Manifestations and treatment of hydronephrosis in children

Hydronephrosis is a kidney disease characterized by an enlargement of the urinary tract( pelvis and calyx) caused by a violation of the passability of urine from the pelvis to the ureter.

In other words, the pelvis and calyx are a collection system designed to accumulate urine. If the volume of incoming liquid exceeds the allowable limit, they are stretched.

The disease occurs both in childhood and in adults.

If we talk about hydronephrosis in children, then this is quite a frequent occurrence. This diagnosis is more often given to boys, where in most cases left-sided lesion of the kidney predominates.

Classification of hydronephrosis

There are 3 stages of hydronephrosis.

1. stage - enlargement of the pelvis with preservation of kidney function and parenchyma integrity.
2. stage - the size of the kidney is somewhat enlarged, the parenchyma is damaged, there is a significant enlargement of the pelvis with thinning of its walls, the kidney function is reduced by 20-40%.
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3. stage - a significant increase in the size of the kidney, atrophy of the parenchyma, decreased kidney function to 80%, or its absence.

Hydronephrosis can be:

• congenital( primary);
• purchased( secondary);
• unilateral( one of the kidneys is affected);
• bilateral( both kidneys affected).

Causes of hydronephrosis in children

Hydronephrosis in children in most cases is a congenital disease characterized by such anomalies as:

• narrowing of the ureter;
• presence of an additional arterial vessel, compressing the ureter and interfering with the normal outflow of urine;
• incorrect position of the ureter.

Acquired hydronephrosis can develop for several reasons. The most basic of them:

• Genital tract injury, obtained during surgical intervention;
• Bubble - ureter reflux( return urine outflow from the bladder to the kidney);
• In rare cases - urolithiasis.

Symptoms of the disease

In contrast to the acute form, with mild to moderate disease, the symptoms are mild or nonexistent. In more severe cases of kidney failure, there may be:

• the presence of blood and an increased number of white blood cells in the urine;
• aching, dull pain in the lumbar region;
• tumor formation in the hypochondrium region;
• temperature increase in the presence of an infectious process.

Diagnostic methods

The traditional method of diagnosis is ultrasound.

Hydronephrosis of the kidney in the fetus can be diagnosed even at the stage of fetal development, about 15-20 weeks. When a pathology is detected, the disease is monitored and monitored throughout the gestation period. In addition, the possibility of the presence of anomalies, all organs of the urinary system are examined.

In addition to ultrasound, hydronephrosis in newborns, the position of the kidneys and their condition, an experienced specialist can determine by palpation, because at this age the kidneys are well probed.

In this case, the final diagnosis should be made not earlier than one month after birth, becauseDuring this period, significant changes occur in the newborn's body, and manifestations of hydronephrosis may disappear on their own, even if there is no appropriate treatment.

If an ultrasound is not sufficient for the diagnosis, then an X-ray, radioisotope study is used, as well as intravenous urography, computed tomography and MRI.

Treatment Therapy

With mild disease, no special treatment is usually required, provided that the child is under constant observation by a specialist.

Hydronephrosis of the kidney in a newborn at moderate severity requires more careful monitoring with ultrasound every 2-3 months.

In severe form and progression of the disease, accompanied by a significant impairment of kidney function, a surgical operation is performed, aimed at removing the obstruction that interferes with the normal outflow of urine.

If hydronephrosis of the kidney in children is accompanied by pyelonephritis, then in addition to surgical treatment, antibiotic therapy is performed.

Operative intervention is possible in the fetus. But in this case it is necessary to take into account the high risk of premature birth and complications that can lead to the death of an unborn child.

The purpose of the surgical operation for this diagnosis is the preservation of the organ, but if the kidney function is reduced by more than 80%, the involuntary measure is nephrectomy - kidney removal.

Generally, hydronephrosis in children is a disease that is well treatable. In patients under 3 years of age, a favorable outcome after reconstructive surgery is approximately 90%.But the success in treatment largely depends on how accurately and timely the diagnosis was made.