Hydronephrosis of the right kidney in women. Causes of development of kidney hydronephrosis and diagnosis of pathology

Among kidney diseases in urology, right-sided lesions are most common. This is due to the topographical features of the location of the organs of the urinary system. For example, hydronephrosis of the right kidney is one of the most common problems in urology. There are also left-sided kidney lesions and bilateral kidney damage, when the disease has spread to both organs. Of course, unilateral hydronephrosis has a more favorable course and is easier to treat than bilateral hydronephrosis.

Why does kidney hydronephrosis develop?

Hydronephrosis of the kidneys can be primary or secondary. Primary is associated with congenital disorders in intrauterine development and is detected in the fetus or newborn. And secondary hydronephrosis occurs due to various acquired diseases. The causes of secondary hydronephrosis can be:

• Stones in the kidneys
• Tumors genitourinary system or abdominal organs
• Chronic inflammatory diseases urinary organs
• Injuries spinal cord leading to disruption of the innervation of the pelvic organs
• Postoperative adhesions and scars due to trauma to the ureters during surgery.

The most common is obstructive hydronephrosis caused by kidney stones.

All of the above reasons cause organic hydronephrosis. Along with it, functional hydronephrotic kidney damage is distinguished, caused by a temporary condition of the body. This includes hydronephrosis in pregnant women.

What is the danger of the disease?

Hydronephrosis on the right is accompanied by an increase in pressure in the cavities of the kidney, which leads to thinning of the cortex and medulla, which makes up the parenchyma of the organ. And the parenchyma consists of the functional units of the kidney that provide blood filtration. Therefore, when the parenchyma becomes thinner, renal failure develops.

In grades 1 and 2 of the disease, the renal parenchyma suffers slightly. Of course, the filtration function of the affected kidney is reduced, but not as much as with terminal hydronephrosis. Besides healthy kidney takes on the missing function and compensates for the insufficient functioning of the affected organ.

Hydronephrosis grade 3 is characterized as an advanced stage of the disease, which leads to renal failure.

Despite the fact that the second kidney is not affected by hydronephrosis, its function also decreases. Chronic renal failure is an indication for lifelong treatment. The only method to eliminate it is a kidney transplant. Therefore, you should not hesitate to treat hydronephrosis, because the sooner it is done, the more favorable the outcome will be.

For a better understanding of the problem, below is a photo that illustrates what hydronephrosis is and what the kidney looks like when different stages diseases.

Principles of combating this pathology

Treatment for hydronephrosis includes:

• Eliminating the cause of the disease
• Combating symptoms of pathology
• Restoring and maintaining kidney function.

The symptoms of hydronephrosis manifest differently in everyone, so symptomatic therapy will also be different for each patient. In general, the following principles can be noted symptomatic treatment hydronephrosis:

• For severe pain, painkillers and antispasmodics are used
• To correct increased blood pressure Antihypertensive drugs are prescribed in individual dosages
• When a secondary infection occurs, antibacterial therapy is used
• If the patient has pyelonephritis, which is accompanied by high temperature body, then a one-time dose of antipyretic drugs is prescribed.

To eliminate the factor that caused the disease, it is usually indicated surgery. And the restoration and preservation of kidney function is carried out by following a special diet, which is selected by the attending physician. Typically the diet includes limiting salt and protein. It is also important to drink enough fluids and eliminate alcohol and carbonated drinks from your diet.

The use of traditional medicine in the treatment of hydronephrosis

Treatment with folk remedies is carried out in combination with traditional medicine methods. Various infusions of herbs and herbs are used that help restore kidney function. At long-term use patients actually notice an improvement in their condition. However, no remedy, even a folk one, should be taken without consulting a doctor.

This video explains what kidney failure is:

Self-treatment cannot be carried out for the reason that there are a number of herbs that are contraindicated in concomitant diseases. In particular, bearberry is contraindicated for patients with glomerulonephritis, so taking it will only worsen the condition. Also, many people have an individual increase in sensitivity to certain herbs, and taking them will cause an allergic reaction.

It should be remembered that no remedy traditional medicine will not be able to cope with the cause of hydronephrosis. Therefore you cannot refuse traditional methods therapy, because they are the key to complete recovery.

Kidneys are one of the most important organs, but their importance is often underestimated. While the appearance alarming symptoms and then the death of the kidneys leads to lifelong disability and the need for constant hemodialysis. Therefore, it is important for everyone to know what kidney diseases exist and how to avoid them. For example, hydronephrosis is a pathology that occurs very often under the influence of a range of causes. The outcome of the disease will depend entirely on the adequacy and timeliness of the treatment.

Hydronephrosis - what is it?

Kidney - an organ that filters blood and removes it from the body excess liquid together with urea, uric acid, creatinine and other substances. Necessary, useful material, for example, protein, are filtered back into the blood using special membranes.

For this purpose, there is a urinary system, which consists of two kidneys, two ureters going from them to the bladder, the Bladder And urethra.

The liquid that will become urine at the end of the urinary system must pass unhindered all the way from the kidneys to the urethra. If there are physical obstacles along this path, the kidney will fill with fluid and expand, that is, hydronephrosis of the kidney will develop.

Hydronephrosis has three stages:

• Stage 1 – dilated renal pelvis, all functional tests stable and within normal limits;
• Stage 2 – the kidneys are enlarged, their walls are thinned, the Rehberg test readings drop by 30%;
• Stage 3 - the kidneys are almost doubled in size, the kidney is hollow with empty chambers inside, the end stage of renal failure begins.

Kidney with hydronephrosis

What can cause the pathology?

The main cause of hydronephrosis is a decrease in passage along any segment of the urinary tract. But the word “cause” itself can mean many different phenomena, both related to urology and not related.

