Hydronephrosis - Causes, symptoms and treatment. MF.

Hydronephrosis is a kidney disease characterized by progressive expansion of the bowl-and-pelvis system due to impaired urine outflow and increased hydrostatic pressure in the calyxal system, atrophy of the parenchyma and progressive deterioration of the basic functions of the kidney.

If urine is formed in the kidney tissue, then in the cup-and-pelvis system( it consists of several cups that combine into the pelvis), it accumulates and enters the next section of the urinary tract, the ureter. It also empties into the bladder.

Disease is more common in women, mainly aged 25-35 years;one-sided lesion of the kidneys prevails.

Symptoms of hydronephrosis

Clinical picture.

Hydronephrosis often develops asymptomatically and manifests itself when an outbreak of infection, trauma or accidentally occurs with palpation of the abdominal cavity. Symptoms, characteristic only for hydronephrosis , no. The most common pain in the lumbar region of varying intensity, a constant noisy character, and in the early stage - in the form of attacks of kidney colic. Pain with

hydronephrosis , can occur in the day and night, regardless of on which side the patient sleeps.

Attacks are accompanied by nausea, vomiting, bloating and increased blood pressure. Often, patients notice a decrease in the amount of urine before and during attacks and an increase in the amount of urine after an attack. In the advanced stages of hydronephrosis, acute pain is uncharacteristic.

Temperature rise during pain episodes is possible only with infected hydronephrosis .

An important symptom for large hydronephrosis is a tumor-like formation that is palpable in the hypochondrium.

Sometimes the only symptom is hematuria( micro- and macroscopic), more often observed in the initial stages of hydronephrosis. Macroscopic hematuria is observed in 20% of patients with hydronephrosis, microhematuria is much more frequent.

In the terminal stage of the disease, the kidney function is severely impaired. Signs of kidney failure appear mainly in a bilateral process.

Causes of hydronephrosis

Hydronephrosis can be congenital and acquired. The causes of congenital hydronephrosis are urinary tract distension;congenital anomaly of the location of the renal artery( or its branch), compressing the ureter;congenital valves and strictures of the ureter;retrocaval arrangement of the ureter;ureterocele, congenital obstruction of the lower urinary tract. The causes of acquired hydronephrosis are certain urological diseases: renal stone disease, inflammatory changes in the urinary system, traumatic narrowing of the urinary tract, urinary tract tumors, prostate tumors, as well as tumors of the cervix, malignant infiltration of retroperitoneal tissue and pelvic floor tissue, tumor metastases in retroperitoneal lymphaticnodes, finally, various traumatic and other injuries of the spinal cord leading to violations of the outflow of urine.

Anatomical obstructions are divided into five groups:

• located in the urethra and bladder;
• located along the ureter, but outside its lumen;
• caused by abnormalities in the position and progress of the ureter;
• existing in the lumen of the ureter itself or in the cavity of the pelvis;
• located in the wall of the ureter or pelvis.

One of the common causes of hydronephrosis is the so-called supplementary vessel, which goes to the lower pole of the kidney and squeezes the ureter at the site of its departure from the pelvis. The role of an additional vessel in the development of hydronephrosis is expressed both in mechanical compression and in its effect on the neuromuscular device of the tuberculosis-ureter segment. As a result of constant interdependence and as a result of this inflammatory reaction around the additional vessel and ureter, scars forming fixed excesses or compression of the ureteropelvic segment are formed, and in place of pressure on the ureter, scar tissue arises in it, causing narrowing of its lumen. Obstacles to urinary outflow, located in the lumen of the ureter and pelvis, can be valves and spurs on their mucous membrane, narrowing of the ureter, swelling of the pelvis and ureter, stones, diverticulum.

Complications of hydronephrosis

Danger of hydronephrosis is the occurrence of renal failure. The kidney ceases to work in connection with which death from intoxication with metabolic products may occur-an increase in the content of residual nitrogen in the blood and other violations of homeostasis, which are normally excreted along with the urine.

With hydronephrosis, urolithiasis can occur, as well as infection( pyelonephritis), which in turn can aggravate the course of the disease.

A dangerous complication of hydronephrosis is the spontaneous rupture of the pelvis or calyx. In this condition, urine pours directly into the retroperitoneal space.

Diagnosis of hydronephrosis

At the slightest suspicion of hydronephrosis, it is necessary to apply diagnostic methods that confirm the diagnosis, which determine the cause of hydronephrosis, which determine the stage of its development;

• A comprehensive examination should be conducted: blood tests, urine tests.
• Ultrasonography of kidneys - allows to determine the increase and size of the pelvis and calyxes of the kidney, the degree of their expansion, the thickness of the kidney tissue.
• X-ray examination of the kidney is the main method of diagnosing hydronephrosis. An overview radiograph provides the opportunity to determine the size of the kidneys and to detect stones, if any. On a series of intravenous urograms, one can note a slow accumulation of contrast solution in the dilated pelvis( pelvis) and calyx. On urograms, an enlarged, rounded pelvis, enlarged calyxes are seen. If the kidney function is significantly impaired, the contrast solution can accumulate in sufficient concentration only after 1 to 2 hours or not to stand out at all by a diseased kidney.
• To determine the extent of impaired renal function, radioisotope and kidney scanning is performed.
• To clarify the diagnosis, it is possible to perform angiography, computer and magnetic resonance imaging.

Treatment of hydronephrosis

Treatment should be aimed at eliminating the cause that caused the development of hydronephrosis, if necessary - reducing the size of the pelvis and preserving the kidney.

Conservative treatment is usually ineffective and is used only in the inflammatory process in the kidneys, to relieve pain, to lower blood pressure, symptoms of kidney failure and is used as preparation for surgery.

Among the various methods of surgical treatment are the most common reconstructive, organ-preserving operations. There are a lot of ways of reconstruction, and the type and volume of the operation largely depends on what disease caused hydronephrosis, the same depends on the prognosis for the further life of the patient.

Indications for plastic surgery are those stages of one- and two-sided hydronephrosis , in which the parenchyma function is sufficiently preserved, and the cause that caused the disease can be eliminated.

Kidney removal is resorted to when the kidney function is practically lost, and preservation of the kidney is dangerous because of possible complications. More often such operation is carried out at elderly patients.