What is hydronephrosis of the kidneys. Hydronephrosis of the right kidney - how dangerous is it

Hydronephrosis of the kidney is a specific disease characterized by a pathological increase in the internal size of the pyelocaliceal region of the kidneys due to strong pressure on its walls of a large volume of fluid (urine excreted by the kidneys). In this article, you will learn what signs pathology accompanies, how to treat hydronephrosis of the kidneys. modern methods what else can be done.

Hydronephrosis of the kidneys: what is it?

What is kidney disease called hydronephrosis? Hydronephrotic transformation of the kidney or hydronephrosis of the kidneys is a serious pathology, consisting in an increased content of fluid in both or one kidney. The normal outflow of urine is disturbed, and this leads to inflammation of the renal tissue - parenchyma, followed by its atrophy and deterioration of the filtering and excretory function of the kidney.

As a result of this, partial, and then, with the progression of the disease, complete renal failure may occur at first.

In medical practice, both hydronephrosis of the right and left kidneys are equally common. As for bilateral hydronephrosis, it is recorded in 5-9% of detected cases. Hydronephrosis can be not only congenital, but also acquired. Moreover, congenital hydronephrosis occurs against the background of urinary tract dyskinesia, an anomaly in the placement of the renal artery (possibly its branches), which compresses the ureter.

Causes of hydronephrosis

The disease develops due to a violation or absolute cessation of the movement of urine from the kidney to the bladder, which occurs due to a number of physiological or anatomical factors. An additional renal vessel passing to the bottom of the kidney from the aorta can also cause the disease. This additional vessel is located crosswise with the ureter and presses on it, which leads to narrowing.

Depending on the causes of the development of the disease, its forms are distinguished:

Congenital - hydronephrosis develops in utero or immediately after birth. Acquired - hydronephrosis appears as a result of damage to a previously healthy kidney.

The acquired form of hydronephrosis can have both anatomical causes of a violation of the outflow of urine from the renal pelvis, and physiological (arising against the background of diseases of the central and peripheral nervous system).

In total, there are five main groups of pathological conditions that create mechanical obstacles of anatomical nature in the urinary system:

Thickening of the walls of the ureter or pelvis as a result of tumors. The presence of tumors in surrounding organs and tissues that compress the ureter, kidney or urethra. Violation of the normal location of the ureter or kidney (omission of the kidney, bending or torsion of the ureter). Overlapping of the internal lumen of the ureter and pelvis with formed kidney stones. Compression or damage to the lower organs of the urinary system as a result of cancer and other diseases or injuries.

Quite often, women develop hydronephrosis during pregnancy. Its cause is mechanical compression of the ureter and other organs of the urinary system by an enlarged uterus.

Degrees of the disease

Doctors share several degrees of development of this disease, which have individual characteristics.

Hydronephrosis is also classified according to the type of development. If the disease is complicated by an attached infection, then it proceeds according to the infected type. If not, such a disease proceeds aseptically, the symptoms in these two cases will differ somewhat.

Symptoms of hydronephrosis

In the photo on the left is a healthy kidney, and on the right is hydronephrosis

Often the development of hydronephrosis of the kidneys goes unnoticed. The disease has no specific symptoms. On the early stages the clinical picture is due to the cause that caused the development of hydronephrosis. For example, with urolithiasis, attacks may occur renal colic, characterized by severe acute pain along the ureters.

If hydronephrosis of the kidneys progresses, and no treatment is provided, then the following symptoms of hydronephrosis appear:

pronounced pain from the problem kidney; pain attack is accompanied by nausea, in some cases - vomiting; blood pressure rises; flatulence increases, the patient complains of discomfort due to bloating; when the infection enters the kidney, the body temperature rises - the most dangerous sign; there is blood in the urine - this applies to those patients who are diagnosed with urolithiasis disease.

Hydronephrosis of the left kidney

Hydronephrosis of the left kidney is one of the most frequent complications urolithiasis, which can also manifest itself on the right. Hydronephrosis of the left kidney increases the internal pressure of the calyces and pelvis. The walls of these organs “fight” with high pressure for some time. Unable to withstand the pressure, the pressure gradually acts on the kidney itself, which in turn prevents urine from being excreted. Such a process can affect the tissues of the left kidney. The tubules and glomeruli atrophy and shrivel. As a result, the layer of the organ in which urine was formed decreases.

The first symptoms of urinary stasis are: sharp pains in the lateral part of the abdomen, radiating to the leg on the side of the lesion. If hydronephrosis of the left kidney is observed, then the pain will also radiate to the back.

Symptoms of hydronephrosis of the left kidney:

pain in the kidneys, aggravated to the damaged area; nervous excitement, anxiety; symptoms of intoxication of the body with nitrogenous products - loss of appetite, dizziness, migraines, vomiting and nausea, insomnia; back pain that radiates to the groin and under the shoulder blades; pain in the abdomen (stretching of the walls of the ureter under the size of the stone); a small amount of urine excreted per day. It may also appear a large number of mucus and blood when urinating

With untimely diagnosis, as well as unqualified treatment, the tissues of the left kidney can be severely damaged. This process leads to a partial loss of organ functionality or even to a complete loss of the ability to perform its functions.

Hydronephrosis of the right kidney

Hydronephrosis of the right kidney must be treated. If this is not done, kidney failure may develop. Stopping the work of the kidney can lead to intoxication and end in the death of the patient. Another possible outcome is urolithiasis, which can be aggravated by infection. The most common complication in this case is rupture of the calyx.

Depending on the level at which the long-term blockage took place, hydronephrosis of the right kidney proceeds with various symptoms. The most common cause is urolithiasis. urinary stones, exceeding the size of the natural pathways of the excretory system, get stuck in places of constriction, and therefore completely or partially disrupt the outflow of urine.

Symptoms and signs:

At the initial stage of the disease, a person usually complains of renal colic; in the evening, as a rule, there is a dull pain in the lumbar region, which disappears by night. Seizures can be caused physical activity or general fatigue. Presence of blood in urine high blood pressure in cups, as well as in the presence of kidney stones. Another feature- kidney enlargement. In people with an asthenic physique, it can even be felt through the front wall of the abdomen.

Most cases of hydronephrosis (more than half) have a left-sided localization, in about 40% of cases the pathology affects the right kidney, and only 5% of hydronephrotic transformation is bilateral.

Complications

A dangerous complication of hydronephrotic transformation is renal failure and atrophy. Due to changes in tissues, the kidney loses its functionality, and death occurs from intoxication with metabolic products.

Due to renal dysfunction in the blood, the content of residual nitrogen and other substances that are normally excreted through the kidneys with urine increases.

To avoid fatal intoxication, patients are shown the removal of the affected organ, after which patients undergo hemodialysis procedures with an artificial kidney machine or transplant an organ from a donor.

Diagnostics

During the examination, the doctor can preliminarily diagnose hydronephrosis through palpation. In the area of ​​​​the organ there is a seal. The patient's symptoms are also taken into account. general state his health.

Ultrasound of the kidneys with hydronephrosis

For an accurate diagnosis, instrumental and laboratory tests are prescribed:

general analysis of urine and blood; Ultrasound of the kidneys; x-ray examination of the kidneys. If the results of previous examinations are ambiguous, the patient may be referred for MRI or CT.

Hardware diagnostic methods help to determine and compare on which side there is, or kidney damage predominates. So hydronephrosis of the right kidney has a larger size of the pelvic region compared to a healthy left kidney. Or vice versa, hydronephrosis of the left kidney has a large pelvis compared to the right kidney.

There are also many additional methods by which pathology is detected. But they are not that common. The expediency of using one or another individually or many in combination is determined by the attending physician.

Treatment of hydronephrosis of the kidney

The course of treatment that the doctor will select has three directions: relieving symptoms, eliminating the cause, and reducing the load on the kidneys. The goal of treating hydronephrosis is to:

remove accumulated urine and reduce the pressure exerted by it on the kidneys; prevent irreversible deformation; eliminate the cause of hydronephrosis.

Medical treatment

Operation

If the condition of the kidney worsens over time, then hydronephrosis should be treated with surgical intervention.

There are two types of operations aimed at improving function in hydronephrosis:

Diet

Not the last place in the treatment is diet. The diet is prescribed by the doctor individually. Nutrition should be such as to help restore the flow of urine and kidneys.

The following foods should be excluded from the daily diet:

salty; fatty; smoked; sweets; alcohol; fried meat and spicy dishes.

Instead, the diet should include the following:

vegetables and fruits; dairy; proteins.

Such a diet in combination with the right treatment gives positive results. By the way, a diet can help improve metabolism, which is good for the whole body.