1. Urolithiasis is a disease that results in the formation of stones in the kidneys and urinary tract that can interfere with the smooth flow of urine.
2. Neoplasms in the ureters, bladder or even prostate, which, like stones, can interfere with the outflow of urine.
3. Sometimes the tumor may not be related to the urinary system, sometimes the tumor may be in another, neighboring system, but also compress the organs of the urinary system.
4. Prostate adenoma, which compresses the urethra.
5. Congenital anomalies of the structure of the ureters - when their diameter is less than normal.
6. Narrowing of the ureter due to changes in tissue structure, for example, after a kidney stone passes through the ureter. Also, the cause may be tuberculosis or abdominal trauma, which will also involve the ureters.
7. Narrowing of the ureteropelvic segment - a fragment of the urinary system, which is located where the renal pelvis ends and the ureter begins. The cause of the narrowing may be tissue trauma.
8. Sometimes lymphomas and lymphadenopathy are the cause.

Most common cause Kidney hydronephrosis is urolithiasis, so it is very important to treat this pathology in a timely manner, without waiting for complications.

Symptoms of hydronephrosis

The main symptom of the disease is pain in the back and abdomen, which is aching character. When palpating the abdominal cavity, you can notice compactions at the location of the kidneys.

Hydronephrosis is characterized by blood in the urine. And if we're talking about about microhematuria, then a person can only learn about it from the conclusions laboratory analysis urine. But gross hematuria is obvious to the naked eye - the urine takes on a pink, sometimes brown tint.

In the acute form of the disease, all the symptoms of inflammation are present:

• heat;
• symptoms of intoxication (nausea, headache);
• general weakness, drowsiness.

Important! It is necessary to consider hydronephrosis together with the likelihood of developing renal failure, which is quite real if we are talking about hydronephrosis of both kidneys. Then the following symptoms will be added to the above symptoms:

• swelling;
• increased blood pressure;
• decreased diuresis;
• nausea and vomiting.

In this case, immediate hospitalization is required, since kidney failure can lead to death or lifelong disability.

Obstructed outflow due to hydronephrosis

Diagnostics

At the initial consultation, the doctor will find out from the patient what symptoms he is experiencing, how long the ailments have been noted, whether there have been any injuries, surgical interventions, or somatic pathologies.

To make a diagnosis, the doctor prescribes a standard list of laboratory tests:

• clinical blood test;
• biochemical blood test for the amount of protein, creatinine, uric acid;
• general urine analysis;
• Rehberg's test.

All of these tests are needed to evaluate your kidney function so that your doctor can understand whether you are at risk of developing acute kidney failure.

Diagnosis of kidney hydronephrosis is made using functional diagnostics:

• Ultrasound of the kidneys;
• Ultrasound of the bladder with a bladder filled with urine and after emptying to detect residual urine;
• urography urinary tract by introducing contrast agent;
• computed and magnetic resonance imaging;
• nephroscintigraphy – assessment method functional work urinary system using a contrast agent and a gamma camera.

It is important for the doctor not only to determine the presence of hydronephrosis, but also to identify the reasons that led to the pathology.

Ultrasound of the right kidney

Conservative treatment

Conservative treatment for this disease is used extremely rarely, because the cause of hydronephrosis is a mechanical obstruction in the urinary tract, so it is impossible to cure the disease otherwise than by removing them and ensuring proper urine outflow.

However, if the process is accompanied by inflammation, it is necessary to symptomatic therapy, namely:

• taking anti-inflammatory drugs;
• taking antibiotics;
• taking medications for hypertension.

In addition, a special diet is prescribed with limited consumption of table salt, rest, and a gentle regime.

Surgery

During surgery, an obstruction in the urinary system, such as a tumor, can be removed.

When the ureter is narrowed, surgical treatment of hydronephrosis can be carried out in three ways:

1. By installing a stent - a tube that will be placed in the ureter, connecting the kidney and bladder, ensuring the unimpeded outflow of urine. The size of the stent is selected by the surgeon based on the anatomical characteristics of the patient. Typically, all stents have a diameter of 1.5 cm and a length of up to 30 centimeters. The ends of the tubes have a curved shape - this is necessary so that the tube is securely fixed in the patient’s body.

The procedure is most often carried out under general anesthesia. A cystoscope is inserted into the bladder to visualize the opening of the ureter in the bladder. A stent is inserted there under the control of a radiographer.

1. Using a nephrostomy - inserting a thin tube into the kidney through a puncture in the lower back. It is necessary for removing urine from the kidney in order to protect the organ tissue from damage when it is full of urine. Nephrostomy is a temporary and emergency method that is used during surgery or when a patient is admitted to the department during emergency hospitalization, so that urine is removed from the body until the patient undergoes surgery.
2. Using ureteroplasty - the latter option is increasingly used for hydronephrosis due to narrowing of the junction of the pelvis and the ureter. The operation is absolutely non-traumatic: the surgeon makes punctures in the patient’s abdomen, removes the narrowed section of the ureter and stitches the edges of the urinary tract. On average, such an operation lasts no more than one hour.

If the operation is performed correctly, the effect can be lifelong.

Thus, there are two options for surgical treatment for hydronephrosis: ureteroplasty and stent installation. The advantage of the stent is its ease of installation and low price, and the disadvantage is the need to replace the tube every 3-4 months.

Ureteroplasty provides a long-lasting and reliable effect, but such an operation requires more serious surgical intervention, the search for a reliable doctor and, possibly, financial expenses.

Surgery for hydronephrosis of the kidney

Why is hydronephrosis dangerous?

Hydronephrosis of even one kidney is very dangerous. For example, a disruption in the flow of urine causes a bacterial infection, which first flows into acute pyelonephritis, and then may result in the formation of a bag of pus, which must be removed surgically. The second danger of the disease is organ atrophy, that is, complete death of the kidney. In this case, the entire functional load falls on the second kidney, and even if it is absolutely healthy, this seriously affects both the person’s health and his ability to work.

