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Hydronephrosis: Symptoms, Causes, Diagnosis and Treatment

  • Hydronephrosis: Symptoms, Causes, Diagnosis and Treatment

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    What is this - increased hydrostatic pressure, as a result of a global malfunction of the ureter causes a disease - hydronephrosis( uronephrosis).

    Characterized by pathologies in the kidneys expressed by pyeloectasia, progressive expansion of calyx in the kidney, and parenchymal dystrophy - instead of the parenchyma, a thin connective tissue membrane is formed.

    The localization of obstructions causing a violation of urinary outflow can be on any segment of the urinary canal. The location of the obstruction in the lower part of the ureter causes its dilatation( expansion) - one-sided or bilateral urethrohydronephrosis.

    In the initial stage of the disease, the effect of increased hydrostatic pressure causes the body's response in the form of stimulation of protective functions, which result in the increased development of elastic fibers and the muscular layer in the kidneys of the kidney. Such a measure, at first, makes it possible to cope with the effect of excess pressure, restraining its onslaught.
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    Progression of urinephrosis and the duration of the period, leads to an even greater increase in pressure, causing pathologies not only in the CLS, but also pathologies in the kidney itself. Damaged her tissue, atrophy of the kidney cortical substance and the loop "Henle", which leads to their reduction and wrinkling, the formation of the first and final stage of urine. The unsettled cause leads to the further development of hydronephrosis, leading to a significant increase in the size of the renal reservoir, thinning of the renal tissue and, as a result - under its own weight, the kidneys can not hold on to their site, and descend.

    Causes of hydronephrosis


    Hydronephrosis manifestations are polytheological in nature of the formation, which indicates multiple causes of the disease. Depending on the nature of the pathology preventing the outflow of urine, the primary species of hydronephrosis is inherent in nature, and secondary hydronephrosis is acquired disease.

    The causative factor is based on anatomical and functional pathologies:

    • is a consequence of urolithiasis.
    • abnormal development of the urinary tract or narrowing.
    • abnormal location of the artery of the kidney or its branches.
    • retrograde ureter.
    • abnormalities of the renal vessels, in the form of an additional renal artery.
    • effects of inflammatory processes of the ureter or its atony.
    • is the result of retroperitoneal fibrosis.
    • is a neoplasm in the urinary system, prostate or bladder.
    • hematologic tumors with lymphoma and lymphadenopathy, causing compression of the urinary system, or sprouting into it.
    • consequence of relapses of surgical interventions.

    Determining the severity of the disease


    The severity of hydronephrosis depends on the severity of renal parenchymal dystrophy.

    1. 1) The first degree of the disease - the defeat of the parenchyma is not ascertained.
    2. 2) In the second degree - the damage is insignificant.
    3. 3) The third degree - is characterized by significant structural changes in the parenchyma.
    4. 4) The fourth degree of hydronephrosis is characterized by complete destruction of the parenchyma and complete absence of kidney function.


    The course of hydronephrosis and its stages


    The clinical characteristics mark three main stages of the course of the disease.

    1. 1) The first, the initial stage of hydronephrosis is characterized by minor functional impairments. The pelvis is slightly enlarged, but, in general, the functioning of the kidney is almost normal.
    2. 2) The second stage is characterized by a very significant increase in the renal tank( pelvis), there is an increase in the kidney by almost a quarter, and it halves its functional duties.
    3. 3) The third stage of hydronephrosis is caused by a significant expansion of the multi-cavity cavity, the organ doubles in size, and is practically incapable of functioning.

    Symptoms of hydronephrosis


    Symptoms of hydronephrosis renal transformation, at the onset of the disease may not be manifested at all, or marked with periodic renal colic.