How to treat hydronephrosis folk remedies

Treatment folk remedies involves the use of various herbs and medicinal fees, which improve kidney function and alleviate the condition of patients with hydronephrosis. For this, apply:

Pumpkin, namely the stalks. To prepare the medicine, the stalks are crushed, 500 ml of boiled water is poured and infused in a water bath for 20 minutes. After this, the infusion must be removed, wrapped in a warm towel and infused for about 2 hours. Take 4 times a day for half a cup per reception. 150 gr. birch leaves, 50 gr. nettle leaves, 50 gr. adonis herbs, 50 gr. oat grains, 50 gr. bearberry and 50 gr. field horsetail. Blackcurrant leaves, raspberry leaves, calamus roots, kidney tea, string grass, chamomile flowers are taken in equal proportions. Herbs for hydronephrosis are used in the form of fees, which are recommended to be consumed no longer than 3-4 months. It is necessary to change fees, after each course, after waiting about 2 weeks. Plant infusions are taken on an empty stomach, about half an hour before meals. Chopped parsley root, 1 tbsp. l., pour 100 ml of boiling water. Means insist all night. Gently drain the liquid in the morning and drink 1 tbsp. l. on an empty stomach during the same day. If it is not possible to purchase the roots of the plant, seeds can also be used. However, they give less pronounced positive result. In the same way, you can prepare infusions for hydronephrosis from cumin seeds.

Prevention

Hydronephrosis of the kidneys, if acquired, occurs only under certain conditions. Doctors recommend taking the following preventive measures to avoid its development:

empty the bladder in time - frequent artificial retention of urine can lead to the fact that part of it will splash back into the pelvis; limit the use of salt and water - a violation of the salt and water balance leads to excessive production of urine in the kidneys; avoid hypothermia - this can provoke the development of inflammatory processes in the genitourinary system.

Men who have been diagnosed with "hydronephrosis of the kidneys" during the examination are interested to know what it is and what the outcome of the disease can be. In medicine, this pathology is also called hydronephrotic transformation, that is, a condition in which, due to a violation of the outflow of urine, the cups and pelvises of the kidneys expand, which leads to an increase in hydrostatic pressure in them.

In this article, you will learn what signs pathology accompanies, how to treat hydronephrosis of the kidneys with modern methods, what else can be done. You can see photos and videos on the topic.

Causes and stages of the development of the disease

A factor provoking the development of hydronephrosis of the kidneys is an obstacle to the natural outflow of urine from the organ. The reason for this can be any pathological process that occurs both in the kidney and outside it - in nearby organs and tissues:

stricture (narrowing) of the urinary tract, congenital or acquired; various stones in the genitourinary system; benign neoplasms; malignant tumors; retroperitoneal fibrosis.

As a result of urinary retention and expansion of the calyces and pelvis of the kidney, the parenchyma and muscle fibers of the organ atrophy. This leads to a deterioration in the functioning of the kidney, up to a complete loss of function.

In total, doctors distinguish three stages in the development of pathology, each of which is characterized by changes in the size of the organ and a deterioration in its functioning.

A slight accumulation of urine causes a slight increase in the pelvis. In this case, the function of the organ is not disturbed or there is a slight deterioration in work. The affected kidney increases by 20%, while its walls become thinner, and performance decreases by 40%. At this stage, a healthy kidney "takes" the load, which to some extent compensates for the deficiency. The kidney increases one and a half or two times. The pelvis and calyces expand, the internal cavity has a multi-chamber structure. The outflow of urine is disturbed, the kidney practically does not function, or does not work at all. As a result, the load on a healthy kidney increases, the organ ceases to cope with its function. The third stage of hydronephrosis, called terminal, is accompanied by chronic renal failure. If there is no treatment, then the outcome of the disease is fatal.

In addition to classification according to the stage of development of pathology, in medicine, pathology is designated by four degrees, depending on the state of the parenchyma.

Kidney parenchyma unchanged. Slight structural damage. Major violation. Absence, complete atrophy of the parenchyma of the damaged kidney.

Hydronephrosis with the same frequency develops both in the left and in the right kidney. In some cases, two kidneys are damaged at once. This condition is called bilateral hydronephrosis of the kidney.

Symptoms of the disease

At the first stage, hydronephrosis proceeds without pronounced signs and is often detected by chance, when examining a patient in connection with various complaints. At this stage, the signs directly depend on the causes that caused the pathology. For example, if hydronephrosis appeared as a result of the formation of stones, then a sharp, sharp pain along the ureters will be an accompanying symptom.

As the pathology progresses, the patient complains of the following problems:

dull pain in the lower back, independent of the time of day and position of the body; painful sensations are most pronounced in the area of ​​the affected kidney: if the left side of the lower back hurts, then the left kidney is affected and vice versa; in some cases, pain appears in the right side of the abdomen; the pain is often accompanied by nausea and vomiting.

The patient may have high blood pressure and bloating. When an organ becomes infected, body temperature rises. In some cases, the only symptom of hydronephrosis of the left or right kidney is the presence of blood particles in the urine. This situation is possible if the problem is caused by the development of urolithiasis. Stones coming out Bladder, injure the walls of the ureters, while hindering the outflow of urine.

At the last stage, signs of chronic kidney failure, edema develops, blood pressure rises and anemia. The patient should definitely seek help from a doctor if pain in the lower back begins. Hoping for self-treatment, the patient misses a favorable time to start treatment. The outcome in this case can be deplorable: starting with the removal of the affected kidney, ending with a fatal outcome.

Diagnosis of pathology in a medical institution

It is impossible to make any diagnosis, including "hydronephrosis of the 2nd degree of the right kidney", based only on symptoms. The doctor needs to refer the patient for a comprehensive examination in order to exclude other diseases and determine the cause of the pathology.

First, the doctor collects an anamnesis and conducts an external examination of the patient. The presence of a slight swelling in the lumbar region, a violation of symmetry in this area and the detection of a volumetric formation on palpation give rise to suspect the development of hydronephrosis of the kidneys. An instrumental examination is necessary to confirm or refute the doctor's preliminary conclusion.

In modern medicine, the diagnosis is made on the basis of the results of the following types of examinations:

Ultrasound of the kidneys - will reveal an increase in the renal pelvis, a change in the size of the kidney and the thickness of the parenchymal layer; x-ray examination - it can be used to detect stones, the nature of damage to the urinary tract, the size of the kidney and other parameters; radioisotope urogrophy - to make a more accurate diagnosis.

In some cases, if the results of previous examinations are ambiguous, the patient may be referred for an MRI or CT scan.

Except instrumental examination It will be necessary to take urine and blood samples for microscopic examination. Having on hand the results of examinations and tests, the doctor can determine the pathology and identify the problem that caused the formation of hydronephrosis of the left or right kidney.

Treatment methods for hydronephrosis

The course of treatment that the doctor will select has three directions: relieving symptoms, eliminating the cause, and reducing the load on the kidneys. For this, the following measures are effective:

conservative therapy - the use of drugs that help eliminate the disease and alleviate the patient's state of health; surgical intervention- operations aimed at restoring the kidney or removing it; adjustment of the patient's lifestyle - diet and other restrictions.

Consider each measure to combat hydronephrosis of the kidneys in more detail.

Medical treatment

Often the application medicines before the operation. At this stage, the symptoms of hydronephrosis are eliminated, urination is stimulated, and side pathological processes, such as foci of infection, are removed.

The doctor may prescribe the following drugs:

painkillers - to relieve pain in the patient; antibiotics - if there are signs of infection in the body; drugs that lower blood pressure; anti-inflammatory drugs; other medicines, depending on the patient's symptoms.

It should be remembered that drug treatment is used only in the first and second stages and often does not eliminate the pathology. Therefore, surgery, today, is the only effective method of combating pathology.

Operations for hydronephrosis of the kidneys

Surgical intervention in the first stages of the development of hydronephrosis is aimed at preserving the affected kidney. If necessary, the urinary tract is restored, the plastic of the renal pelvis is performed. Of particular difficulty is surgery hydronephrosis of the right kidney: high probability of damage to the pancreas.

If you are interested in the methods of conducting operations, see the table.

After the operation recovery period lasts a week - one and a half, depending on the method of surgical intervention chosen by the doctor. The patient is in the hospital under observation medical professionals. During this period, anti-inflammatory drugs are prescribed, general strengthening therapy is carried out. Spicy and salty dishes are excluded from the patient's diet.

After the operation to remove the kidney, it is advisable to adhere to the following dietary rules for three years:

remove fatty, spicy and salty foods; increase daily intake of fresh vegetables and fruits; drink two liters of liquids a day, give up alcohol and smoking.

As for physical activity, you need to follow the doctor's instructions. Usually, the restriction of physical activity is relevant for a month after the operation. In some cases, especially if the intervention was carried out by the laparoscopic method, this period can be reduced.