Hydronephrosis of both kidneys is doubly dangerous: if both kidneys atrophy due to hydronephrosis, renal failure will develop. In this case, the person will face either death or a constant need for hemodialysis: a procedure in which a person’s blood is cleansed by a special device instead of the kidneys. One procedure lasts 3-4 hours and should be performed 3-4 times a week for the rest of your life or until you undergo a kidney transplant.

Another complication of hydronephrosis is a decrease in hemoglobin if, against the background of the disease, blood is excreted in the urine, that is, microhematuria or macrohematuria occurs.

Prognosis for kidney hydronephrosis

In the absence of proper treatment, the outcome of the disease is extremely unfavorable: in a short time, renal function will decline to the terminal stage. And, if the process affects both kidneys, the person will need lifelong hemodialysis or an organ transplant.

When treating an adult, the prognosis is moderately favorable - according to statistics, full recovery occurs in half of the urologist’s patients with this diagnosis. The most favorable prognosis with proper treatment is for children under three years of age: in their case, going to a good surgeon guarantees success in 8 cases out of 10.

These data allow us to talk about hydronephrosis as a serious somatic pathology that can cause disability or even death of a person who does not receive treatment in a timely manner.

Hydronephrosis - treatment with folk remedies

Traditional medicine offers methods of therapy for any disease, including renal hydronephrosis. Of course, problems can only be radically solved through surgery, but as a means for rapid rehabilitation or disease prevention, traditional medicine recipes can be very effective.

1. Buy dry herbs at the pharmacy:

• burdock;
• celery;
• chamomile;
• bearberry;
• rose hip

Mix all the ingredients in a jar or bag, brew two teaspoons with boiling water, cool to a comfortable temperature, strain and drink instead of tea three times a day an hour before meals.

1. Find the following ingredients:

• 1 part Adonis
• 3 parts of dry birch leaves;
• 1 part nettle;
• 1 part dry oatmeal;
• 1 part bearberry;
• 1 part horsetail.

Mix the ingredients, pour boiling water and leave in a thermos for 12-14 hours. Strain and take one glass per day. You can pour half a glass of the product, and then dilute it with boiling water, like tea.

1. Cornflower tea is the easiest option traditional treatment with hydronephrosis. For it you need to take:

• 10 grams of dried cornflower flowers (can be purchased at a pharmacy or prepared independently in the summer);
• 100 ml boiling water.

Brew tea in a thermos, divide into three doses and drink before breakfast, lunch and dinner, diluting with boiling water.

It is important to know! You cannot make a decision on using traditional medicine methods on your own! All recipes can be used only after consultation with your doctor.

All herbs produce a narcotic effect to one degree or another, so excessive use of traditional medicine methods can be very harmful. But when strictly followed, alternative medicine methods are usually effective.

Prevention

Prevention of hydronephrosis includes all the basic rules healthy image life. It is very important not to overcool, eat right, and give up bad habits. Both men and women need to visit doctors - a urologist and gynecologist, at least twice a year, especially if the disease has already been diagnosed in a chronic or latent form.

The functioning of the urinary system depends on the correct elimination of fluid. If its outflow is disrupted, 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 associated pathologies that explain what hydronephrosis is:

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

Why is hydronephrosis dangerous?

The progressive disease causes the slow death of the structural units of the kidney. At first, the disease hydronephrosis is accompanied by a slight dysfunction of the organ and does not significantly affect the general condition urinary system. Later observed partial failure, which can occur with rare relapses. With absence effective treatment hydronephrosis of the right kidney will develop into severe stage with absolute disruption or shutdown of organ functions. This is fraught with complete deficiency and poisoning with waste products.

Hydronephrosis of the kidneys - causes

Urologists name acquired and congenital factors that predispose to the development of the disease described. Hydronephrosis – causes of the first group:

• a rapidly 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;
• presence of stones, sand;
• ovarian cyst;
• inflammatory diseases of the genitourinary system;
• tuberculosis;
• metastases and others.

Sometimes the outflow of urine is disrupted due to 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 abnormal structure of the main systemic artery or its large branches. The abnormally formed blood vessel has the shape of a ring that compresses the ureter. Such a “collar” prevents normal flow and removal of excess fluid, leading to expansion of the calyces and pelvis of the left or right kidney.

Hydronephrosis during pregnancy

The problem in question is considered a typical phenomenon during pregnancy, 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 the uterus stretches, 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 disease are distinguished:

1. Hydronephrosis 1st degree (compensated) characterized by complete preservation of the functions of the right kidney. A small volume of urine accumulates in the pelvis, so the walls and cups of the organ practically do not stretch.
2. Hydronephrosis 2nd degree (partially compensated) is accompanied by transformation of the tissues of the damaged kidney and a decrease in its functions by 40-45%. In order for the excretory system to function normally, the work of a healthy paired organ is enhanced.
3. Hydronephrosis grade 3 (terminal) represents failure of the right kidney. Due to excessive load, the healthy organ cannot cope with the elimination of excess urine, and severe failure progresses. Without treatment, death 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 location of urinary tract obstruction. In the 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;
• decreased ability to work;
• nausea;
• renal colic;
• fever;
• vomit;
• chills;
• rare and less abundant urination;
• back and lower back pain;
• swelling;
• anemia.

Hydronephrosis - diagnosis

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

• blood (biochemistry, electrolytes);
• urine (general, expanded, bacterial culture);
• tests according to Nechiporenko, Reberg, Zimnitsky, Addis-Kakovsky.

Help to definitively establish the diagnosis of “hydronephrosis of the right kidney” instrumental studies:

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

Treatment of kidney hydronephrosis

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

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

Hydronephrosis - treatment without surgery

Conservative therapy is practiced exclusively for early stages illness when the activity of the urinary system is still being 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.

