There are grade 1, 2 and 3 hydronephrosis. In the first degree, the accumulation of urine in the kidney is insignificant, its parenchyma is stretched in small degree, the function of the organ is not impaired. With hydronephrosis of the 2nd degree, thinning of the parenchyma begins, greater stretching of the organ, reducing its capabilities by almost half. The second kidney works in an enhanced mode, which allows you to maintain excretory function at normal level.

In the third degree, the kidney loses most its functions, eventually stops working (terminal hydronephrosis). The second kidney cannot cope with the increased load, so the patient is at risk of developing renal failure. If the condition is ignored, the patient dies.

Symptoms of hydronephrosis

At the beginning of the disease there are no specific symptoms. There are signs of the underlying disease, the cause of hydronephrosis. But as the pathology develops, the patient begins to worry about specific manifestations.

The main complaints include dull, aching pain in the lower back. These symptoms are constant, appear regardless of the time of day, and do not disappear with changes in body position. They are localized on the affected side, but there is one peculiarity: hydronephrotic transformation of the right kidney almost always has signs of liver disease. For right-sided hydronephrosis painful sensations arise not in the back area, but from right side belly. The pain is accompanied by typical “liver” symptoms: nausea and vomiting, bloating.

But with hydronephrosis, there are also symptoms such as increased blood pressure, which distinguishes right-sided or bilateral hydronephrosis from liver diseases.

The pathology is also manifested by symptoms of increased body temperature, which is a sign of infection. This complication occurs often, since a violation of the outflow of urine creates good conditions for the development of pathogenic bacteria.

In many cases, the disease makes itself known only by the presence of blood in the urine. In 20% of patients, macrohematuria (large blood clots) is detected, but in most cases. Mostly these signs are present if the cause of the disorder is kidney stones that injure the walls.

The terminal stage of this disease is manifested by obvious symptoms. The pain does not disappear, but intensifies. These are accompanied by symptoms of renal failure: decreased amount of urine, edema, increased blood pressure, anemia. If one kidney is affected, the symptoms are less pronounced; if both kidneys are pathological, the symptoms are more obvious, and the patient’s condition worsens faster.

Diagnosis of hydronephrosis

Among the most common research methods, ultrasound is considered the most accessible and informative. With its help, you can easily identify pathology in children and adults, assess the condition of both kidneys, and determine the stage of the disease. In some cases, the cause of the ureteral blockage can be discovered, but not always.

X-rays (panoramic radiography), contrast intravenous and radioisotope urography help to clarify why the disease developed. X-ray examination prescribed to determine the size of organs and identify stones.

When performing contrast urography, the doctor can assess the intensity of urine formation and excretion, which is slowed down in hydronephrosis. This research method gives a clear picture of dilated pelvis and calyces, and also shows the cause of blockage of the ureter.

Thanks to radioisotope urography, it is possible to assess the degree of kidney damage and accurately determine the characteristics of dysuria.

To test excretory function, urine tests are prescribed, including general tests according to Nechiporenko, Zimnitsky. Additionally, blood is taken for analysis, general and biochemical. To clarify the diagnosis, an MRI or CT scan is done.

Conservative treatment

Regardless of the stage of the disease, the urologist will prescribe drug therapy. But in all cases, such treatment of hydronephrosis will be symptomatic, and it is carried out only in preparation for surgery.

Therapy is aimed at relieving pain (prescribed tablets or injections), normalizing blood pressure, and reducing inflammation. If an infection occurs, antibiotics are indicated. Based on the severity of the disease and the patient’s complaints, diuretics or other symptomatic treatment are prescribed.

Treatment with surgical methods

- the only way to preserve the functionality of the organ if they are carried out in the first stages of the disease. During surgery, the cause of obstruction of the urinary canal is eliminated, and the earlier the pathology is identified and its treatment is started, the more successful the outcome of the operation.

If hydronephrosis is detected terminal stage if the kidney is still viable, plastic surgery is performed to restore the size of the pelvis.