Diet for hydronephrosis of the kidney

The main task of adjusting the diet for hydronephrosis of the kidneys is to reduce the load on the affected organ. For this, diet No. 7 according to Pevzner is effective, enriched with vitamins and limiting the intake of fat and protein. With this diet, the diet may include:

baking from yeast dough without salt; cereal or vegetable soups; egg yolk; whole milk and dairy products (sour cream, curdled milk); oils, including ghee and butter; cereals and any pasta; fresh vegetables and herbs; fruits and berries in any form; compotes and kissels; sugar or honey; weak tea; natural juices; rosehip decoction.

Dishes are prepared without salt, frying without breading is allowed. The preferred method of cooking is boiling. Possibly baking. Deeply fried food with hydronephrosis is prohibited.

From the diet of the patient must be excluded:

ordinary bread and other flour products, especially if soda is present in the recipe; legumes in any form; meat, fish and mushroom broths; any meat and fish; cottage cheese and cheese; animal fats; pickled, salted or pickled vegetables and mushrooms; sweets.

It is forbidden to drink strong tea and coffee, alcohol and mineral water.

Nutrition is fractional, eating 5-6 times a day, in small portions. Such a diet is prescribed for a week, then the doctor can adjust the diet: exclude or, conversely, introduce certain dishes and foods into the diet.

Conclusion

You should not be afraid of the diagnosis of hydronephrosis of the left or right kidney. State of the art modern medicine allows you to cope with the disease even at the last, third stage. To learn how to treat hydronephrosis of the kidneys, you need to see a doctor at the first symptoms. Compliance with the doctor's recommendation, a timely operation, lifestyle adjustments will help to cope with the pathology and restore the usual quality of life.

Hydronephrosis is an expansion of the renal pelvis caused by an increase in pressure within the kidney itself or by an obstruction to the flow of urine.

There are two types of hydronephrosis:

congenital, or primary hydronephrosis, the appearance of which is associated with abnormalities in the development of the kidneys or ureters, acquired, resulting from diseases and injuries of the genitourinary system.

Stages and signs

There are three stages during hydronephrosis.

stage is characterized by the appearance of pyeloectasia - expansion of the pelvis. stage - the expansion of not only the pelvis, but also the calyces of the kidney, that is, the kidney tissue itself begins to suffer. stage - the kidney tissue completely atrophies, the organ ceases to function.

This pathology does not have any specific complaints and symptoms. Often, at the initial stage, the patient has no complaints at all, and in other cases, the following symptoms are most common:

dull pain in the lower back, blood in the urine, increased blood pressure, periodic rises in body temperature, general weakness.

Why is hydronephrosis dangerous?

If the violation of the outflow of urine is not eliminated, the kidney will atrophy. In addition, there are a number of related problems associated with the fact that the affected kidney releases substances in an increased amount (renin and angiotensin), leading to an increase in blood pressure. That is, nephrogenic arterial hypertension develops, which is considered to be malignant.

This kind of hypertension does not lend itself well. drug therapy and often leads to various complications, including stroke. Also, an atrophying kidney is often infected, which leads to the development of purulent complications that require emergency surgery for health reasons. Bilateral hydronephrosis is fraught with renal failure and the need for a donor kidney transplant or lifelong hemodialysis.

How to treat the disease?

When hydronephrosis is detected, treatment is primarily aimed at eliminating the cause that caused its development. For example, if these are stones with urolithiasis, then they are crushed, and congenital anomalies are eliminated with the help of plastic surgery.

Depending on the stage of hydronephrosis, treatment can be either active surgical or conservative medication.

If the kidney function is not impaired and there are no complications, then the condition of the kidney is monitored in dynamics and no treatment is prescribed. The localization of a unilateral process does not affect the choice of patient management tactics; hydronephrosis of the left kidney treatment provides the same as the right.

Nutrition for hydronephrosis

Regardless of the chosen treatment tactics, hydronephrosis requires a diet that provides for the consumption of about 3000 calories per day. Proteins containing essential amino acids must be included in the diet. However, meat and fish with hydronephrosis must be excluded from the diet. Egg dishes are acceptable and the basis of the diet should be vegetables and fruits. The patient needs to limit salt intake and drink at least 2 liters of fluid every day.

Treatment with folk remedies

Folk methods can treat only hydronephrosis of the first degree.

In folk medicine, various herbal preparations are used to treat hydronephrosis.

The most effective are the following:

Kidney tea, string grass, raspberry leaves, chamomile flowers, currant leaves, calamus root, meadowsweet flowers and knotweed grass are taken in equal parts and finely chopped. Then the infusion is prepared: 2 tablespoons of the collection are poured with a glass of boiling water. Infusion drink 50 ml 3 times a day. Herbs of knotweed, mint, volodushka, fireweed and celandine, marshmallow root, alder cones and coriander fruits are taken in equal parts, the infusion is prepared in the same way as the previous one. The method of treatment is also the same.

Both collections are applied in turn: after a course of treatment with one collection for 2-3 weeks, a two-week break is made, after which they begin to take the second collection.

Medical treatment

If the pathology is complicated by the addition of infection and the development of pyelonephritis, then antibiotic therapy is necessary. In the presence of stones in the kidney, consisting of uric acid - urates, alkalizing therapy is carried out. Pain is also relieved with medication. And in cases where retroperitoneal fibrosis leads to the development of hydronephrosis, hormonal treatment is prescribed.

Surgery

If the condition of the kidney worsens over time, then hydronephrosis should be treated with surgical intervention. There are two types of operations aimed at improving function in hydronephrosis:

creation of an additional channel for the exit of urine, narrowing of the expanded pyelocaliceal system of the kidney.

As a rule, radical surgery is preceded by drainage of the kidney. They are also used to treat hydronephrosis during pregnancy, which is caused by compression of the ureter by the growing uterus.

If the patient has grade 3 hydronephrosis, the treatment involves the removal of a no longer functioning kidney, which is, in fact, a thin-walled bag with liquid contents.

The functioning of the urinary system depends on the correct excretion of fluid. If its outflow is disturbed, stagnation occurs, as a result of which the renal pelvis and calyces expand. This leads to progressive tissue atrophy and organ death.

Hydronephrosis of the kidney - what is it?

When urine is retained in the excretory system, its volume constantly increases. A large amount of fluid provokes stretching of the kidney cavities and comorbidities that explain what hydronephrosis is:

• increased pressure in the ureter;
• deterioration of glomerular filtration;
• violation of pyelovenous, pyelolymphatic and pyeloarterial flow;
• decreased patency of the tubules;
• atrophy of interstitial tissue, parenchyma;
• death of nephrons.

Why is hydronephrosis dangerous?

A progressive disease causes the slow death of the structural units of the kidney. At first, the disease hydronephrosis is accompanied by a weak violation of the functions of the organ and does not affect the general condition of the urinary system too noticeably. Later, partial insufficiency is observed, which can occur with rare relapses. With absence effective treatment hydronephrosis of the right kidney will go into a severe stage with an absolute violation or shutdown of the functions of the organ. This is fraught with complete insufficiency and poisoning with waste products.

Hydronephrosis of the kidneys - causes

Urologists call acquired and congenital factors predisposing to the development of the described disease. Hydronephrosis - causes of the first group:

• fast-growing tumor pressing on the ureters;
• post-traumatic or postoperative narrowing of the tubules with the formation of scar tissue;
• vessel embolism;
• spinal cord injury;
• cancer of the right, left kidney or bladder;
• the presence of stones, sand;
• ovarian cyst;
• inflammatory diseases genitourinary system;
• tuberculosis;
• metastases and others.

Sometimes the outflow of urine is disturbed against the background of various anomalies in the structure of the excretory tract. Hydronephrosis on the right and left is diagnosed with the following congenital pathologies:

• obstruction of the urinary tubules;
• additional structures, septa and valves in the urinary tract;
• diverticula;
• anatomical obstacles located in the bladder, urethra, wall and lumen of the ureter, pelvis;
• dyskinesia and dysthenesia;
• ureterocele.

Hydronephrosis of the right kidney often occurs due to an abnormal structure of the main systemic artery or its large branches. The abnormally formed blood vessel is in the form of a ring that compresses the ureter. Such a "clamp" prevents the normal flow and removal of excess fluid, leads to the expansion of the cups and pelvis of the left or right kidney.

Hydronephrosis during pregnancy

The problem under consideration is considered a typical phenomenon during gestation, especially from the 2nd trimester. Hydronephrosis of the kidney during pregnancy develops due to a significant increase in the size of the uterus. Its walls begin to bulge into the peritoneal space and put pressure on the ureter. The more intense the uterus is stretched, the more fluid is retained in the kidney.

Degrees of hydronephrosis

Depending on the severity of the pathology and the severity of its symptoms, 3 stages of the course of the disease are distinguished:

1. Hydronephrosis 1 degree (compensated) characterized by complete preservation of the functions of the right kidney. A small amount of urine accumulates in the pelvis, so the walls and cups of the organ practically do not stretch.
2. Hydronephrosis 2nd degree (partially compensated) accompanied by the transformation of the tissues of the damaged kidney and a decrease in its functions by 40-45%. In order for the excretory system to work normally, the work of a healthy paired organ is enhanced.
3. Hydronephrosis 3 degrees (terminal) represents a failure of the right kidney. Due to excessive load, a healthy organ cannot cope with the excretion of excess urine, and severe insufficiency progresses. In the absence of therapy, a fatal outcome is likely.