The use of pharmacological agents is not effective way treatment of the right kidney. 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 – surgery

Choice of radical therapeutic approach carried out only after a thorough diagnosis. First, it is important to find out why hydronephrosis occurred - treatment is developed depending on the provoking factor. If there are stones or sand in the right kidney, their remote crushing (lithotripsy) is recommended. The manipulation is performed using ultrasonic and radio wave influences.

If hydronephrosis of the right (left) kidney is caused by a tumor, a decision is made to resect the tumor. Additionally, radiation and chemical therapy can be performed. 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.

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

is a progressive expansion of the pyelocaliceal complex followed by atrophy renal parenchyma, developing due to a violation of the outflow of urine from the kidney. Manifested by lower back pain (aching or renal colic type), hematuria, painful frequent urination, arterial hypertension. Diagnosis may require ultrasound of the bladder and kidneys, bladder catheterization, intravenous urography, cystourethrography, CT or MRI of the kidneys, pyelography, renal scintigraphy, nephroscopy. Treatment of hydronephrosis involves eliminating the cause of impaired urinary passage; method emergency care is nephrostomia.

General information

Hydronephrosis or hydronephrotic transformation of the kidney is a consequence of a violation of the physiological passage of urine, which leads to pathological expansion of the renal cavities, changes in the interstitial renal tissue and atrophy of the parenchyma. At the age of 20 to 60 years, the incidence of hydronephrosis is higher in women, due to reasons related to pregnancy and gynecological cancer. After 60 years, hydronephrosis more often develops in men, mainly against the background of prostate adenoma or prostate cancer.

Causes of hydronephrosis

The causes of the disease are variable, but can be divided into two groups: caused by obstruction or obstruction in any part of the urinary system (ureters, bladder, urethra) or reverse flow of urine caused by incompetent bladder valves. According to the location and nature, the causes of hydronephrosis can be internal, external and functional.

1. At the level of the urethra. Among internal lesions In the urethra, the development of hydronephrosis is facilitated by diverticula, urethral strictures, and urethral atresia. External obstacles, as a rule, are prostate hyperplasia and cancer.
2. At the level of the bladder. On the part of the bladder, internal factors for the development of hydronephrosis can be urolithiasis, cystocele, carcinoma, bladder diverticulum, bladder neck contracture. An external obstruction to the flow of urine from the bladder can occur with pelvic lipomatosis.
3. At the level of the ureters. Internal reasons In the development of hydronephrosis, tumors, fibroepithelial polyps, blood clots, stones, fungal infections urethra (aspergilemma, mycetoma), ureterocele, tuberculosis, endometriosis, etc. An external obstacle to the passage of urine in the ureteral segment can be created by retroperitoneal lymphoma or sarcoma, pregnancy, cervical cancer, uterine prolapse, ovarian cysts, tubo-ovarian abscess, prostate tumors, aneurysm of the abdominal aorta, lymphocele, abnormally located renal artery compressing the ureter.

With hydronephrosis, damage to the urinary tract various levels can also be caused by congenital dyskinesia and obstruction of the urinary tract, their injuries, inflammation (urethritis, cystitis), and spinal cord injuries. When an obstacle to the outflow of urine is localized below the ureteropelvic segment, not only the pelvis, but also the ureter expands, which leads to hydroureteronephrosis. Functional disorders include the presence of a neurogenic bladder and vesicoureteral reflux.

Pathogenesis

Impaired urine flow leads to increased pressure inside the ureter and pelvis, which is accompanied by noticeable impairments in glomerular filtration, renal tubular function, pyelolymphatic flow, pyeloarterial and pyelovenous blood flow. The outcome of hydronephrosis is atrophy of the renal tubules and death of the structural units of the kidney - nephrons.

Classification

Depending on the time of development, hydronephrosis can be primary (congenital) or acquired (dynamic). According to the severity of the course, mild, moderate and severe hydronephrosis is distinguished; by localization - one-sided and two-sided. In practical urology, hydronephrosis of the right and left kidney occurs with equal frequency; bilateral hydronephrotic transformation is observed in 5-9% of cases.

The course of hydronephrosis can be acute or chronic. In the first case, with timely correction it is possible full recovery renal functions; in the second, kidney function is lost irreversibly. Depending on the presence of infection, hydronephrosis can develop aseptic or infected type.

Symptoms of hydronephrosis

Manifestations of pathology depend on the location, rate of development and duration of obstruction of a segment of the urinary tract. The severity of symptoms is determined by the degree of expansion of the renal pyelocaliceal complexes. Acute hydronephrosis develops rapidly, with severe paroxysmal pain in the lower back, similar to renal colic, spreading along the ureter, into the thigh, groin, perineum, and genital area. There may be an increased urge to urinate, painful urination, nausea and vomiting. With hydronephrosis, blood appears in the urine, visible to the eye(macrohematuria) or laboratory determined (microhematuria).

Unilateral aseptic chronic hydronephrosis long time proceeds latently. In most cases, there is discomfort in the lumbar-costal angle, periodic dull pain in the lower back, which intensifies after physical activity or taking large amounts of liquid. Over time, chronic fatigue and decreased ability to work progress, transient arterial hypertension occurs, and hematuria appears.

With an increase in body temperature, as a rule, one should think about infected hydronephrosis and acute purulent obstructive pyelonephritis. In this case, pus appears in the urine (pyuria). A pathognomonic sign for hydronephrosis is the patient's preference to sleep on his stomach, since this position leads to changes in intra-abdominal pressure and improved urine outflow from the affected kidney.