When performing surgery on the right kidney, it is necessary to take into account the proximity of the pancreas, there is high risk its damage.

If the kidney is not viable, the only solution is nephrectomy. In another case, the patient will face death due to progressive renal failure and accompanying inflammatory complications. After nephrectomy, kidney transplantation is recommended, but urology knows a lot of cases where voluntary donors, people who lost one kidney due to injury or illness, continued to lead a full, active lifestyle. Therefore, even such a radical surgical intervention should not be scary. It is much worse if it is not carried out, then the prognosis for the patient is the most negative.

Diet for hydronephrosis

The food must be complete and high in calories. Those patients who have been prescribed diuretics, even potassium-sparing ones, need to eat foods rich in potassium: legumes, dried fruits, nuts, potatoes, seaweed. The same food helps fight swelling.

The main component is vegetables and fruits; it is recommended to consume at least 600 grams of them per day. Protein food must also be present, but in limited quantities, no more than 0.5 g of protein per 1 kg of human weight. Protein should be easily absorbed by the body; the best sources are dairy products, legumes, buckwheat, lean meat and fish.

In addition to the above, patients are allowed to eat yesterday's bread, crackers, various cereals, eggs (but not more than 1 per day). Jelly and jelly are allowed as desserts.

There are limits on the salt content in food, the amount is limited to 2 grams per day. But natural spices, onions and garlic are not prohibited.

All foods must be boiled or steamed. It is allowed to add a small amount of oil to already cooked food.

Fried foods are strictly prohibited, stews, smoked meats, pickles, canned food, exclude any sauces, mayonnaise, ketchup. Limit sweets containing fats and a large number of sugar (baked goods, chocolate, cream products), fatty varieties meat and fish, mushrooms. Carbonated drinks, alcohol, and fast food are strictly prohibited, even in minimal quantities.

The volume of fluid consumed is calculated based on daily diuresis (+ 0.5 liters to the daily volume of urine excreted over the previous day). This amount should include all liquid, including first courses, drinks, and water. It is recommended to exclude tea and coffee; drink compote or diluted juice, mineral or plain water.

Prevention

The basis for the prevention of hydronephrosis is the timely detection and treatment of pathologies of the urinary system. It is recommended to follow the rules healthy eating with reasonable consumption of protein, sugar and salt. Welcome physical activity, complete abstinence from alcohol, strong tea and coffee.

It is necessary to monitor the functioning of the bladder and prevent it from overflowing. Experts recommend preventing general hypothermia or overheating of the patient. Hypothermia is fraught with the development of inflammation, and when overheated due to profuse sweating, the blood thickens, and it is more difficult for the kidneys to filter it.

Pregnant women should be especially careful, since while they are expecting a baby, their kidneys experience increased stress.

Kidney diseases are studied by two major branches of medicine: nephrology and urology. Nephrology is classically considered a therapeutic specialty and studies problems that occur in the kidney during urine production.

In the event that urine has already been formed and problems arise with its excretion, these problems will most likely be dealt with by urology. Thus, glomerulonephritis is a nephrological disease, and urolithiasis is a urological problem.

Let's talk about hydronephrotic transformation of the kidney, or hydronephrosis. What kind of disease is this, how does it occur, is it diagnosed and treated?

Let's use the old way to find out about a disease using only the name of the diagnosis. The term "hydronephrosis" can be translated as "kidney rich in water." What kind of water is this and where does it come from?

Quick page navigation

What it is?

photo diagram

Hydronephrosis of the kidneys is a disease in which the pyelocaliceal system of the kidney expands, secondary parenchymal hypotrophy occurs and its function deteriorates due to impaired passage of urine from the kidney. If you hear the term “hydronephrotic transformation of the kidney”, then this is the same as hydronephrosis.

The transformation lies in the fact that if the cavity system increases, then pressure is exerted from within on the layers of parenchyma, which are engaged in the “production of urine.” As a result, they become thinner and their function is impaired. This is a very crude but correct explanation.

