Hydronephrosis

Hydronephrosis (synonym pronephros) is a disease of the kidneycaused by the complicated flow of urine; urine concentrations pelvis and cups are stretched, renal parenchyma gradually atrophy. The simultaneous expansion of the pelvis and ureter is called hydroretarder. The disease may be congenital or acquired, is more frequent in women aged 20-40 years. Obstacle to the flow of urine (stricture, valves, compression of renal tumors, inflammatory infiltrates in the retroperitoneal fat and pelvis, the stone of the ureter, incremental renal vessel, perekrasivshis the ureter) may be localized in any part of the urinary tract, but more often is prilagaemom Department of the ureter. Hydronephrosis progresses until and unless addressed its cause. The pelvis and cups expand, renal parenchyma gradually transformed into a thin connective tissue membrane (Fig.).

hydronephrosis
Fig. 1. Hydronephrosis when vnutripechenochny sack. Fig. 2. Hydronephrosis when vnepochechny sack.

Clinically hydronephrosis is manifested constant aching pains in the lumbar region. Sometimes the pain is in the nature of renal colic. When the infected hydronephrosis the temperature rises. Sometimes in hypochondrium determine tumor formation, which may reach large sizes. Bilateral hydronephrosis leads to kidney failure. Hydronephrosis may be complicated by the formation of stones, the accession of infection or kidney rupture in trauma.
Diagnosis is primarily based on the excretory urography (see) or retrograde pielografii (see). On the overview picture of the urinary tract can see the shadow of an enlarged kidney. Functional gidroenergeticheskiy affected kidney can be judged on the basis of isotope renografii (see Kidneys). Hydronephrosis differentiate with urolithiasis (see), nephroptosis. When nephroptosis the pain subsides in a horizontal position of the patient. Palpable mass education should be differentiated from a tumor of the kidney, polycystic, solitary cyst kidney. In those cases, when the main symptoms of hydronephrosis are hematuria or Peoria, the correct diagnosis is possible only on the basis of full urological examination (see Kidney, research methods).
The forecast for the affected kidney with hydronephrosis, if not corrected, unfavorable. For the life of the patient at a healthy second kidney forecast is favorable, because along with atrophy of the tissues sick kidneys healthy compensatory hypertrophies.
Treatment of hydronephrosis aimed at removing barriers to the outflow of urine from the kidneys. If the function renal parenchyma stored, used organ-retaining plastic surgery, which create normal outflow of urine from the kidney and ureter. Special diets unilaterally hydronephrosis is not required.