Hydronephrosis of the kidney - symptoms

The described pathology is extremely rarely accompanied by noticeable clinical signs. The severity and specificity of symptoms depends on the stage of hydronephrosis, the causes and duration of its progression, and the localization of urinary tract obstruction. AT early period it is almost impossible to detect the disease, there are no signs of disruption of the excretory system and the right kidney.

Hydronephrosis - symptoms of severe degrees of the disease:

• discomfort in the lumbar region;
• chronic fatigue;
• arterial hypertension;
• decrease in working capacity;
• nausea;
• renal colic;
• fever;
• vomit;
• chills;
• infrequent and less profuse urination;
• pain in the back and lower back;
• puffiness;
• anemia.

Hydronephrosis - diagnosis

The urologist can suspect the ailment in question during a physical examination, during palpation, percussion, auscultation. To confirm hydronephrosis of the right or left kidney, a number of laboratory tests are required:

• blood (biochemistry, electrolytes);
• urine (general, deployed, bakposev);
• samples according to Nechiporenko, Reberg, Zimnitsky, Addis-Kakovsky.

Instrumental studies help to finally establish the diagnosis of "hydronephrosis of the right kidney":

• magnetic resonance or computed tomography;
• retrograde ureteropyelography;
• ultrasound diagnostics;
• dopplerography;
• endoluminal echography;
• chromocystoscopy;
• renoangiography;
• percutaneous antegrade pyelography;
• radioisotope dynamic nephroscintigraphy and others.

Treatment of hydronephrosis of the kidneys

Therapy of the presented pathology is developed individually for each patient. Ways to treat hydronephrosis are selected by the urologist in accordance with the nature of the course of the disease, the severity of the symptoms, and the cause of the accumulation of urine. The main objectives of therapeutic measures:

• removal of excess fluid from the urinary system;
• prevention of stretching of the right kidney and atrophy of its tissues;
• normalization of urine outflow;
• elimination of factors that provoke violations of renal activity.

Hydronephrosis - treatment without surgery

Conservative therapy is practiced exclusively in the early stages of the disease, when the activity of the urinary system is still compensated. Kidney disease "hydronephrosis" involves the use of symptomatic medications of several groups:

• anti-inflammatory - Ketoprofen, Ibuprofen, Tenoxicam;
• painkillers - Ketorolac, Naproxen,;
• antibiotics -, Flemoxin Solutab, Clindamycin;
• hypotensive - Metoprolol, Physiotens, Albarel and others.

Application pharmacological agents is not effective way right kidney treatment. Courses of medications are often prescribed on the eve of surgery to stabilize the condition, improve the patient's well-being and prevent infection of the urinary system. Without surgical procedures, the pathology will progress.

Hydronephrosis - operation

The choice of a radical therapeutic approach is carried out only after a thorough diagnosis. First, it is important to find out why hydronephrosis arose - the treatment is developed depending on the provoking factor. In the presence of stones or sand in the right kidney, their remote crushing (lithotripsy) is recommended. Manipulation is performed using ultrasonic and radio wave effects.

If hydronephrosis of the right (left) kidney is caused by a tumor, a decision is made to resect the neoplasm. Additionally, radiation and chemical therapy can be carried out. Often it is not possible to remove only the tumor and metastases, so the surgeon recommends partial or complete excision of the organ in which the growth is found, with simultaneous drainage of the right kidney.

With congenital anomalies in the development of the urinary system, plastic surgery is performed. Such operations are aimed at restoring the normal flow of the fluid. In severe cases, when hydronephrosis leads to complete failure of the right kidney, there is a risk of complications in the form of acute intoxication with urine decay products, the organ has to be removed (nephrectomy).

Hydronephrosis is a kidney disease caused by a violation of the outflow of urine in the calyx and pelvis.

As a result of the disease, the pelvicalyceal segment of the kidney expands, which ultimately can lead to irreversible changes in the parenchyma and impair the performance of the affected part of the kidney. In a group of people over sixty, the disease is recorded predominantly in males. Hydronephrosis can be detected in a pregnant woman.

Hydronephrosis is almost always the result of a congenital pathology, such as a malformation of the pyeloureteral anastomosis. The disease can manifest itself both immediately and after a long time. Regardless of what causes the disease, the outcome is the same: urine is retained in the pelvis due to the fact that there are problems with the outflow. This process causes ischemia, part of the renal system may atrophy.

Hydronephrosis can develop immediately due to several reasons.

What it is?

Hydronephrosis is pathological condition, in which the expansion of the pelvis and calyces of the kidneys occurs due to a violation of the outflow of urine and an increase in hydrostatic pressure in the pelvicalyceal system. Such violations lead to a gradual deterioration of kidney function and atrophy of the parenchyma.

Causes of hydronephrosis of the kidneys

As already mentioned, hydronephrosis of the kidneys is congenital and acquired. Each of these forms of pathology has its own etiology. Congenital hydronephrosis is associated with the anatomical features of the child's body. Certain changes can be noticed by an experienced specialist even during an ultrasound examination of the fetus. Even then, the renal pelvis can be enlarged to varying degrees. Depending on how serious the abnormalities are, a decision is made to conduct appropriate treatment or even terminate the pregnancy if doctors evaluate the fetal kidney function as incompatible with life.

The causes of hydronephrosis can be divided into external, internal and functional. Pathological changes can affect both the ureter and bladder. From the side of the ureter internal reasons hydronephrosis can become:

• blood clots;
• tumors of various etiologies;
• narrowing of the mouth of the ureter (urethrocele);
• endometriosis;
• tuberculosis;
• fibroepithelial polyps, etc.

Among the external causes that can cause dysfunction of the ureter, the following can be distinguished:

• pregnancy;
• oncological diseases of the female reproductive system(cervical cancer, polycystic ovaries, etc.);
• prolapse of the uterus;
• prostate tumors of various etiologies;
• aortic aneurysm in its abdominal region;
• anatomically incorrectly located renal artery, which in this case compresses the ureter.

If we are talking about the bladder, then among internal factors contributing to the development of hydronephrosis, the following can be distinguished:

• bladder neck contracture;
• urolithiasis disease;
• prolapse of the bladder into the vagina in women (cystocele);
• carcinoma;
• bladder diverticulum, etc.

Pelvic lipomatosis can become an external obstacle to the physiological outflow of urine from the bladder. Functional disorders include various filling and emptying disorders of the bladder and retrograde vesicoureteral flow of urine (reflux).

On the part of the urethra, the cause of hydronephrosis can be prostate cancer, its hyperplasia (external causes), as well as urethral strictures (pathological narrowing of the urethra) or urethral diverticula (internal causes).

Also, various injuries, postoperative conditions, inflammatory diseases can become the cause of hydronephrosis. various genesis, urinary tract obstruction, etc.

Symptoms of hydronephrosis

At an early stage in the development of hydronephrosis, there are practically no symptoms. In some cases, the patient may be disturbed by such symptoms:

• colic;
• more frequent urination, which does not bring proper relief;
• a feeling of heaviness in the area of ​​​​the organ.

As congenital or acquired hydronephrosis develops, dull, aching pain in the lumbar region may be felt. Localization of pain depends on which kidney is affected. The following symptoms can be observed:

• lower abdominal pain;
• weakness;
• elevated temperature;
• nausea;
• bouts of pain in the area of ​​the location of organs;
• bloating;
• increased blood pressure.

If a person has a fever (more than 37 oC), then this indicates the beginning of an infectious process, especially when there is a suspicion of hydronephrosis in children. In some cases, the patient does not experience the above symptoms, except for one - urine mixed with blood. Such a violation requires immediate examination by a doctor.

Hydronephrosis of the left kidney

Hydronephrosis of the left kidney is one of the most common diseases of the genitourinary system. The main provoking factor is a stone that can block the outflow of urine. In this case, if the stone enters the urinary canal, bilateral hydronephrosis is considered.

The first and most common symptom in this disease is pain on the left side, which radiates to the leg. There is also a painful outflow of urine mixed with blood and mucus. In some cases, the patient cannot urinate, although the urge to urinate is present.

With such symptoms, you should immediately consult a doctor for an accurate diagnosis and immediate treatment. Operation is almost always prescribed.

Hydronephrosis of the right kidney

Hydronephrosis of the right kidney is a urological disease that is caused by blockage of the urinary tract. The main risk group is the elderly and those who abuse alcohol.

Symptoms of hydronephrosis of the right kidney are the same as with the localization of the pathological process in the region of the left kidney. The only difference is that with hydronephrosis of the right kidney, pain radiates to the entire lower back.