Hydronephrosis is very common in children, and in adults it occurs most often in the active middle of life - between 20 and 40 years. In adulthood, it is more often found in women, 1.5 times more often. Since a person has 2 kidneys and two independent urinary drainage systems, there can be either a unilateral (which happens much more often) or a bilateral process.

Classification

Hydronephrotic transformation occurs:

Primary, or congenital. Occurs as a result of disturbances in the intrauterine development of the urinary tract, for example, as a result of a genetic abnormality or intrauterine infection;
Secondary, or acquired. In this case, it always occurs as a complication of many kidney diseases.

Since the expansion of the cups and pelvis leads to disruption of the passage of urine, stagnation occurs. And where there is stagnation, sooner or later infection with microorganisms occurs. Therefore, hydronephrosis can be both aseptic and infectious.

Reasons for the development of the disease

We said that this condition is based on a violation of the outflow of urine. What exactly can be an obstacle to urine? Sergei Petrovich Fedorov, the “father of Russian urology”, who did a lot for the development of this branch of medicine, identified the following etiological variants of the disease:

“Problems” of the urethra and bladder.

In this case, bladder outlet obstruction develops (that is, an obstruction located below the bladder). This is the lowest section, which gradually causes a retrograde increase in pressure higher and higher, up to the kidney.

These can be tumors and stones, diverticula, that is, protrusions of the wall, and even foreign bodies urethra. Often the cause is prostate hyperplasia, adenoma, and even phimosis, beyond which nothing can go further.

Since the bladder is divided into two kidneys, then high blood pressure then it “distributes” symmetrically, and bilateral hydronephrosis occurs. The cause may also be vesicoureteral reflux, or the reflux of urine from the bladder into the ureter against its normal flow.

At different neurological diseases An autonomous neurogenic bladder occurs, in which reflex urinary retention and paradoxical ischuria occur (when urine is released drop by drop when the bladder is full). In this case, the pressure also increases retrogradely, with development in severe cases hydronephrosis.

An obstacle in the projection of the ureter, but external, that is, outside the lumen.

These are various ureteral anomalies, curvatures and kinks, all kinds of torsions. Most often, these spontaneous disorders lead to unilateral hydronephrosis.

Deviation (deviation of the course) of the ureter itself. These are congenital or acquired curvatures.

They can be caused by kidney cysts, a variety of tumor processes in the pelvic cavity, as well as retroperitoneal formations. The cause may be intestinal tumors, Crohn's disease, lymphomas, sarcomas, metastases from advanced cancer processes, as well as the consequences of a variety of operations in the pelvic cavity.

An internal obstruction of the ureter, or pelvis, located in its cavity.

In this group, the “leaders” are stones, strictures, or narrowings of the pelvis, all kinds of growths of the mucous membrane like “valves” and tumors.

Thickening or change in the structure of the wall or ureter or pelvis, causing disturbance passage of urine.

Most often the cause is functional states, for example, decreased tone (hypotonia or atony) of the ureter.

Degrees of hydronephrosis (stages)

The stages of development of hydronephrotic transformation are clearly defined and do not cause any particular difficulties:

First degree Only the pelvis expands, and pyelectasis occurs. Kidney function suffers slightly.

There are muscles in the calyx and pelvis. Their resistance to increased pressure leads to their hypertrophy. This causes a secondary increase in pressure in the system, and urine from the parenchyma into the pelvis begins to be released in a reduced amount, compensating for the increased pressure. Then the muscles “get tired”, become thinner, and a breakdown in balance occurs. Stage 2 hydronephrosis occurs.

On the second degree expansion of the pelvis is accompanied by expansion of the calyces, or hydrocalycosis. Hydronephrosis of the kidney, stage 2, at this stage, the function of the kidney is significantly impaired and its parenchyma becomes thinner.

Increased pressure in the pyelocaliceal system “drives” urine back up into the kidney parenchyma, and renal pelvic reflux appears.

The kidney glomeruli are still slightly affected, since they operate under different filtration pressures, both low and high. Therefore, primary urine formed in the zone high pressure, is still able to overcome resistance in the calyxes, but this mechanism is also disrupted, and atrophy of the tubules and glomeruli occurs.