Complications

Chronic hydronephrosis often contributes to the occurrence of urolithiasis and pyelonephritis, hypertension, which further aggravate the clinical picture of hydronephrotic transformation of the kidney. Sepsis sometimes develops against the background of infected hydronephrosis. The course of hydronephrosis may be complicated by the development of renal failure. In this case, especially with bilateral hydronephrosis, the patient’s death occurs from intoxication with nitrogen metabolism products and disturbances in water-electrolyte balance. A life-threatening complication of hydronephrosis can be spontaneous rupture of the hydronephrotic sac, resulting in urine leakage into the retroperitoneal space.

Diagnostics

For hydronephrosis diagnostic algorithm consists of collecting anamnestic data, conducting a physical examination, laboratory and instrumental studies. In the process of studying the anamnesis, the nephrologist finds out the presence of reasons that may contribute to the development of hydronephrosis. Physical data are uninformative and nonspecific.

With deep palpation of the abdomen, a distended bladder can be detected; in children and thin adult patients, an enlarged kidney can be detected. Percussion of the abdomen in the area of ​​the altered kidney, even with slight hydronephrosis, reveals tympanitis. For renal colic, tension and bloating, bladder catheterization is often used. The release of a large volume of urine through the catheter may indicate obstruction at the level of the urethra or bladder outlet. The defining methods for diagnosing hydronephrosis are x-ray and ultrasound examinations.

• Echography. Ultrasound of the kidneys is performed polypositionally, examining longitudinal, transverse, oblique projections with the patient positioned on the stomach and side. During echography, the size of the kidneys, the condition of the pyelocaliceal complexes, the presence of additional shadows, and the condition of the ureters are assessed. If necessary, an additional ultrasound of the bladder is performed to determine the amount of urine and ultrasound of the kidney vessels. Endoluminal echography allows identifying changes in the area of ​​the ureteropelvic segment and periureteric tissue.
• Radiodiagnostics. The priority for identifying hydronephrosis is X-ray contrast studies, primarily excretory urography and retrograde ureteropyelography, which allow one to judge the excretory function of the kidney. In some cases, to determine the causes of kidney obstruction during hydronephrosis, chromocystoscopy, renal angiography, percutaneous antegrade pyelography, MRI and CT scan of the kidneys are used. Radioisotope dynamic nephroscintigraphy and renoangiography are used to assess organ blood flow.

Can be used to visualize obstructions to the outflow of urine in hydronephrosis. endoscopic methods– ureteroscopy, cystoscopy, ureteroscopy, nephroscopy. Signs of impaired renal function in hydronephrosis can be detected by blood and urine tests. Biochemical blood parameters are characterized by increased levels of creatinine, urea, and changes in electrolyte balance (sodium, potassium). IN general analysis urine is determined by leukocyturia, pyuria, hematuria. If necessary, the Reberg, Zimnitsky, Nechiporenko, Addis-Kakovsky test and urine culture are examined.

Hydronephrosis should be distinguished from conditions with similar symptoms that are not complicated by hydronephrotic transformation of the kidney - kidney stone disease, nephroptosis, polycystic disease, kidney cancer.

Treatment of hydronephrosis

Conservative therapy is ineffective. It can be aimed at stopping pain syndrome, prevention and suppression of infection, lowering blood pressure, correction of renal failure in preoperative period. The emergency method for acute hydronephrosis is percutaneous (percutaneous) nephrostomy, which allows you to remove accumulated urine and reduce pressure in the kidney.

Kinds surgical treatment hydronephrosis can vary and is determined by the cause this state. All methods surgical treatment hydronephrosis are divided into reconstructive, organ-preserving and organ-removing. Indications for reconstructive plastic surgery serve to preserve the function of the parenchyma and the possibility of radical elimination of the cause of hydronephrosis. For urethral strictures or ureteral strictures, balloon dilatation, bougienage, endotomy, and ureteral stenting are performed.

In case of obstruction caused by hyperplasia or cancer prostate gland, prostate resection, urethral dilatation, prostatectomy may be performed or prescribed hormone therapy. In case of urolithiasis, lithotripsy or surgical removal stones from the obstruction zone. Open operations are performed for retroperitoneal tumors, aortic aneurysm, and the impossibility of endoscopic stenting or shock wave lithotripsy. Nephrectomy - removal of a damaged kidney - is resorted to when its function is lost and there is a risk of complications.

Prognosis and prevention

Rapid elimination of the causes of hydronephrosis allows the kidney to restore its functions due to its large reserve capacity. In case of prolonged obstruction, damage to another kidney, or infection, the prognosis of hydronephrosis is serious. The development of hydronephrosis can be prevented by undergoing periodic examinations by a urologist with ultrasound of the kidneys and preventing urinary tract diseases.

Hydronephrosis is one of those pathologies that doctors call the “silent killer.” The disease affects the kidneys, causing them to enlarge and then die. In most cases the patient does not experience severe pain, therefore, does not even attach importance to some symptoms characteristic of the disease. Meanwhile, the lack of timely and proper treatment may lead to the development severe consequences, and sometimes fatal.

What is hydronephrosis

Hydronephrosis is a progressive pathology in which the kidney gradually expands as a result of impaired urine outflow.

The disease, in the absence of adequate treatment, leads to the death of the organ.

Hydronephrosis is a pathology in which urine accumulates in the renal pelvis

With this pathology, pressure in the pelvis increases, blood supply and nutrition to the organ deteriorate. Functional impairments gradually begin to develop. The kidney loses its ability to produce urine and turns into a “bag” filled with urine. An infection can very easily penetrate such an organ, leading to purulent inflammation. Neither immunity nor antibiotics act on the affected kidney, so the only way saving a patient's life is surgical excision organ.

Hydronephrosis is also called hydrocalycosis, uronephrosis, or hydronephrotic transformation.