Degrees

There are three degrees of hydronephrosis:

1. Hydronephrosis in 1 degree. At this stage, the pyelocaliceal apparatus of the kidney is enlarged, but this is not accompanied by an increase in the organ itself. Kidney function is preserved, the clinical picture can be manifested by symptoms such as aching pain in the lumbar region. Sometimes there may be hematuria (blood in the urine). In the analyzes, the protein may be slightly increased, with hematuria, red blood cells will also be present.
2. Hydronephrosis in 2nd degree. At the second stage, simultaneously with the pelvis, the kidney itself also increases. On average, it increases by 10 - 20 percent of its original volume. However, it should be understood that the increase in the kidney does not occur due to an increase in its tissue or function, but due to the stretching of the pelvis and the accumulation of urine in them. The very same function of the kidney is reduced by 30 - 40 percent. Protein begins to appear in the urine (proteinuria), and toxic metabolic products - creatinine and urea - grow in the blood. At this stage, the first signs of renal failure begin to appear - blood pressure rises, renal edema appears in the morning.
3. Hydronephrosis grade 3. It represents kidney failure. At this stage, the kidneys almost double in size while their function is reduced by more than 60 to 70 percent. The parenchyma of the kidney (its tissue) almost completely atrophies, and large cavities form in its place. The kidney takes the form of a multi-chamber cavity, which, in turn, is filled with urine residues. Arterial hypertension becomes resistant (poorly amenable) to treatment, the pressure is constantly elevated. Protein continues to be lost by the body, at the terminal stage proteinuria reaches 3 grams per liter of urine. Such a massive loss of protein provokes large edema. Patients at this stage are very edematous, swelling is observed not only in the eye area, but throughout the body.

Hydronephrosis is also classified according to the type of development. If the disease is complicated by an attached infection, then it proceeds according to the infected type. If not, such a disease proceeds aseptically, the symptoms in these two cases will differ somewhat.

Features of hydronephrosis in pregnant women

The main reason for the development of this pathology in pregnant women is considered to be anomalies in the development of the urinary tract. Why is this happening? The development of the fetus does not occur unnoticed by the mother's body. While the baby is growing inside the uterus, the woman's kidneys have to work for two. If the mother before conception had certain malformations of the genitourinary system that did not bring her discomfort, then with the advent of the child, the work of the kidneys is completely decompensated.

How does hydronephrosis manifest in pregnant women?

• in most cases, late gestosis develops (increased blood pressure, the appearance of edema and protein in the urine);
• an enlarged kidney can compress the uterus, disrupting the blood supply to the fetus, which leads to intrauterine growth retardation. Also, the large size of the kidney interferes with the normal delivery of the mother;
• the disease can be complicated by the development of pyelonephritis and chronic renal failure, as well as an increase in the blood of nitrogenous slags (urea, creatinine).

The development of hydronephrosis in some cases threatens the life of a woman, so the pregnancy must be terminated if:

• the diagnosis of "bilateral hydronephrosis" was made before conception;
• the mother has only one functioning kidney;
• with a complicated course of pathology;
• the disease is not amenable to conservative and surgical treatment.

Pregnancy is not a contraindication for reconstructive plastic surgery. In severe cases, the kidney may be removed.

Hydronephrosis in children

Hydronephrosis in children is usually congenital. The slowdown in the outflow of urine leads to its accumulation in the cups and pelvis and an increase in pressure in them. Additional elastic fibers appear in the walls of the pelvis and calyces to counteract the increasing pressure. For some time the situation will stabilize. And, if the cause that hinders the outflow of urine is eliminated, for example, the lumen of the ureter develops further, then hydronephrosis in children disappears.

Hydronephrosis in newborns is accompanied by blood in the urine, urinary infections, and abdominal pain. If the kidney is greatly enlarged, then the parents themselves can feel it as a rounded formation in the baby's stomach. The expanded pelvis with hydronephrosis of newborns is easily determined by ultrasound. This is the very first study that must be completed if hydronephrosis is suspected. Next, the doctor prescribes a deeper examination to establish the degree of the disease and the state of kidney function. As a rule, studies with contrast agents or radioisotopes are performed for this.

Hydronephrosis of newborns as a diagnosis during the first three to four weeks is not made, because during this period, strong changes in the structure of the kidneys and water-salt metabolism occur in the child's body, so the symptoms of hydronephrosis in newborns may spontaneously disappear.

Diagnostics

It is important not only to see everything diagnostic signs hydronephrosis, but also to identify the cause, to assess the functional ability of the contralateral kidney.

Clinical and urological examination is carried out in the following volume:

• general analysis of blood and urine;
• bakposev urine with the definition of the pathogen;
• blood biochemistry;
• electrolytes;
• examination for urogenital tuberculosis (with the constant presence of leukocytes in the urine, but sterile urine culture results for flora);
• Doppler ultrasound of the kidneys;
• review and excretory urography;
• voiding cystoureterography;
• dynamic scintigraphy with an assessment of the functional ability of each kidney.

If a tumor pathology is suspected, an MRI may be performed. According to the indications can be performed additional methods examinations.

Differential diagnosis is carried out with polycystic kidney disease (with a 2-sided process), a solitary cyst, a malignant neoplasm. With concomitant pain syndrome, urolithiasis and nephroptosis are excluded. Often there is a combination of a lowered kidney with a stricture of the LMS. If there is pyuria and hematuria in the urine, oncology, pyonephrosis and tuberculosis are excluded.

Pyelocalicectasia, in addition to hydronephrosis, can occur in conditions such as:

• taking diuretics;
• diabetes insipidus;
• extrarenal pelvis;
• parapelvic cyst;
• papillary necrosis;
• calyx diverticula;
• pregnancy.

Complications

Chronic hydronephrosis often contributes to the occurrence of urolithiasis and pyelonephritis, hypertension, which further aggravate the clinic of hydronephrotic transformation of the kidney. Against the background of infected hydronephrosis, sepsis sometimes develops.

The course of hydronephrosis can be complicated by the development of renal failure. In this case, especially with bilateral hydronephrosis, the death of the patient occurs from intoxication with nitrogen metabolism products and disturbances in water and electrolyte balance. A life-threatening complication of hydronephrosis can be a spontaneous rupture of the hydronephrotic sac, resulting in the outflow of urine into the retroperitoneal space.

Treatment of hydronephrosis of the kidneys

Therapy of the disease should be aimed at eliminating its cause and preserving kidney function. Conservative and surgical treatment is possible. Drug therapy methods are used to relieve pain, lower blood pressure, eliminate uremia and destroy secondary infection.

What drugs are prescribed for hydronephrosis:

• β2-adrenomimetic hexoprenaline (ginipral) - it reduces the tone and expands the lumen of the ureter;
• broad-spectrum antibacterial drugs - protected penicillins (augmentin), cephalosporins (cefadox), fluoroquinolones (levofloxacin, ciprofloxacin);
• diuretics - more often loop (furosemide, torasemide);
• myotropic antispasmodics - drotaverine (no-shpa), papaverine;
• painkillers - opioids (morphine, promedol) for renal colic or non-steroidal anti-inflammatory drugs (movalis, nimesil);
• antihypertensive drugs - best manifest themselves ACE inhibitors(Enap, Prestarium) and calcium channel blockers (amlodipine).

To eliminate uremia, afferent methods of detoxification are used: plasmapheresis, hemodialysis.

Operation

Target surgical treatment- creation of an artificial way for the outflow of urine from the kidney and elimination of the root cause of the disease.

The choice of the method of surgical intervention depends on what exactly caused the hydronephrosis. There are two most common operations (with many modifications) used to treat hydronephrosis:

1. Transurethral catheterization followed by stenting of the ureter, used for persistent spasm of the ureters that is not amenable to drug correction.

The meaning of this operation is to introduce a catheter equipped with a camera and carrying a stent through the urethra - a special device that looks like a small spring. The stent is placed at the narrowing of the urinary tract and then expanded. After the spring has expanded, the patency of this area is restored, the catheter is removed, and the patient is placed under observation. As a rule, such an operation does not take more than 40-60 minutes, and the patient can be discharged home the next day for outpatient observation.

2. The imposition of a nephrostomy (creation of an artificial path for the outflow of urine) is used in cases where the patency of the urinary tract cannot be restored on an emergency basis (for example, when squeezed by a tumor, the removal of which requires a long preliminary examination).

There are many modifications of such an operation, which differ in the place and type of access, as well as the extent of the intervention, but the main meaning of surgical procedures is as follows: a catheter is inserted into the pelvis by means of an incision or puncture of the skin above the kidney, the other end of which is fixed with a special device on the skin. Thus, urine begins to flow out through the catheter, where it is collected in a sterile container - a urinal. The duration of the operation takes up to 1 hour, and after a follow-up ultrasound examination and recommendations for the care of the nephrostomy, the patient can be discharged home. Such a nephrostomy can function sufficiently long time, which is necessary to identify and eliminate the underlying cause of urinary tract obstruction.