The glomeruli begin to collapse. Tears occur in the arches of the calyces and urine freely enters the circulatory system.

In the third degree the parenchyma becomes sharply atrophic, and the kidney, in fact, turns into a bag with thin walls. Signs of severe chronic renal failure appear.

This occurs during a long process; first, atrophy of the medulla occurs, and then the cortex, that is, the process of hydronephrosis is completely retrograde and consistent.

General symptoms of kidney hydronephrosis

Symptoms of kidney hydronephrosis often do not appear at all, and the diagnosis is made by chance, in case of complaints. And they happen with infection, with kidney injury, or the discovery can be accidental.

After all, even with severe hydronephrosis of the 3rd degree healthy kidney completely takes over all blood purification, and a diseased kidney can be identified as a tumor-like formation with normal palpation of the abdomen. But this only happens in the case of an aseptic process, when there is no rise in temperature and dysuric disorders.

The following symptoms can perhaps be considered characteristic of hydronephrosis:

before painful attacks in the lower back, the amount of urine decreases and increases after the attack;
disappearance acute pain in the second, and especially the third stage of the disease.

Often with pain there is an increase in temperature, which can be regarded as an exacerbation of pyelonephritis and “revelry” urinary infection against the background of increased blood pressure and stagnation of urine.

The patient needs to pay attention to whether there is any blood in the urine. This is also a symptom indicating hydronephrosis. It occurs when the outflow of urine from the kidney is restored for some time. This symptom is usually of the nature of microhematuria.

With severe bilateral renal hydronephrosis, the outcome of the disease is unfavorable: chronic renal failure occurs and without a kidney transplant the patient will die.

Features of hydronephrosis in children

Hydronephrosis of the kidneys in children (newborns) most often develops due to underdevelopment of the muscular layer of the ureter, or due to its narrowing (stenosis). Sometimes it extends too high from the pelvis.

Often the cause of hydronephrosis in older children is aberrant renal vessel passing over the ureter. Blood pressure inflates a vessel that “squeezes” the ureter, in which the pressure is weaker.

Treatment of hydronephrosis in children is always surgical, and the results are more favorable, since the child’s kidney has a high potential for recovery. Therefore, only reconstructive plastic surgery is performed if there is any hope of restoring the renal parenchyma.

During pregnancy

Pregnancy is an “extreme time.” The size of the uterus is constantly increasing and one day, especially with an anatomical predisposition, this factor may become decisive.

The uterus compresses the ureter, and hormonal changes in the pregnant woman’s body lead to increased contractility of the smooth muscles of the bladder. This combination of reflux and external compression more often leads to hydronephrosis, more often on the right than on the left.

This condition develops in the second half of pregnancy, is functional, and goes away on its own after childbirth. The only thing a pregnant woman needs to do is to undergo a kidney ultrasound in a timely manner, and, if necessary, resolve the issue with gynecologists about the timing of delivery in case of progression of unilateral hydronephrosis. It is clear that operating on a pregnant woman is dangerous, first of all, because anesthesia can harm the baby.

Therefore, in extreme cases, with the progression of unilateral hydronephrosis, you can decide on C-section at an earlier date.

Diagnostics

Anamnestic data are important in diagnosis ( dull pain in the lower back, or renal colic). The presence of microhematuria allows one to suspect hydronephrosis of the right/left kidney. Immediately after this, an ultrasound is performed. This study provides information about the size of the pyelocaliceal system, the presence of stones, the thickness of the parenchyma and allows you to assess the condition of the other kidney.

To enhance the value of ultrasound (which shows structure well but does not functional assessment organ function) Doppler ultrasound should be used to assess renal blood flow. After this, urologists perform renal angiography, excretory urography, necessarily with the use of diuretics and with the implementation of delayed x-rays, to avoid diagnostic errors.

To determine the presence of vesicoureteral reflux, voiding cystography is performed. Retrograde ureteropyelography and, of course, CT and MRI are also prescribed as research methods.