    What can, is caused by pressure jumps or the consequence of the formation of concrements in the ureter, which is a frequent background in hydronephrosis. Symptoms are manifested:

    • with turbid urine, sometimes with impurities of blood;
    • feeling ill and fast fatigue;
    • weight loss and sleep disorder
    • blunt or severe pain from the side of the affected organ, in the lower back or lower abdomen.
    • in the evening the pain intensifies, but at night it can decrease.
    • pain symptom may appear as a consequence of physical exertion.
    • with the development of the disease with its progression, pain symptoms are poorly expressed, but irradiates into the groin or leg area.
    It is believed that the main symptoms in hydronephrosis are the three components. The possibility of probing the enlarged organ with palpation, pain symptoms and manifestation of hematuria( blood in the urine), which is not the reason for the approval of the final diagnosis of the disease. Because such symptoms are inherent in many diseases.

    Diagnosis of hydronephrosis


    To confirm the accurate diagnosis of hydronephrosis, differentiation is used that excludes:

    • nephroptosis;
    • nephrolithiasis;
    • is a tumor kidney disease;
    • solitary cysts and polycystosis;
    The final diagnosis is possible only with a complete examination:

    1. 1) Investigation of the condition of the urinary system and the renal reservoir with the help of elastic bougies.
    2. 2) Cystoscopic examination of the mucosa in the bladder and the mouth of the ureter. Controlling the release of urine.
    3. 3) By means of chromoscopy - the introduction of a contrast agent, the pathologies of renal functions are determined.
    4. 4) For diagnosis and detection of abnormalities in the CLS, a catheterization cystoscope is used, which can be administered up to the pelvis itself, using the method of retrograde pyelography - X-ray images of pelvis and introduction of a contrast agent into the vein. That allows you to see the changes not only in the organ itself, but also in the ureter and bladder.
    5. 5) If renal function is not impaired, excretory urography helps to determine their morphological state.
    6. 6) To determine the degree of pathology of the functional abilities of the kidneys, a number of functional tests - with water, concentration tests and Zemnitsky samples, are performed, which help to determine the violations of the basic functional features of the kidney. These samples are based on the determination of the specific gravity of the excreted urine with various variations in fluid intake.
    7. 7) For more accurate clarification of the severity of urinephrosis, the organ is scanned with a radioisotope test.

    Treatment of hydronephrosis


    A correctly formulated hydronephrosis treatment program and reasoned tactics provide a favorable prognosis.

    The treatment method includes measures to eliminate the causative factor and restore lost kidney function. The complex of drug therapy is limited to the coping of pain syndromes, by methods facilitating the course of the disease, preventing the possible attachment of infection and preventing relapses.

    The basic procedure for treating hydronephrosis is surgical intervention. In surgery, there are many techniques for eliminating such pathologies. The choice of the method is based on the localization of the causative factor, the severity of the course and the stage of the disease.

    The main goal of the operative intervention is to normalize the outflow of accumulated urine, by eliminating the cause. If this cause is caused by stones, the following applies:

    • contact ureterolithotripsy:
    • method of percutaneous nephrolithotomy;
    • or non-surgical, remote lithotripsy
    With top obstruction, hydrourethritis, and signs of sub-tubular obstruction of the ureter, kidney drainage is carried out with a nephrostomy tube or inserted into the ureter of the stent. A course of anti-inflammatory therapy is conducted, and only then an operation is carried out to remove the obstruction.

    With hydrourethritis of the lower urinary tract, as a result of compression of the urethra or formed due to prostate adenoma, a catheter or cystroma( suprapubic catheter) is established, which allows to restore the outflow of urine. In the next stage of treatment, the causative factor is eliminated. The adenoma is eliminated by the TUR method or vaporization by the laser.

    In congenital or acquired hydronephroses endourological, laparoscopic or open operations and plastics of various types are used.

    Complications of hydronephrosis


    If any signs of hydronephrosis are found, treatment should be started immediately. With early diagnosis, the disease is easily treatable without surgery.

    The launched form of the disease will undoubtedly lead to complications - the formation of kidney stones, kidney failure, infection or organ rupture. Bilateral hydronephrosis causes renal failure, often with a fatal outcome.


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