Classification of pathology

In urology, several classifications of hydronephrosis are used. Depending on the origin, the pathology can be:

• Primary (or congenital). Hydronephrosis is caused by abnormalities of the urinary system. This pathology most often begins during fetal development and is diagnosed in childhood.
• Secondary (acquired). The disease develops against the background of illnesses occurring in the body. Such hydronephrosis serves as a complication of pathologies (for example, urolithiasis).

Depending on the location, hydronephrosis can be:

• unilateral (right- or left-sided) - only one kidney is affected (right or left);
• bilateral - this is a rather rare type of hydronephrosis (diagnosed in approximately 5–8% of all cases), with this pathology there is a violation of the outflow of urine in both kidneys.

Depending on the nature of the process, hydronephrosis occurs:

• closed - the pathology is characterized by complete obstruction of the urinary tract;
• open - urine output is partially preserved;
• intermittent - the outflow of urine is maintained only in certain body positions.

According to the type of course, the pathology can be:

• acute - develops over several days, has vivid symptoms, with such hydronephrosis the kidneys can be restored;
• chronic - associated with gradual destruction of the organ, the disease develops over several months, the lost functionality of the kidneys most often is not restored.

Depending on the presence or absence of an infectious process, hydronephrosis occurs:

• infected - the pathology is complicated bacterial infection;
• aseptic - there is no infectious-inflammatory process in the urinary system.

Quite often calculous hydronephrosis is diagnosed. This is a pathology in which stones are detected in the kidneys.

Degrees of the disease

During hydronephrosis, doctors distinguish 3 stages:

1. The first degree is considered the easiest. The renal pelvis is slightly stretched. About 10 ml of urine accumulates in it. Despite the enlargement of the kidney, the organ still copes with its functions. Symptoms at this stage are mild or completely absent.
2. Hydronephrosis of the second degree is characterized by the accumulation of more fluid in the pelvis. The pressure on the tissue increases. The kidney begins to atrophy. Healthy tissues are replaced by fibrous ones. Kidney function decreases to 40%. It is still possible to save the organ at this stage.
3. Hydronephrosis of the third degree is accompanied by pronounced structural and functional disorders of the kidneys. Such changes are already irreversible. The kidney is enlarged 1.5–2 times, the tissues are almost completely atrophied. At this stage, organ death is inevitable.

Hydronephrosis in its development goes through 3 stages, each subsequent one is characterized by sharp decline organ functioning

Causes congenital hydronephrosis connected with anatomical features the child’s body and consist of the following anomalies:

• urinary tract dyskinesia (urinary disorder caused by atony or spasm of the ureter);
• pathological localization of the ureter;
• incorrect position of the renal arteries, which provide pressure on the ureter;
• obstruction of the urinary tract (difficulty in the outflow of urine), caused by a narrowing of the ureter.

An experienced specialist can notice pathological kidney disorders even during the period of intrauterine development during an ultrasound examination.

Hydronephrosis has several causes, either congenital or acquired.

The causes of acquired hydronephrosis are varied. Pathological disorders may affect the ureter, bladder and even the urethra. The following factors are known to lead to the development of hydronephrosis:

• Obstruction (obstruction or narrowing) in the area of ​​the ureters. This pathology can be caused by the following groups of reasons:
  
• Bladder obstruction. The following groups of reasons can impede the flow of urine:
  • Internal problems. Hydronephrosis can be caused by the following bladder pathologies:
    • neoplasms;
    • presence of stones;
    • bladder diverticula;
    • cystocele (prolapse of the bladder);
    • fibrosis of the organ neck.
  • External reasons. Difficulty in the outflow of urine can be caused by pelvic lipomatosis (a pathology in which many lipomas form in the fatty tissue).
• Obstruction of the urethra (urethra). The following reasons can cause a violation of the outflow of urine:
  

At-risk groups

The following categories of people are most susceptible to developing hydronephrosis:

• aged people;
• children;
• population living in the radioactive zone;
• workers in contact with heavy metals and pesticides;
• people leading a sedentary lifestyle.

According to statistics, hydronephrosis is more often diagnosed in women than in men. This is due to the structure of the genitourinary system and bearing a child.

Video: causes and manifestations of pathology

Symptoms of hydronephrosis

The clinical picture of hydronephrosis depends on the rate of development pathological process, location of obstruction and stage of progression.

Determine yourself renal pathologies, it seems to me, is almost impossible. One day my friend decided to sign up for a swimming pool. Naturally, she had to go to the doctor for a certificate. The therapist looked carefully at my friend, who had probably not been to the hospital for 5 years, and gave her a whole list of directions for laboratory and instrumental tests. The unfortunate woman was indignant, but still went to undergo a medical examination. The results showed that one of her kidneys was enlarged. The doctor referred her to a urologist with suspicion of hydronephrosis. Surprisingly, my friend never complained of discomfort in the lower back.

Signs of chronic pathology

With slow blockage (chronic course), the patient may complain of the following symptoms:

• periodic aching pain in the lower back on the affected side;
• increased discomfort after physical activity;
• gradual decrease in working capacity, the appearance of chronic fatigue;
• causeless increase in blood pressure;
• the appearance of blood in the urine.

With chronic hydronephrosis, lower back pain may periodically appear

Manifestations of acute form

If the obstruction process develops rapidly, then a person may experience the following symptoms:

• severe pain - discomfort is localized in the lower back, sometimes it can radiate to the groin, genitals, leg, the pain is very sharp, acute, in its strength it resembles renal colic;
• increased urge to urinate - the patient is faced with a persistent desire to frequently run to the toilet, while the urge to urinate may be false;
• the presence of blood in the urine - sometimes streaks of blood are visible in urine, but most often they are invisible to human eye, and hematuria (blood in the urine) is determined only in laboratory conditions;
• nausea - such discomfort often occurs when stones move through the ureter, as a result of which the outflow of urine is disrupted, nausea can turn into vomiting, which does not bring relief;
• manifestations of intoxication - if an infection occurs, the patient experiences a sharp increase in temperature (sometimes even up to 40°C), severe headache, chills;
• pressure surges - such hypertensive crises are very difficult to control with medications, patients may complain of increased heart rate;
• feeling of weakness - gradually turning pale skin, sweating increases, the patient complains of severe weakness.