The complex is being carried out laboratory research to determine filtration and reabsorption indicators (nitrogen, creatinine, urea, Rehberg test) in order to resolve the issue of the presence of renal failure or its absence.

Treatment of kidney hydronephrosis in children and adults

Treatment of hydronephrosis is surgical. Conservative methods are used to prepare the patient for surgery, in which the cause of hydronephrosis is eliminated, for example, narrowing of a tortuous ureter.

TO conservative methods include relief of microbial inflammation, pain relief, anti-inflammatory drugs, lowering blood pressure in case of hypertension. Often these activities are carried out against the background of drainage of the collecting system by installing a nephrostomy, or intraureteral stent.

Nephrostomy is indicated in the following cases:

Microbial pyelonephritis does not stop, so you need to install a nephrostomy and wash it with antibiotics;
kidney destruction and renal failure progresses (transition from stage 2 to stage 3);
severe pain syndrome.

Temporary nephrostomy is a life-saving operation that allows you to take a break, stop the progression of the disease, restore normal filtration pressure and improve blood flow in the kidney, eliminating urine hypertension in the collecting system as the main damaging element.

Then, depending on the indications, either reconstructive plastic surgery or endoscopic views intervention or kidney transplant.

Forecast

It cannot be said that the prognosis after surgery will always be favorable. Good results with full recovery occur in half of the patients, the other half have partial recovery, so you often have to fight, even with for preventive purposes, with pyelonephritis.

For this purpose, courses of antibacterial drugs are prescribed.

In the case of unilateral hydronephrosis, the prognosis for life is always favorable, and in the case of a bilateral process, it is serious, due to the progression of chronic renal failure.

Kidneys are one of the most important organs, but their importance is often underestimated. While the appearance alarming symptoms and then the death of the kidneys leads to lifelong disability and the need for constant hemodialysis. Therefore, it is important for everyone to know what kidney diseases exist and how to avoid them. For example, hydronephrosis is a pathology that occurs very often under the influence of a range of causes. The outcome of the disease will depend entirely on the adequacy and timeliness of the treatment.

Hydronephrosis - what is it?

The kidney is an organ that filters the blood and removes excess fluid from the body along with urea, uric acid, creatinine and other substances. Necessary, useful material, for example, protein, are filtered back into the blood using special membranes.

For this purpose, there is a urinary system, which consists of two kidneys, two ureters leading from them to the bladder, the bladder itself and the urethra.

The liquid that will become urine at the end of the urinary system must pass unhindered all the way from the kidneys to the urethra. If there are physical obstacles along this path, the kidney will fill with fluid and expand, that is, hydronephrosis of the kidney will develop.

Hydronephrosis has three stages:

Stage 1 – dilated renal pelvis, all functional tests stable and within normal limits;
Stage 2 – the kidneys are enlarged, their walls are thinned, the Rehberg test readings drop by 30%;
Stage 3 - the kidneys are almost doubled in size, the kidney is hollow with empty chambers inside, the end stage of renal failure begins.

Kidney with hydronephrosis

What can cause the pathology?

The main cause of hydronephrosis is a decrease in passage along any segment of the urinary tract. But the word “cause” itself can mean many different phenomena, both related to urology and not related.

Urolithiasis is a disease that results in the formation of stones in the kidneys and urinary tract that can interfere with the smooth flow of urine.
Neoplasms in the ureters, bladder or even prostate, which, like stones, can interfere with the outflow of urine.
Sometimes the tumor may not be related to the urinary system, sometimes the tumor may be in another, neighboring system, but also compress the organs of the urinary system.
Prostate adenoma, which compresses the urethra.
Congenital anomalies of the structure of the ureters - when their diameter is less than normal.
Narrowing of the ureter due to changes in tissue structure, for example, after a kidney stone passes through the ureter. Also, the cause may be tuberculosis or abdominal trauma, which will also involve the ureters.
Narrowing of the ureteropelvic segment - a fragment of the urinary system, which is located where the renal pelvis ends and the ureter begins. The cause of the narrowing may be tissue trauma.
Sometimes lymphomas and lymphadenopathy are the cause.