Nutrition and diet

With hydronephrosis, the process of natural removal of decay products from the body is inhibited. To reduce the intoxication of the body with harmful substances, the patient must follow a special diet.

The provisions of the diet for hydronephrosis are as follows:

1. Limited intake of animal protein;
2. Exclusion of certain products;
3. The use of the required amount of plant products.

With hydronephrosis, it is recommended to consume no more than 0.5 grams of protein per 1 kilogram of the weight of a sick person. So, if a patient weighs 70 kilograms, he can eat 35 grams of protein per day. Replenish protein intake lean fish or meat, dairy products of low fat content. In this case, you need to choose natural (not frozen, not processed) products.

Foods that should be removed from the diet for hydronephrosis are:

• any kind of meat or fish with high fat content;
• jellied meat and other types of rich broths from meat or fish;
• dishes prepared by frying, smoking, drying;
• industrial and home preservation (salted, pickled, pickled vegetables or fruits);
• sweets, cakes, pastries and other products with a lot of sugar;
• food products with a high salt content (chips, crackers, salted sticks);
• any product that has an unnatural smell, color or taste.
• carbonated drinks, alcohol.

Products that are allowed for hydronephrosis are:

• meat (chicken, turkey, veal);
• offal (liver);
• fish (cod, zander, pike);
• dairy and sour-milk products (cottage cheese, kefir, milk, sour cream, yogurt).

The most useful cultures for hydronephrosis are:

• watermelon;
• grape;
• apples;
• apricots;
• plums;
• pumpkin;
• beet;
• potato;
• cauliflower.

Folk remedies

Treatment with folk remedies involves the use of various herbs and medicinal preparations that improve kidney function and alleviate the condition of patients with hydronephrosis. For this, apply:

1. Pumpkin, namely the stalks. To prepare the medicine, the stalks are crushed, 500 ml of boiled water is poured and infused in a water bath for 20 minutes. After this, the infusion must be removed, wrapped in a warm towel and infused for about 2 hours. Take 4 times a day for half a cup per reception.
2. 150 gr. birch leaves, 50 gr. nettle leaves, 50 gr. adonis herbs, 50 gr. oat grains, 50 gr. bearberry and 50 gr. field horsetail.
3. Blackcurrant leaves, raspberry leaves, calamus roots, kidney tea, string grass, chamomile flowers are taken in equal proportions.
4. Herbs for hydronephrosis are used in the form of fees, which are recommended to be consumed no longer than 3-4 months. It is necessary to change fees, after each course, after waiting about 2 weeks. Plant infusions are taken on an empty stomach, about half an hour before meals.
5. Chopped parsley root, 1 tbsp. l., pour 100 ml of boiling water. Means insist all night. Gently drain the liquid in the morning and drink 1 tbsp. l. on an empty stomach during the same day. If it is not possible to purchase the roots of the plant, seeds can also be used. However, they give a less pronounced positive result. In the same way, you can prepare infusions for hydronephrosis from cumin seeds.

Prevention

It is difficult to prevent the congenital form of the disease. To do this, you need to plan a pregnancy and undergo medical examination during childbearing. The expectant mother must avoid contact with teratogenic substances, do not drink alcohol and do not smoke. In order to prevent acquired hydronephrosis, it is necessary:

• timely treat diseases of the urethra, bladder and ureters;
• dress warmly in cold weather;
• eat properly;
• drink more pure water;
• rule out injury
• observe the rules of intimate hygiene;
• do not engage in casual sex;
• empty the bladder in a timely manner;
• not be stressed;
• to refuse from bad habits.

Forecast

The outcome of the disease can give different indicators. The prognosis depends on the course of the operation and possible complications. In half of patients after operable intervention, complications are found that lead to repeated operations, systematic hospitalization and continuous therapy. If hydronephrosis has developed only on the left or only on the right, then the prognosis is relatively favorable, since even with a severe form of the disease, one kidney can be removed, thereby saving the entire body from infection and further diseases.

In the case of a dual diagnosis, surgery is not always effective. And although double hydronephrosis is too rare, the patient may not survive without transplantation of at least one kidney, since in most cases there is every indication for the removal of both kidneys, which is incompatible with life. If, nevertheless, both kidneys can be saved, then every second patient has kidney failure. As with other diseases, the state of the prognosis depends on the age and stage. The sooner the operation is completed, the greater the chances for a full, healthy life.

Children under three years of age in 90% of cases after surgery lead a normal life. Good results are determined in 80% of children aged 3 to 15 years. Adults make a definitive recovery in fifty percent of cases.

Thanks

The site provides reference information for informational purposes only. Diagnosis and treatment of diseases should be carried out under the supervision of a specialist. All drugs have contraindications. Expert advice is required!

What is hydronephrosis?

Causes of hydronephrosis

The structure of the kidneys

kidney parenchyma
Parenchyma ( i.e. the kidney tissue itself) has a heterogeneous structure and consists of cortical and medulla. The cortex has dark color and contains renal glomeruli. The main function of this part of the kidney is to filter and form primary urine. The medulla of the kidney has a lighter shade and consists of renal tubules. The function of the medulla is to form a secondary ( final) urine and excretion of metabolic products from the body.

pelvicalyceal part of the kidney
This part of the kidney is responsible for the accumulation and further excretion of urine into the ureter. After the blood has passed through the kidney tissue, the liquid part is filtered out of it and urine is formed. Urine collects in structures called calyces. In the kidney, from 6 to 10 small calyces and up to 4 large ones are distinguished. The large calyces open into the pelvis, which in turn passes into the ureter. The pelvis is a funnel-shaped cavity in which urine accumulates. The pelvis and calyx are composed of mucous and muscular membranes. Due to contractions of the muscle layer, urine from the pelvis passes into the ureter, and from it into the bladder. Thus, in the cups and pelvis there is a continuous accumulation of urine, which subsequently flows into the ureters. If something interferes with the outflow of urine, then it begins to accumulate in the pelvis. Most often, the flow of urine from the pelvis is obstructed by stones, tumors, or narrowing of the ureter.

If urine accumulates for a long time, then it begins to compress the kidney tissue. Being under constant pressure, the parenchyma ( the cloth) kidney begins to atrophy ( ceases to function).

The causes of hydronephrosis are:

• tumors;
• anomalies of the urinary system.

Urolithiasis disease

Tumors

Anomalies of the urinary system

Abnormalities of the ureter that can cause hydronephrosis include:

• constriction initial department ureter- with this anomaly, urine passes further, but not in its entirety. Due to the narrowed ureter, some of the urine remains in the pelvis and begins to accumulate over time.
• Curvature of the ureter- also prevent the complete outflow of urine from the pelvis. Curvature can be both acquired ( adhesions due to past infections) and congenital.
• High outlet ureter- similarly impedes the flow of urine through the ureter.
• ureteral valve defect- this anomaly, as a rule, is detected even in the first years of life, because it is accompanied by total urinary retention in the pelvis. The valve is a flap of mucous membrane that closes the lumen of the ureter.

The result of this is stagnation and accumulation of urine first in the ureter and then in the kidney. At the same time, hydronephrosis can also be a consequence of hypertonicity ( voltage) ureter. This pathology ( also called dyskinesia) is expressed in frequent and irregular contractions of the ureter.

Often, hydronephrosis is a consequence of vesicoureteral reflux. With this pathology, urine is thrown from the bladder into the ureter, and from there, as it accumulates, into the kidney.

Symptoms of hydronephrosis

Symptoms of hydronephrosis are:

• blood in urine- if the cause of hydronephrosis is kidney stones, then hematuria ( or blood in urine) is a common symptom;
• fever- noted when hydronephrosis is accompanied by pyelonephritis ( urinary tract infection);
• - a symptom that is already noted in the later stages of hydronephrosis;
• edema- also appear at decompensated stages;
• decrease in daily diuresis ( or oliguria) - less than 500 milliliters in 24 hours, at a rate of 1.5 liters.

Hydronephrosis on the left

Also, hydronephrosis on the left is accompanied by the development of edema, high blood pressure, a decrease in daily diuresis ( urine volume). However, all these symptoms develop already in the last stages of hydronephrosis. In addition to dull, unexpressed pain in the early stages of the disease, there may be a symptom such as blood in the urine ( medical term– hematuria). It can be of two types - macroscopic and microscopic. In the first case, the presence of blood in the urine is visible to the naked eye. The patient himself notices that the urine has changed color and acquired a red tint. In the second case, the presence of blood elements in the urine is confirmed only by laboratory methods.