For last stage hydronephrosis is characterized by the following symptoms:

• swelling of the legs and face;
• the appearance of shortness of breath;
• a sharp decrease in pressure;
• loss of consciousness;
• cessation of urine output.

Swelling of the legs may indicate progressive hydronephrosis.

If hydronephrosis affects both kidneys, then the patient is at very high risk of developing renal failure. Failure of both organs can be fatal. Such a patient requires urgent hospitalization.

Diagnostic methods

If renal pathologies are suspected, the patient should consult a urologist or nephrologist. The doctor will initially examine the patient and ask him about bothersome symptoms. During palpation (feeling), the doctor may detect a stretched bladder or an enlarged kidney, but such data is not enough to make a diagnosis, so doctors prescribe a comprehensive examination.

Diagnostics includes the following studies:

• Analysis of urine. This study allows us to identify typical signs of kidney dysfunction. Blood streaks, leukocytes, and purulent discharge may be found in the urine.
• Blood analysis. Increasing ESR and leukocytes in the blood indicates development in the body inflammatory process.
• Blood biochemistry. This analysis in case of development of hydronephrosis will show increased level creatinine, urea.
• Ultrasound examination of the kidneys. Diagnosis is carried out in different positions (on the back, side, stomach). Ultrasound determines the size of the kidneys, assesses the condition of the parenchyma, cups, and pelvis. The study gives an idea of ​​the patency of the ureter and the presence of stones in the kidneys.

  The doctor can see the pathological enlargement of the kidney using an ultrasound examination.

• X-ray contrast studies. Using a contrast liquid injected into the urethra or vein, the rate of urine accumulation in the kidneys is determined, narrowing of the ureter is detected, and the location of blockage with stones is identified.
• Endoscopic examination. An endoscope is used to examine the condition of the urinary tract.

  An endoscopic examination method helps determine the condition of the urethra, bladder and lower ureters

• Dynamic nephroscintigraphy. This is a radioisotope method that allows you to assess the degree of impairment of renal blood flow.
• Magnetic resonance or computed tomography. MRI and CT are recognized as the most accurate diagnostic methods. Such studies make it possible to determine the causes of obstruction and clarify the degree of kidney damage.

Hydronephrosis causes symptoms similar to some other ailments. Therefore, the urologist must carry out differential diagnosis With urolithiasis, nephroptosis (prolapse of the kidney), polycystic disease.

Treatment of hydronephrosis

Treatment methods for hydronephrosis are selected individually in each case. The tactics to combat pathology depend on the cause of the disease, the severity of obstruction of the urinary system, individual characteristics patient.

The patient is prescribed complex treatment, which may include the following areas:

• drug therapy;
• diet;
• physiotherapeutic methods;
• folk remedies.

In case of ineffectiveness conservative treatment urologists recommend surgery.

Drug therapy

The following groups of drugs can be prescribed for the treatment of hydronephrosis:

• Painkillers. These medications are prescribed during acute form hydronephrosis. These drugs effectively stop painful sensations. The following medications may be included in therapy:
• Tempalgin;
• Ibuprofen;
• Ketoprofen.

Photo gallery: medications for hydronephrosis

Baralgin helps reduce pain No-spa relieves spasms Ceftriaxone helps fight bacterial infections Canephron reduces the severity of the inflammatory process Trental restores renal blood flow

Diet food

The diet is selected by the doctor individually for each patient. Choice therapeutic nutrition depends on the cause, nature and stage of the disease.

The basic principles of nutrition for hydronephrosis are based on the following recommendations:

• Fluid intake should be moderate. During the day, doctors advise drinking about 1.5–2 liters of water.
• You need to eat 5-6 times a day. In this case, all portions should be small.
• Preference is given to boiled, stewed, baked dishes. It is advisable to avoid fried foods, which increase the load on the kidneys.
• You should not overuse salt. Nutritionists advise limiting intake of this spice to 2–2.5 g per day.

Table: healthy and harmful foods

Photo gallery: useful foods for hydronephrosis

For hydronephrosis, it is useful to eat fresh vegetables Doctors recommend including in the menu walnuts The diet for hydronephrosis is enriched with low-fat dairy products Nutritionists advise eating cereals The diet must include fruits and berries as a source of vitamins and minerals.

Surgery

Surgery is the main method of combating hydronephrosis. Surgical measures can quickly restore the outflow of urine from a damaged kidney and protect the parenchyma (kidney tissue) from further destruction.

For hydronephrosis it is carried out the following types operations:

• Temporary drainage. This event normalizes the flow of urine and allows the kidney to restore function. The operation is temporary. Subsequently, doctors assess the degree of damage to the organ and perform another intervention (reconstructive or organ removal).
• Reconstructive surgery. This intervention is designed to completely normalize the functioning of the urinary system.
• Organ removal surgery. Such interventions are resorted to in extreme cases when it is impossible to save the kidney.

If the patient has both kidneys affected, the presence of purulent discharge is confirmed, the renal colic, then surgery is performed immediately.

Temporary drainage

To save a person’s life, surgeons can resort to the following measures:

Restoring the outflow of urine causes the kidney to function normally. And if the organ is not yet destroyed, then it quickly returns to its normal work.

Main types of operations for hydronephrosis

Tactics surgical intervention depends on the location of the obstruction and the degree of kidney recovery. Most often, doctors resort to the following operations:

After the operation, the patient is prescribed antibiotic therapy, a diet is recommended, and physical therapy may be recommended. Rehabilitation depends on the extent of the operation performed. With gentle surgical techniques, the patient recovers in 4–6 days. For open, major surgeries, it may take 2–4 weeks.