Most common cause Kidney hydronephrosis is urolithiasis, so it is very important to treat this pathology in a timely manner, without waiting for complications.

Symptoms of hydronephrosis

The main symptom of the disease is pain in the back and abdomen, which is aching character. On palpation abdominal cavity You can notice compactions at the location of the kidneys.

Hydronephrosis is characterized by blood in the urine. And if we are talking about microhematuria, then a person can only learn about it from the conclusions of a laboratory urine test. But gross hematuria is obvious to the naked eye - the urine takes on a pink, sometimes brown tint.

At acute form all symptoms of inflammation are present:

heat;
symptoms of intoxication (nausea, headache);
general weakness, drowsiness.

Important! It is necessary to consider hydronephrosis together with the likelihood of developing renal failure, which is quite real if we are talking about hydronephrosis of both kidneys. Then the following symptoms will be added to the above symptoms:

swelling;
increased blood pressure;
decreased diuresis;
nausea and vomiting.

In this case, immediate hospitalization is required, since kidney failure can lead to death or lifelong disability.

Obstructed outflow due to hydronephrosis

Diagnostics

At the initial consultation, the doctor will find out from the patient what symptoms he is experiencing, how long the ailments have been noted, whether there have been any injuries, surgical interventions, or somatic pathologies.

To make a diagnosis, the doctor prescribes a standard list of laboratory tests:

clinical blood test;
biochemical blood test for the amount of protein, creatinine, uric acid;
general urine analysis;
Rehberg's test.

All of these tests are needed to evaluate your kidney function so that your doctor can understand whether you are at risk of developing acute kidney failure.

Diagnosis of kidney hydronephrosis is made using functional diagnostics:

Ultrasound of the kidneys;
Ultrasound of the bladder with a bladder filled with urine and after emptying to detect residual urine;
urography of the urinary tract using injection contrast agent;
computed and magnetic resonance imaging;
nephroscintigraphy is a method for assessing the functional functioning of the urinary system using a contrast agent and a gamma camera.

It is important for the doctor not only to determine the presence of hydronephrosis, but also to identify the causes that led to the pathology.

Ultrasound of the right kidney

Conservative treatment

Conservative treatment for this disease is used extremely rarely, because the cause of hydronephrosis is a mechanical obstruction in the urinary tract, so it is impossible to cure the disease otherwise than by removing them and ensuring proper urine outflow.

However, if the process is accompanied by inflammation, it is necessary to symptomatic therapy, namely:

taking anti-inflammatory drugs;
taking antibiotics;
taking medications for hypertension.

In addition, it is assigned special diet with restricted use table salt, rest, gentle regimen.

Surgery

During surgery, an obstruction in the urinary system, such as a tumor, can be removed.

When the ureter is narrowed, surgical treatment of hydronephrosis can be carried out in three ways:

By installing a stent - a tube that will be placed in the ureter, connecting the kidney and bladder, ensuring the unimpeded outflow of urine. The size of the stent is selected by the surgeon based on anatomical features patient. Typically, all stents have a diameter of 1.5 cm and a length of up to 30 centimeters. The ends of the tubes have a curved shape - this is necessary so that the tube is securely fixed in the patient’s body.

The procedure is most often carried out under general anesthesia. A cystoscope is inserted into the bladder to visualize the opening of the ureter in the bladder. A stent is inserted there under the control of a radiographer.

Using a nephrostomy - inserting a thin tube into the kidney through a puncture in the lower back. It is necessary for removing urine from the kidney in order to protect the organ tissue from damage when it is full of urine. Nephrostomy is a temporary and emergency method that is used during surgery or when a patient is admitted to the department during emergency hospitalization, so that urine is removed from the body until the patient undergoes surgery. surgery.
Using ureteroplasty - the latter option is increasingly used for hydronephrosis due to narrowing of the junction of the pelvis and the ureter. The operation is absolutely non-traumatic: the surgeon makes punctures in the patient’s abdomen, removes the narrowed section of the ureter and stitches the edges of the urinary tract. On average, such an operation lasts no more than one hour.

