Hydronephrosis – is an enlarging and expansion of the renal pelvis and calyces caused by obstruction (obstacle) the free flow of urine from the kidney
This disease can have serious consequences. Without treatment it can lead to progressive atrophy of the kidney. In cases hydrourethranephrosis also occurs swelling of the ureter, renal pelvis and calyces.
Signs and symptoms
Signs and symptoms depend on the nature of hydronephrosis disease – acute or chronic, unilateral or bilateral, partial or complete. Acute hydronephrosis which may be part of the contents of kidney stones) can cause severe pain in the thighs and between the ribs. A hydronephrosis that develops gradually, usually does not cause any pain, but discomfort. It is also possible nausea and vomiting. Due to obstruction of urine into the urethra may be pain and pressure, resulting in bladder distension. Blocking the flow of urine, as a rule, leads to infection of the urinary tract, which in turn can cause the development of additional stones, fever, occurrence of blood or pus in the urine. If the obstruction is complete, it can lead to kidney failure.
Blood tests can detect impaired renal function (increase of urea or creatinine) or an electrolyte imbalance, such as hyponatremia or violations hyperchloremic metabolic acidosis. In the analysis of urine can be revealed elevated pH due to the secondary destruction of nephrons in the diseased kidney. On physical examination can be detected swelling caused by increased kidney.
Causes of hydronephrosis
Hydronephrosis is the result of several abnormal pathophysiological phenomena. Structural abnormalities of the joints between the kidneys, ureters and bladder, which leads to hydronephrosis, can form even in utero. Some of these inherent defects have been identified as genetic diseases, other structural abnormalities can be caused by trauma, surgery or radiotherapy.
Compression of one or both ureters may also be caused by other development defects, such as abnormally placed vein, artery or tumor formation. Bilateral ureteral compression may occur during pregnancy because of the increase of the uterus. Changes in hormone levels during this period may also affect the muscle contractions of the bladder, which further complicates the situation.
Sources obstruction may occur due to other various reasons that include kidney stones, clots or retroperitoneal fibrosis.
Obstacle may be either partial or complete, and can form anywhere from the urethra to the cups of the renal pelvis.
Hydronephrosis can also result from reflux – the backflow of urine from the kidney to the bladder. Reflux can be caused by such factors as compression of the bladder outlet to the urethra, prostate enlargement or faecal impaction in the colon, as well as abnormal muscle contraction of the urinary bladder resulting in neurological dysfunction, or other neuromuscular abnormalities.
Anything that causes obstruction leads to an increase in the pressure transmitted to the thin fabric which constitute the filtration system of the kidneys, which can ultimately lead to infections, the formation of stones or failure. Further complications resulting from obstruction of the lower urinary tract include urinary stasis, which can also lead to infection of the bladder. Such obstruction may be the result of a tumor in the pelvis, ureters or urethra compression, for example in patients with advanced cervical cancer.
Diagnosis of hydronephrosis
Diagnostic procedures prescribed by the doctor. Diagnosis depends on the age of the patient, and also on whether the coincidence is detected hydronephrosis or prenatally or associated with other symptoms.
Blood tests (measurement of serum creatinine) should be interpreted in experienced hands, with great care, because even in cases of severe unilateral hydronephrosis, total renal function may remain normal.
Urine analysis is usually performed to determine the presence of blood (which is typical for kidney stones), or signs of infection (eg, positive leukocyte esterase or nitrite).
Visual Diagnostics – intravenous urography (IVU), ultrasound, CT or MRI – are also important in the study to determine the presence or causes hydronephrosis.
Ultrasound allows visualization of the ureters and kidneys (to determine hydronephrosis or hydroureter)
Intravenous urography (IVU) is used to assess the anatomic location of the obstruction. Antegrade or retrograde pyelography will show similar results to ultrasound.
Selecting images depends on the clinical picture (history, symptoms). In the case of renal colic (unilateral pain usually accompanied by traces of blood in the urine), original research, usually is a CT. It has the advantage of showing whether there is obstruction of the flow of urine as a result of hydronephrosis, and demonstrates the function of the other kidney. Many stones are not visible on conventional x-ray or ultrasound, but 99% of the stones are visible on CT and therefore CT is generally used in most cases.
For the detection of antenatal hydronephrosis used postnatal renal ultrasonography. This is usually done within the first few days after birth. Sometimes performed cystourethrogram (VCUG) urination, to exclude the possibility of TMR (vesicoureteral reflux) or anatomical abnormalities such as posterior urethral valve. If hydronephrosis is significant and is accompanied by obstruction such as ureteral junction or urethrovesical junction using such diagnostics as MAG-3 scan (MRI).
Forecast hydronephrosis may be volatile and depends on certain conditions, which led to hydronephrosis, there is vulnerability – unilateral or bilateral hydronephrosis, renal function provisional, hydronephrosis duration (acute or chronic), and the fact arose whether hydronephrosis in developing or mature kidney.
When unilateral hydronephrosis caused by stone disease is likely to be held after the removal of the stones and the likelihood of recovery is very high. In severe form of bilateral prenatal hydronephrosis (eg when posterior urethral valves), the prognosis may be less successful, as the developing kidney is in permanent damage.
Management of hydronephrosis
Treatment of hydronephrosis focuses on removing barriers and drainage of urine accumulated due to obstruction. Thus, the treatment depends on where there is an obstacle, and whether the disease is acute or chronic.
Acute obstruction of the upper urinary tract is usually corrected by setting nephrostomy. Chronic obstruction of the upper urinary tract can be solved by ureteral stenting or pyeloplasty.
Lower urinary tract obstruction caused by benign prostatic hyperplasia) is usually treated by administering a urinary catheter or suprapubic catheter.
Correct, the appropriate method of treatment is determined by an experienced physician in each individual case, based on our diagnosis and a personal inspection.
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