Physiotherapeutic methods

To speed up the patient’s recovery after surgery, the patient may be prescribed the following types of physical therapy:

Folk remedies

Along with drug therapy, folk remedies can be used. Before using witchcraft recipes, you must consult your doctor. It should be understood that such drugs cannot replace the treatment prescribed by a doctor; they act only as additional therapy.

Kidney tea

Kidney tea has a diuretic effect. In addition, it reduces pain and eliminates spasms.

Components:

• orthosiphon stamen - 2 tbsp. l.;
• boiling water - 100 ml.

Cooking method:

1. Pour boiling water over dry grass.
2. Cover the container with a lid and leave for 20 minutes.
3. Strain the drink and squeeze out the herb thoroughly.
4. Drink 50 ml of kidney tea twice a day, 20 minutes before meals.
5. The duration of tea treatment is discussed individually with your doctor. One course can last 2–4 weeks.

Bearberry infusion

Bearberry leaves will help with hydronephrosis. They reduce pain, have an anti-inflammatory effect and provide a diuretic effect.

Components:

• bearberry leaves - 1 tbsp. l.;
• water - 1 tbsp.

Cooking method:

1. Pour boiling water over dry grass.
2. Wrap the container with the infusion and keep it warm for half an hour.
3. Strain the medicine.
4. Use the drug 1 tbsp. l. 30 minutes after meals 5 times a day.
5. Duration of treatment is 7–10 days.

Healing infusion

Very useful for hydronephrosis medicinal collection, combining birch buds, dandelion roots and juniper fruits. This remedy has a diuretic and anti-inflammatory effect. In addition, the infusion helps reduce blood pressure.

Components:

• birch buds - 2 tbsp. l.;
• juniper fruits (chopped) – 2 tbsp. l.;
• dandelion roots - 2 tbsp. l.;
• water - 0.3 l.

Cooking method:

1. Grind all dry ingredients and mix.
2. Pour boiling water over dry raw materials (a quarter cup).
3. Infuse the drink in a thermos for 6 hours.
4. Strain the finished drink.
5. Take 50 ml infusion before meals 3-4 times a day.
6. Continue treatment for 7–10 days.

Photo gallery: components of folk recipes

Orthosiphon stamen relieves spasms and relieves pain Bearberry leaves have diuretic and anti-inflammatory effects Birch buds reduce the severity of inflammation Juniper fruits serve as an effective antiseptic Dandelion roots effectively stop inflammatory processes

Prognosis and possible complications

Hydronephrosis is a very serious pathology. But with timely access to doctors, according to statistics, 95 out of 100 patients recover. With bilateral kidney damage, the prognosis is not so favorable, but even in this case, doctors find an opportunity to save the patient by prescribing regular hemodialysis.

If you contact doctors late, the prognosis is disappointing. Advanced hydronephrosis can lead to:

• urolithiasis (prolonged stagnation of urine leads to the formation of kidney stones);
• nephrogenic hypertension (hypertension develops against the background of renal dysfunction ( high blood pressure), which does not respond well to drug treatment);
• pyelonephritis (inflammation occurring in the kidneys);
• sepsis (infection can spread throughout the body);
• renal failure (due to prolonged stagnation of urine, the kidney may lose the ability to produce it);
• lethal outcome (prolonged stagnation of urine can lead to rupture of the kidneys and spillage of contents into the abdominal cavity, resulting in the development of uremic coma, and subsequent death may occur).

Hydronephrosis that does not receive adequate treatment can lead to the development of pyelonephritis

It is useful for patients who have suffered hydronephrosis to exercise, but only in gentle forms. Heavy physical activity (for example, weightlifting) is strictly prohibited. Yoga classes are very useful. In each case the recommended volume physical activity discussed with the doctor individually.

Hydronephrosis in pregnant women

Sometimes hydronephrosis can develop during pregnancy. This pathology appears as a result of compression of the ureters by the growing uterus. This disease is completely reversible and goes away after childbirth. But hydronephrosis is dangerous both for the pregnant woman and for the fetus. The disease can lead to the following unpleasant complications:

• Fetal pathologies. Impaired urine outflow can provoke the development of functional disorders, as a result of which the blood supply to the placenta will significantly deteriorate. Due to malnutrition, a baby can develop various pathologies.
• Infection. Hydronephrosis creates favorable conditions to introduce infection into the body. This is very dangerous during pregnancy. The infection can penetrate the placenta and cause congenital diseases in the fetus.

Treatment of hydronephrosis during pregnancy is carried out only by a doctor. Typically, a woman is recommended to take the knee-elbow position 4-5 times a day. This position takes the load off the ureters, and urine leaves the kidney freely.

Hydronephrosis can develop during pregnancy as a result of compression of the ureter by the growing uterus.

If hydronephrosis developed in a woman long before childbirth and managed to acquire chronic form, then the patient may require serious treatment. Sometimes doctors even resort to placing a stent (ureteral catheter) to ensure the outflow of urine.

If hydronephrosis in a woman is provoked by pathological congenital strictures, then the risk of similar anomalies in the fetus is high.

Prevention

Preventive measures include the following recommendations:

• stick to proper nutrition, completely give up junk food (fried, spicy foods, alcohol, fast food);
• wear clothes according to the season, many kidney pathologies develop (or worsen) against the background of hypothermia;
• promptly and correctly treat all infections of the genitourinary system;
• Visit your gynecologist and urologist regularly.

Hydronephrosis is an extremely unpleasant disease that can have unpredictable consequences. Despite the complexity of the disease, doctors know how to deal with it and almost always win, of course, if the patient seeks help in a timely manner.