Hydronephrosis

The word "hydronephrosis" consists of two parts: "hydra" - water, "нефро" - a kidney. That is the hydronephrosis means the increased content of liquid in a kidney when normal outflow of urine is broken. This serious disease as in the absence of treatment of a hydronephrosis the affected kidney can lose the functions that is life-threatening a state.

Types and reasons of a hydronephrosis

The hydronephrosis happens inborn, or primary, and acquired, or secondary. The hydronephrosis at children, as a rule, has inborn character, at adults – acquired.

Congenital anomalies of a structure of a kidney or its vessels are the most frequent reasons of a hydronephrosis at children. A hydronephrosis secondary this consequence of change of structure of a kidney or urinary tract (an ureter, an urethra, and sometimes and a bladder) as a result of any disease. It can be an inflammation of a renal pelvis or an ureter, adenoma of a prostate, a cyst and a stricture (narrowing) of urinary tract, etc.

The hydronephrosis can be unilateral, affecting only one kidney, or bilateral. The bilateral hydronephrosis arises when outflow of urine in lower parts of urinary tract – a bladder and an urethra therefore both kidneys suffer from the increased content of liquid is broken. The hydronephrosis at children, as a rule, has unilateral character.

In that case when not only the renal pelvis, but also an ureter underwent pathological expansion under pressure of urine, speak about an ureterohydronephrosis.

Hydronephrosis degrees

Distinguish three degrees of a hydronephrosis:

• Hydronephrosis in degree of the first. Extension of a renal pelvis results (pyeloectasis) from urine supertension. At this stage function of a kidney is not broken yet, but the kidney is already increased in a size;
• Hydronephrosis in degree of the second. There is further, more considerable pyelectasia and renal cups (hydrocalycosis). As a result the liquid which is contained in tubules squeezes a parenchyma of a kidney which under the influence of pressure becomes thinner (atrophies). At this stage function of a kidney is considerably broken;
• Hydronephrosis in degree of the third. The atrophy of renal fabric accrues, accepting irreversible character. Function of a kidney is gradually lost, in a final stage of a hydronephrosis the kidney perishes. The kidney which lost the function in this case poses a considerable threat for health.

Hydronephrosis symptoms

Expressiveness of symptoms of a hydronephrosis depends on degree on which there is a disease. Early symptoms of a hydronephrosis are not expressed therefore the disease sometimes is found already in the started state.

The hydronephrosis at newborns and in general a hydronephrosis at children usually does not prove up to the third degree of a disease in any way unless the increased concern of the kid can attract attention, sometimes at a hydronephrosis blood impurity is found in newborns in urine. The hydronephrosis at newborns is usually known in advance as it is found even when carrying out prenatal ultrasonic diagnosis of a fruit. The hydronephrosis, as well as at adults, can be found in children of later age accidentally, at inspection in other occasion.

Sometimes an early symptom of a hydronephrosis is renal colic, especially it is peculiar to the hydronephrosis caused by an urolithiasis. When the disease reaches considerable extent of development, the main symptoms of a hydronephrosis are the aching dull and constant ache in kidneys and signs of reduced renal function: hypostases, supertension because of the broken water exchange. One of frequent symptoms of a hydronephrosis is emergence of blood in urine (hamaturia).

Diagnosis of a hydronephrosis

The leading method at diagnosis of a hydronephrosis is ultrasound examination of kidneys and urinary tract. As addition use the color Doppler mapping (CDM), a radio isotope renografiya, and sometimes a computer or magnetic and resonant tomography. Also in certain cases a hydronephrosis the endoscopic research – an uretrotsistoskopiya or an ureteroskopiya can be applied. All these methods are directed to visualization of internal structure of a kidney, ureters and the vessels supplying them.

As the hydronephrosis promotes accession of an infection, carry out бакпосев urine. Functional trials of urine (test across Zimnitsky, test across Nechiporenko) carry out for studying of function of kidneys.

Treatment of a hydronephrosis

Treatment of a hydronephrosis is carried out only by a surgical way. Conservative treatment of a hydronephrosis is applied only to elimination of an inflammation if there was an accession of consecutive infection, or as the therapy facilitating hydronephrosis symptoms before carrying out operation.

Operation on treatment of a hydronephrosis consists in elimination of the obstacle breaking normal outflow of urine. In each case individual approach therefore the choice of a surgical method of treatment of a hydronephrosis remains for the surgeon is necessary. Now operational treatment of a hydronephrosis is made in the endoscopic way, not demanding a big and traumatic section for access to a surgery field.

The endoscope is entered into an abdominal cavity through two small punctures, all manipulations are made by a thin surgical instrument under control of the events on the monitor. Such way of treatment of a hydronephrosis allows to reduce many times injury of operation, risk of emergence of postoperative complications and is almost bloodless.

The hydronephrosis in an insignificant stage can not demand medical intervention from children of early age. In such cases recommend dynamic observation by means of ultrasonography from two to four times a year. The hydronephrosis at children of the first and even the second degree sometimes within the first year of life passes independently, surgical treatment of a hydronephrosis at the same time is not required. However a disease in the third degree, and also increase of symptoms of a hydronephrosis at children, demand urgent surgical intervention.

At a hydronephrosis in an end-stage, in case of death of a kidney, it is deleted. Usually such operation is performed at elderly people when regenerative functions of an organism are considerably reduced.