If the operation is performed correctly, the effect can be lifelong.

Thus, surgical treatment for hydronephrosis, there are two options: ureteroplasty and stent installation. The advantage of the stent is its ease of installation and low price, but the disadvantage is the need to replace the tube every 3-4 months.

Ureteroplasty provides a long-lasting and reliable effect, but such an operation requires more serious surgical intervention, the search for a reliable doctor and, possibly, financial expenses.

Surgery for hydronephrosis of the kidney

Why is hydronephrosis dangerous?

Hydronephrosis of even one kidney is very dangerous. For example, a violation of the outflow of urine causes bacterial infection, which first flows into acute pyelonephritis, and then may result in the formation of a bag of pus, which must be removed surgically. The second danger of the disease is organ atrophy, that is, complete death of the kidney. In this case, the entire functional load falls on the second kidney, and even if it is absolutely healthy, this seriously affects both the person’s health and his ability to work.

Hydronephrosis of both kidneys is doubly dangerous: if both kidneys atrophy due to hydronephrosis, renal failure will develop. In this case, the person will face either death or a constant need for hemodialysis: a procedure in which a person’s blood is cleansed by a special device instead of the kidneys. One procedure lasts 3-4 hours and should be performed 3-4 times a week for the rest of your life or until you undergo a kidney transplant.

Another complication of hydronephrosis is a decrease in hemoglobin if, against the background of the disease, blood is excreted in the urine, that is, microhematuria or macrohematuria occurs.

Prognosis for kidney hydronephrosis

In the absence of proper treatment, the outcome of the disease is extremely unfavorable: in short time there will be a decrease renal function to the terminal stage. And, if the process affects both kidneys, the person will need lifelong hemodialysis or an organ transplant.

When treating an adult, the prognosis is moderately favorable - according to statistics, full recovery occurs in half of the urologist’s patients with this diagnosis. The best prognosis for proper treatment in children under three years of age: in their case, exposure to to a good surgeon guarantees success in 8 cases out of 10.

These data allow us to talk about hydronephrosis as a serious somatic pathology that can cause disability or even death of a person who does not receive treatment in a timely manner.

Hydronephrosis - treatment with folk remedies

Traditional medicine offers methods of therapy for any disease, including renal hydronephrosis. Of course, problems can only be radically solved through surgery, but as a means for rapid rehabilitation or disease prevention, traditional medicine recipes can be very effective.

Buy dry herbs at the pharmacy:

burdock;
celery;
chamomile;
bearberry;
rose hip

Mix all the ingredients in a jar or bag, brew two teaspoons with boiling water, cool to a comfortable temperature, strain and drink instead of tea three times a day an hour before meals.

Find the following ingredients:

1 part Adonis
3 parts of dry birch leaves;
1 part nettle;
1 part dry oatmeal;
1 part bearberry;
1 part horsetail.

Mix the ingredients, pour boiling water and leave in a thermos for 12-14 hours. Strain and take one glass per day. You can pour half a glass of the product, and then dilute it with boiling water, like tea.

Cornflower tea is the simplest alternative treatment for hydronephrosis. For it you need to take:

10 grams of dried cornflower flowers (can be purchased at a pharmacy or prepared independently in the summer);
100 ml boiling water.

Brew tea in a thermos, divide into three doses and drink before breakfast, lunch and dinner, diluting with boiling water.

It is important to know! Make your own decisions about using methods traditional medicine it is forbidden! All recipes can be used only after consultation with your doctor.

All herbs produce a narcotic effect to one degree or another, so excessive use of traditional medicine methods can be very harmful. But with strict adherence to the instructions, the methods alternative medicine usually effective.

Prevention

Prevention of hydronephrosis includes all the basic rules healthy image life. It is very important not to get too cold, eat right, and avoid bad habits. Both men and women need to visit doctors - a urologist and gynecologist, at least twice a year, especially if the disease has already been diagnosed in a chronic or latent form.