Hypoplasia of the kidney in the child, the main manifestations, diagnosis and treatment

Hypoplasia of the kidney in a child is a reduction in the size of the body, but with normal functioning and histological structure. In the main this pathology is one-sided, but occasionally affects both kidneys.

When hypoplasia in children resort to surgical intervention only in the case of ineffectiveness of traditional therapy. Among congenital anomalies of the genitourinary system, this deviation is 8-11%.

Classification of pathology

Hypoplasia is formed due to abnormal kidney development even in the embryonic period. In appearance and in terms of its functions, the hypoplastic kidney looks like a normal organ, only a little smaller. But there are some histological changes that make it possible to classify pathology into simple hypoplasia or in combination with oligonephronia and dysplasia.

For simple hypoplasia, only a smaller number of calyxes and nephrons of the kidney are characteristic. Hypoplasia with oligonephronia is manifested by a decrease in the number of glomeruli of the kidneys in combination with an increase in their size, fibrosis of the interstitial tissue, and dilatation of the lumen of the tubules. Hypoplasia with dysplasia is supplemented by the formation of muscular or connective couplings next to the renal tubules, the presence of cysts on the glomeruli or tubules, inclusions of cartilaginous, lymphoid and bone tissue.

Hypoplasia of the right or left kidney in a child can clinically be asymptomatic, but often pyelonephritis develops in the affected kidney, which causes an increase in pressure inside the organ.

Severe forms of bilateral hypoplasia show themselves early - already in the first years of a newborn's life. At the same time, children lag behind in physical development, they have pale skin, frequent fever, diarrhea and signs of rickets. The concentration ability of the kidneys

also worsens severely. Clinical symptomatology of the

pathology Unilateral hypoplasia of the left kidney or the right kidney may not manifest itself throughout life, but often the diminished kidney is affected by pyelonephritis and becomes a source of high blood pressure.

It is the reduced kidney that can cause the development of arterial hypertension in the early stages of the baby's life. Such forms of hypertension can take a malignant course, and the main method of treatment in this situation is nephrectomy, but under the condition of one-sided defeat.

Bilateral lesion of the body is formed very early - the first stage of life after birth, that is, even in the first weeks of life. In this case, children with affected kidneys begin to lag behind in their development and growth. Often they have vomiting, pallor, diarrhea, an increase in body temperature, there may be symptoms of rickets.

There is also a pronounced deterioration in the concentration functions of the kidney, but the biochemical examination data has not changed for a long time and does not deviate from the norm. The indices of blood pressure are also normal, but they rise only if the chronic insufficiency develops. Often the disease can be complicated by a severe form of pyelonephritis.

Diagnosis of pathology

The main method of examining patients is ultrasound diagnosis. In addition, excretory urography and a radioisotope examination are organized to reveal the degree of the organ's functionality.

According to the results of the examination, the kidney is detected, the size of which will be less than the norm, the number of cups will be no more than six, and the pelvis will have a changed structure. Simultaneously with these abnormalities, the ureter may remain of normal size or it will also be reduced. In addition, obstruction, stenosis, enlargement in the ureters can manifest itself, and the artery of the kidney remains underdeveloped in any case.

The histological structure of the reduced organ, provided there are no other complications, corresponds to its age norm. With one-sided lesions, defects in the development of another kidney, such as its duplication, dysplasia or hydronephrosis, can be diagnosed.

Hypoplasia of the kidney in a newborn should be differentiated from secondary organ atrophy processes, for example, from nephrosclerosis or wrinkled kidney, developing due to chronic inflammatory processes, obstructive lesions - pyelonephritis, nephritis, renal artery stenosis, renal failure.

When hypoplasia calyx is not subjected to deformation in contrast to pyelonephritis, but only their number and size decrease, and on urograms compensatory hypertrophy in the second kidney becomes visible.

An important role in the differential diagnosis of the disease is played by angiography of the kidney. With hypoplasia, the diameter of the lumen of the vein and the artery of the kidney decreases by a factor of 1.5 - 2 compared with the vessels of a healthy kidney. Subsequent vascular generations are also thinned, but can be traced down to the periphery of the kidney. With the secondarily wrinkled kidney, the pictures show the normal diameter of the artery of the kidney, but the remaining generations are markedly narrowed, bent, most of them are chopped off, and the periphery is not traced at all.

The diagnostic value of kidney biopsy is extremely small.

Treatment of pathology

If the fetus develops hypoplasia and subsequently does not manifest itself after the birth of the child, then the treatment may not be required, since the condition remains compensated for a long time by the second kidney.

The need for treatment manifests itself in the development of secondary lesions, which are explained by the constantly progressing changes in hemodynamics, urodynamics, infection of the urinary canals and the formation of nephrosclerosis.

In the absence of obvious manifestations of kidney failure, it is recommended that a diet with a low salt concentration and restriction of the intake of animal proteins is recommended. It is important to monitor the diet and life. When activation of negative processes requires embolization of the arteries in the kidney or nephrectomy - removal of the affected kidney. Treatment of kidney hypoplasia in a child, provided that its work is 30% safe, presupposes preservation of the organ.

If the symptoms of kidney failure increase, patients are transferred to dialysis, and organ transplantation is recommended.

In the development of bilateral hypoplasia, complicated by severe form of renal failure, the only option for preserving life is bilateral nephrectomy, and subsequent kidney transplantation. Only a highly qualified specialist can make decisions about certain actions in relation to the patient.