Hydronephrosis is often complicated by the addition of an infection and, as a result, a rise in body temperature ( manifestation of an infectious process). This is explained by the fact that with hydronephrosis, the process of stagnation of urine is noted. Due to impaired outflow from the pelvis, urine is retained in the kidneys. This becomes the soil for the development of bacteria in it ( if there is no movement process, then the bacteria very quickly attach to the substrate, in this case, to the urine). The result of this is a rapid infection of the urine and the transfer of inflammation to the kidneys. Against the background of hydronephrosis, pyelonephritis also often develops, which is also accompanied by elevated temperature body and dull pain in the lower back.

Bilateral hydronephrosis

Symptoms of kidney failure are:

• swelling;
• high blood pressure;
• the presence of protein in the urine proteinuria);
• retention in the body of urea and other metabolic products.

Hypertension is also a persistent and difficult-to-treat symptom in hydronephrosis ( high blood pressure). It develops due to atrophy and insufficient blood supply to the kidneys. As you know, the accumulated urine during hydronephrosis compresses the kidney tissue, which leads to its atrophy. This leads to the activation of the renin-angiotensin system, which triggers a cascade of reactions, the end result of which is increased secretion of the hormone angiotensin II. In turn, angiotensin II constricts blood vessels and stimulates the secretion of aldosterone. Aldosterone retains water in the body, and water retention plus vasoconstriction is high blood pressure.

Together with urine, the kidneys excrete waste products of the body, including such toxic ones as urea and creatinine. These products are highly toxic and can quickly enter the brain and cause encephalopathy ( brain disease). This condition is the final stage of hydronephrosis. characteristic symptom disease at this stage is the specific smell of urea from the patient.

Degrees ( stages) hydronephrosis

The stages of hydronephrosis include:

• the initial stage of hydronephrosis;
• early stage of hydronephrosis;
• terminal stage of hydronephrosis.

stage 1 hydronephrosis

stage 2 hydronephrosis

stage 3 hydronephrosis

Diagnosis of hydronephrosis according to the ICD

Tests for hydronephrosis

Urine analysis indicators for hydronephrosis

In parallel, the patient has pronounced edema ( due to loss of protein) and persistent hypertension.