Hydronephrosis - extension Cup-pelvis system buds with atrophy of the parenchyma.
Cause hydronephrosis is difficult outflow of urine from the renal pelvis. Complete cessation of outflow of urine from the kidneys causes rapid atrophy. Relative violate outflow leads first to the expansion of the pelvis (pyelectasis), and then a slow atrophy of the renal parenchyma due to the direct effects of increased pressure within the kidney and renal pelvis substance and as a result caused them of renal blood flow.
The hydronephrosis are congenital and acquired. Refer to the first hydronephrosis, the cause of which was still in the embryonic period, for example, congenital narrowing, or the valve of the ureter (most often in prilagaemom Department), anomaline vessels, perekrashivaniya ureter at the exit of his pelvis, incorrect (too high) discharge of the ureter from the pelvis, congenital atony urinary tract congenital phimosis or stenosis of the external opening of the urethra.
Purchased hydronephrosis are caused by factors arising in life, such as stone or a tumor of the kidney or ureter, traumatic structure after his discharge or removal of stone, after injury or injury, after inflammatory processes in the retroperitoneal fat (paranemia, suppurative appendicitis, parametritis).
Hydronephrosis may develop as a result not only of Hypo-and hypertension ureter, expressed in frequent and prolonged spastic contractions of his (dyskinesia ureters).
Kidney with hydronephrosis increased in volume. Its surface is large hilly, consistency is elastic - or soft-elastic. In the context of the kidney seems multi, extended smooth Cup separated by a thin walls and widely communicated with a stretched pelvis (Fig. 124). Under the microscope found only a few canals and maleyeva the glomeruli. Vascular walls were thickened; clearance their narrowed.
Symptoms. Patients complain of a feeling of heaviness and blunt abdominal pain on the side of the sick kidneys. Pain depends on the irritation of nerve trunks, members of the renal legs, which undergoes tension increased severe kidney, and the pressure gidropaticheskim bag on a nearby nerve nodes and organs. Pressure on the stomach and intestines are explained complaints dyspepsia, constipation, flatulence (gastro-intestinal syndrome).
Sometimes there are typical episodes of renal colic, which is caused by the sudden strengthening of the existing barriers to the flow of urine. Along with pains in such cases, there is a rapid increase in the volume of the tumor and reducing the amount of urine, and upon termination of the attack marked polyuria and the tumor is reduced or no ewupawly (intermittently, hydronephrosis).
When the infected hydronephrosis high temperature, fever, severe pain in the upper quadrant, nausea, vomiting, septic condition.
Urine when hydronephrosis normal, only the weight of her lowered. When the infected hydronephrosis is cloudy, contains a lot of white blood cells.
Hydronephrosis in most cases, simple. Kidney sometimes ewupawly as barotrauma tumor elastic consistence, with a smooth surface. However, even with large hydronephrosis far not always it is possible to feel the kidney; it depends on the loose consistency gidropaticheskim bag or from what palpation it is partially emptied.
The Indigo Carmine on the side of the disease stands out very late or not outstanding. When injected into the pelvis ureteric catheter urine excreted frequent drops without gaps, and when pressed on the area of the kidney - stream.
On the retrograde pyelogram visible extended pelvis and stretched spherical Cup or a picture of one enormous cavity with blurred contours of cups (Fig. 125).

hydronephrosis pyelogram.
Fig. 125. Hydronephrosis. Pyelogram.

In the strictures pelahenko Department of the ureter or the tumor in this area, the catheter, and Sergazin do not go into the pelvis. The latter performs only the lumen of the ureter, the shadow of which is cut off from the pelvis.
The introduction of contrast fluid in gidroenergeticheskiy cavity is often accompanied by infection with its content and flash ostragehege kidneys with the phenomena of urosepsis. Add 100 000-200 0000 UNITS of penicillin contrast to the fluid, leaving ureteric catheter in the pelvis for 1-2 hours with the purpose of drainage, antibiotics before and after pielografii - significantly reduce the risk of such complications. Instead of sergazina better to fill the buckets with oxygen (newmedialogia).
From a security perspective, it is best to use excretory urography. If parenchyma sick kidneys are partially preserved, it is possible to see the image gidropaticheskim cavities, especially in the later pictures - 1 - 1.5-2 hours. First, there are the shadows extended globular cups, and then and pelvis, but kidney function with hydronephrosis sometimes so bad that the kidney is absolutely not emit sergazina or makes it in very small quantities.
Treatment. When infected hydronephrosis antibiotics are used in accordance with the sensitivity of microflora, for acute pain and outbreaks of temperature - catheterization pelvis.
The basic method of treatment is surgical. The indication for removal of the kidneys is thinned gidroenergeticheskiy bag, causing pain. For asymptomatic hydronephrosis, especially in the elderly, it is possible to refrain from the operation.
If parenchyma partially preserved, and there is a possibility to remove the obstacles to the flow of urine, resort to way to organ-saving operations - crossing scar or extension cords vessels, perekrashivaniya the ureter, the release from adhesions (ureteroceles). There are a number of plastic surgeries, aimed to improve the outflow of urine from the pelvis, for example resection stretched pelvis, dissection stricture along and staple it across (operation Finger), a longitudinal section prilojenii stricture of the urethra and vivania in him wedge-shaped flap of the wall of the pelvis (Foley) and several others. Plastic organ-retaining operations especially valuable when bilateral hydronephrosis.