Blood test indicators for hydronephrosis

laboratory sign	Description
Hypoproteinemia	A decrease in the concentration of total protein in the blood is less than 65 grams per liter.
Hypoalbuminemia	Decreased predominantly albumin ( high density proteins), less than 25 grams per litre.
Hyperlipidemia	The provisions of the diet for hydronephrosis are as follows: limited intake of animal protein; exclusion of certain products; the use of the required amount of plant products. Limited intake of animal protein With hydronephrosis, it is recommended to consume no more than 0.5 grams of protein per 1 kilogram of the weight of a sick person. So, if a patient weighs 70 kilograms, he can eat 35 grams of protein per day. Replenish the norm of protein should be lean fish or meat, dairy products of low fat content. In this case, you need to choose natural ( not frozen, not processed) products. Products that are allowed for hydronephrosis are: meat ( chicken, turkey, veal); offal ( liver); fish ( cod, walleye, pike); dairy and dairy products ( cottage cheese, kefir, milk, sour cream, yogurt). Exclusion of certain products There are some foods that should be reduced in hydronephrosis. Refusal of these products will positively affect the general condition of the body and will allow you to more effectively resist the disease. Foods that should be removed from the diet for hydronephrosis are: any kind of meat or fish with high fat content; jellied meat and other types of rich broths from meat or fish; dishes prepared by frying, smoking, drying; industrial and domestic conservation ( salted, pickled, pickled vegetables or fruits); sweets, cakes, pastries and other products with a lot of sugar; foods high in salt chips, crackers, salty sticks); any product that has an unnatural smell, color or taste. carbonated drinks, alcohol. Eating the right amount of herbal products With hydronephrosis, it is recommended to include at least 600 grams of fruits and vegetables in the daily diet. Plant foods should be consumed mostly raw. The most useful cultures for hydronephrosis are: potato; Folk remedies for the treatment of hydronephrosis In the treatment of hydronephrosis, it is advisable to use products made according to traditional medicine recipes. Such drugs should be used as an addition to the main method of treatment. Carrying out therapy folk methods requires compliance with a number of rules. Failure to follow the rules can lead to various complications. Rules for the use of funds traditional medicine Before carrying out therapy with folk methods, you should definitely make a visit to the doctor. The doctor will determine the appropriateness of such treatment and determine whether there are contraindications. Also, a physician can provide recommendations on the optimal scheme for taking alternative drugs. In order for the treatment to be safe and effective, you must follow the rules for the preparation and use of traditional medicine. The rules for the treatment of hydronephrosis with folk remedies are as follows: Throughout the period of taking folk remedies, you should adhere to a special therapeutic diet. Also, during treatment, alcohol consumption should be limited to a minimum. Before taking any remedy, be sure to do an allergy test. To do this, the first 2-3 times to use the drug in the minimum dose ( less than the one indicated in the recipe by 5 - 7 times). The components from which the drug is prepared must be purchased at specialized places ( pharmacies, shops). It is not recommended to purchase medicinal products in places of unauthorized trade. All components for the preparation of folk remedies are used in crushed form. For grinding, use a meat grinder, blender or food processor. It is necessary to store herbal preparations in glass containers or bags made of natural fabric. During storage, the contact of raw materials with air should be limited. The shelf life of the prepared product does not exceed 12 hours. Therefore, every day it is necessary to prepare a new portion of the drug. With hydronephrosis, all folk remedies are used in the form of a decoction. To do this, pour the required amount of raw materials with warm water ( indicated in the recipe) by the required volume of warm water ( also listed in the recipe.). Then the composition must be put in a water bath and held for 20 - 30 minutes. After this, the broth must be insisted for 1 - 2 hours, filtered and taken orally. The duration of treatment with folk remedies for hydronephrosis is 2-3 months. After each month, you need to pause for 2 weeks, and then return to treatment. Folk recipes for the treatment of hydronephrosis Hydronephrosis uses a variety of herbs, vegetables, and other natural foods. Traditional medicine preparations can improve the functionality of the kidneys, reduce pain, reduce intoxication of the body. Products that are used for hydronephrosis are: pumpkin ( stalks, juice); beans ( sashes); parsley ( root, seed); herbal collections. pumpkin recipe For hydronephrosis, a pumpkin stalk is used ( the part that attaches the vegetable to the stem). To prepare a one-time ( daily) portions of a decoction of the stalk, you must use 2 tablespoons of raw materials and 2 cups of water. Ready broth should be consumed during the day. Also, in the treatment of hydronephrosis, fresh pumpkin juice. You need to prepare the drink yourself, as the finished juice in the bags does not have sufficient medicinal properties. The recommended rate is from 200 to 300 milliliters per day. Recipe from bean sashes To prepare a decoction, dry bean leaves are used. The daily norm of this remedy is 750 - 1000 milliliters, which you need to drink in 6 - 7 doses. To prepare one serving of decoction, you need to use 4 tablespoons of bean shells per liter of water. parsley recipe A daily portion of the decoction is prepared from 50 grams of fresh parsley root and water, one glass in volume. You need to drink the remedy 4 times a day for a tablespoon. Optimal time use of decoction - half an hour before a meal. With hydronephrosis, parsley seeds are also useful, from which a medicinal drink is prepared. The daily volume of the drink is prepared from a tablespoon of seeds and 250 milliliters of water. A remedy is taken at 50 milliliters 3 to 4 times a day. Herbal Recipes With hydronephrosis, various herbal preparations are used, which include several medicinal plants. To prepare the collection, you need to mix the ingredients in the proportions indicated in the recipe, then pour it into a convenient container for storage. Subsequently, a drink is prepared from the collection, for the daily portion of which a tablespoon of raw materials and a glass of water are used. A decoction is prepared in the traditional way - first it is aged in a water bath, after which it is filtered and taken orally. The daily portion of the decoction should be divided into 3 - 4 parts and drink them before meals. Herbal recipes for hydronephrosis Consequences of hydronephrosis The consequences of hydronephrosis are manifested by various pathologies, as a result of which the functionality of the kidneys and the general condition of the body worsen. Complications develop in case of untimely detection or inadequate treatment of the disease. The most common consequences of hydronephrosis are: accession of a bacterial infection; increased blood pressure; the appearance of solid formations in the kidneys; kidney failure. Associated bacterial infection The development of a bacterial infection is a common consequence of hydronephrosis. With this disease, the normal functionality of the urinary system is disrupted, which leads to improper outflow and stagnation of urine. All this creates conditions conducive to the reproduction of bacteria and the development of the bacterial process. The most common form of bacterial infection associated with hydronephrosis is secondary pyelonephritis ( inflammation of the kidneys). The mechanism of development of pyelonephritis In most cases, pyelonephritis provokes Escherichia coli. It can also be Pseudomonas aeruginosa, Proteus, Klebsiella. These microorganisms live in the intestines as part of the normal microflora. But when they get to other organs, it develops inflammatory process. By ascending pathways, the infection penetrates into the kidney cavity and pyelonephritis begins. Quite often, the disease takes a relapsing ( systematically repeated) or chronic form. In female patients due to anatomical features complication in the form of pyelonephritis is more common. In women, the urethra channel for urination) is larger in width, smaller in length and located closer to the anus. These features of the female body increase the likelihood of infection pathogens entering the kidneys. Symptoms of secondary pyelonephritis Secondary pyelonephritis begins with an increase in temperature, which can reach 39 - 40 degrees. The patient is concerned about the general signs of infection, which are expressed by headache, chills, aching muscles and joints. Nausea, vomiting may also be present periodically), heavy sweating. Heart rate ( pulse) increases, breathing becomes rapid, the tongue is dry. The patient behaves apathetically, lethargically. A few days later, in the process of development of the infectious process, local symptoms also join the general signs. Local manifestations of pyelonephritis are: lower back pain ( on the side where the infection develops); increased pain at night, when coughing, taking a deep breath; abdominal muscle tension determined by palpation); problems with urination. Pain that bothers the patient in the lumbar region, as a rule, is given to the upper abdomen, groin area, thigh. The feeling of pain is more pronounced when a person lies on his back or on the side that is opposite to the zone of localization of the infectious process. As mentioned above, pyelonephritis with hydronephrosis often becomes chronic. Like acute form, the chronic stage of a bacterial kidney infection is accompanied by local and general symptoms. In comparison with primary pyelonephritis, which develops as an independent disease, the manifestations of infection in hydronephrosis are more pronounced. The patient may be disturbed by a dull aching pain in the lumbar region, which most often appears during a period when it is damp and cold outside. Pain may spread to other organs and parts of the body ( rarely occurs in primary pyelonephritis). General symptoms of chronic inflammation of the kidneys, which develops against the background of hydronephrosis, are divided into early and late. To general symptoms pyelonephritis, which manifest themselves at the beginning of the disease, include: fast fatiguability ; general weakness that occurs periodically; subfebrile temperature ( 37 to 37.5 degrees); increase in blood pressure ( in about half of the patients). Often in the middle of the day, patients with chronic pyelonephritis have a desire to take a horizontal position due to fatigue. This is due to the fact that with a long stay on the legs in the kidneys, the outflow of venous blood is difficult. Dryness of mucous tissues is a late symptom of secondary pyelonephritis in the chronic stage. oral cavity. At first, dryness appears from time to time, and subsequently becomes permanent. The patient begins to worry about heartburn, belching. The appearance of a person changes - the skin becomes pale, the face acquires puffy outlines. People with chronic inflammation kidneys are characterized by passive emotional behavior, which is manifested in the lack of interest and initiative, inaction, apathy. Increase in blood pressure With hydronephrosis, the affected kidney begins to synthesize the hormone renin in an increased volume, which provokes an increase in blood pressure. As a result, nephrogenic hypertension develops, which is difficult to treat with medications. The mechanism of development of nephrogenic hypertension With hydronephrosis in the affected kidney, blood circulation is reduced, due to which the release of fluid decreases. As a result, severe swelling develops and the blood vessels narrow. In addition, the walls of the vessels become more sensitive to the action of certain substances, as a result of which the vessels begin to contract. Violation of blood circulation and vasoconstriction provokes increased synthesis of renin, as a result of which nephrogenic hypertension develops. Symptoms of nephrogenic hypertension A distinctive characteristic of nephrogenic hypertension is an increase, mainly in the lower ( diastolic) pressure. This condition is poorly corrected by drugs that are designed to lower pressure. Also, patients are worried about a severe headache in the back of the head or in the forehead area. Pain may be accompanied by dizziness. Against the background of narrowing of the blood vessels, the nutrition of the retina is disrupted, which leads to vision problems that progress rapidly. Other symptoms of nephrogenic hypertension are: strong feeling of thirst; increased urination; nausea, vomiting; a sharp increase in temperature; puffiness. Sometimes nephrogenic hypertension is accompanied by disorders of the nervous system, due to which patients become excessively tearful, irritable. With absence timely treatment due to narrowing of blood vessels, a violation may develop brain activity, heart failure . The appearance of solid formations in the kidneys The appearance of solid formations in the kidneys ( urolithiasis disease) can be both a cause and a complication of hydronephrosis. If urolithiasis develops as a consequence of hydronephrosis, it is characterized by the formation of struvite stones, which are also called infectious. The mechanism of the appearance of solid deposits in the kidneys Urine obstruction and bacterial infections, which are characteristic of hydronephrosis, form a favorable environment for the formation of struvite stones. Bacteria such as Proteus, Pseudomonas aeruginosa and Klebsiella break down urine urea, which leads to the formation of sediments from which the stone is formed. Such formations consist of deposits of magnesium, ammonium, calcium carbonate. Infectious kidney stones rapidly increase in volume and are also called staghorn stones due to their specific shape. Symptoms of the presence of kidney stones Such symptoms characteristic of urolithiasis as sharp stabbing pains in the back or lower abdomen with struvite stones are not as pronounced or absent at all. Patients may complain of a general deterioration in their condition, dry mouth, and an increase in temperature. If untreated, such stones can provoke a general purulent infection ( sepsis), kidney failure, shrinkage and loss of the kidney. kidney failure Renal failure is one of the most serious complications hydronephrosis and sometimes leads to irreversible consequences. The mechanism of development of renal failure With hydronephrosis, pressure in the kidney increases, causing the parenchyma ( tissue that covers the kidney) decreases in volume and gradually atrophies. The blood supply to the organ is also disrupted. As a result, the excretory function of the kidneys decreases, and harmful substances begin to accumulate in the blood ( nitrogenous slags), which are normally excreted in the urine. Symptoms of kidney failure The symptomatology of renal failure depends on what form of hydronephrosis this complication developed against. The acute stage of hydronephrosis leads to acute renal failure. With this complication, the kidneys lose their function over a very short period of time ( several weeks to several days). Therefore, when identifying symptoms of a developing complication, it is necessary to immediately resort to medical help. Symptoms of acute renal failure are: sudden decrease in urine volume initially up to 400 milliliters per day, then - no more than 50 milliliters per day); increase in body volume due to fluid); widespread itching of the skin; drowsiness, lethargy; nausea, vomiting, loose stools; swelling of the face, ankles; loss of appetite; In the absence of timely intervention by a doctor, shortness of breath develops, because a large amount of fluid accumulates in the lungs. Hemorrhages and bruises appear on the body. Involuntary muscle contractions may occur ( spasms), hallucinations, loss of consciousness. In chronic hydronephrosis, the decline in kidney function occurs gradually and in most cases is imperceptible ( in the early stages) for the patient. Progressing, chronic renal failure provokes general weakness, decreased performance, and frequent headaches. Patients begin to lose weight skin acquire a yellow tint. Other symptoms of chronic renal failure are: dry mucous membranes in the mouth, ammonia smell; bleeding gums, bruising on the body; menstrual disorders ( among women); persistent increase in blood pressure; increased susceptibility to disease due to reduced immunity). Before use, you should consult with a specialist.

Hydronephrosis of the right kidney

The disease is characterized by an expansion that is constantly increasing. This system consists of several "cups" in which urine accumulates before it enters the urinary tract. Simply put, when too much urine accumulates, the cups involuntarily expand. This is hydronephrosis of the right kidney.

The disease can be caused by various factors. Doctors distinguish between congenital hydronephrosis, which occurs due to an abnormality of the urinary tract or renal tissue in the infant, and secondary - it develops as a result of urolithiasis or urinary tract injury.

Consequences of hydronephrosis

Hydronephrosis of the right kidney must be treated. If this is not done, kidney failure may develop, which can lead to intoxication and end in the death of the patient. Another possible consequence- urolithiasis, which can be aggravated by infection. The most common complication in this case is rupture of the calyx.

If you wondered "how to treat the kidneys", you should know what signs you should pay attention to. Experts call three main symptoms: pain, hematuria and an increase in the size of the kidney.

Pain sensations can be very diverse. At the initial stage of the disease, a person usually complains about the evening, as a rule, there is a dull pain in the lumbar region, which disappears by night. Attacks can be caused by physical exertion or general overwork. Hematuria, or, more simply, the presence of blood in the urine, is observed with increased pressure in the cups, as well as in the presence of another characteristic sign - an increase in the kidney. In people with it, it can even be palpated through the front wall of the abdomen.

Kidney pain: treatment

In order to get rid of hydronephrosis, it is necessary to eliminate its cause. For example, if it is called, you need to direct all forces to remove them. In most cases, the only adequate method is surgery. If the pyelocaliceal complex is narrowed, it is expanded during the operation: the tissues are cut longitudinally and sutured by the surgeon in the transverse direction. With uncomplicated hydronephrosis, surgery is not necessary, but the patient should visit a doctor regularly and follow a special diet: include a large amount of vegetables and fruits in the diet, drink plenty of fluids and, if possible, refuse table salt.