Kidney diseases in childhood are most often caused by various disorders in intrauterine development, as regards newborns, and past inflammatory diseases of the urinary system in older people. Hydronephrosis is somewhat more common in children than in adults. If the disease is not detected in time and does not seek medical help, the consequences can be very different.

The statistics of children dying at birth from bilateral hydronephrosis is not reassuring due to the lack of adequate diagnosis in the prenatal period. However, if a child’s congenital pathology is not very pronounced, it may not be detected even after birth. With age, the severity of hydronephrosis begins to progress, which inhibits kidney function. Therefore, mothers should know about this disease in order to consult a doctor in time, where the child can be given full assistance.

Why does infantile hydronephrosis develop?

Hydronephrosis can be primary, which develops as a result of congenital anomalies, and secondary, which appears as a complication of existing or past diseases. The causes of hydronephrosis in children are often congenital. Among these are:

• Congenital ureteral stenosis
• Segmental dysplasia
• Horseshoe kidney
• Accessory renal vessel crossing the ureter
• Incorrect exit of the ureter from the kidney.

This video explains the causes of kidney problems in children:

As a result, the outflow of urine from the renal pelvis is disrupted, and it accumulates in the kidneys. Congenital hydronephrosis in a child can be initially diagnosed during pregnancy. And acquired or secondary hydronephrosis manifests itself at different ages. They lead to him:

• Benign and malignant tumors of the abdominal organs
• Kidney neoplasms
• Inflammatory infiltrates in the retroperitoneal space
• Chronic inflammatory diseases of the urinary system.

Depending on the extent of the lesion, the pathology can be unilateral or bilateral. Kidney hydronephrosis in children is bilateral in 15% of cases. Moreover, the disease is detected 2.5 times more in boys than in girls.

What clinical manifestations accompany the disease?

Symptoms of hydronephrosis depend on the severity of the disease. The presence of pathology is indicated by the following phenomena:

• Lower back pain on the affected side
• Heaviness in the stomach
• Sensation of a palpable mass in the abdominal cavity
• Blood in urine
• Arterial hypertension
• Weakness and increased fatigue
• Nausea, vomiting, stool disorders.

In young children, the timely detection of hydronephrosis depends on the attentiveness of the mother.

After all, if an adult child can say what is bothering him, then babies show their condition by crying, anxiety, poor sleep, and refusal to breastfeed. Sometimes mothers notice that the amount of urine in the child changes, both upward and downward, and this is also a sign of hydronephrosis.

What happens to a kidney affected by hydronephrosis?

With hydronephrosis, under the pressure of accumulated fluid, the kidney becomes rounded and enlarged. The pelvis and calyces are stretched, and the cortex and medulla are thinned, which leads to a rapidly progressive decline in the function of the urinary system.

In a child, grade 1 hydronephrosis practically does not cause clinical manifestations. And starting from stage 2, various complaints appear.

Visible changes in the kidneys during pathology are as follows:

• The first stage - the pelvis is filled with fluid, the kidney is not enlarged
• The second stage - the fluid is in the pelvis and calyces, which leads to a slight enlargement of the organ
• Third stage - the kidney is significantly enlarged, the cortex and medulla are greatly thinned
• Stage four – the kidney substance is absent, the organ is completely filled with urine and does not function.

How is pathology diagnosed in children?

Congenital hydronephrosis in children is detected from the 15th week of intrauterine development. For this purpose, ultrasound is used to determine the expansion of the renal collecting system and other pathologies of the development of the urinary organs. After diagnosing the disease in the fetus, the issue of immediate treatment or monitoring the further development of the disease is decided. Medical tactics depend on the general condition of the mother and child, as well as the severity of the pathology.

The only problem with diagnosing acquired hydronephrosis is the late presentation of patients for medical help.

Modern examinations make it possible to detect the disease at the very beginning of its development. For this purpose, laboratory and instrumental research methods are used. From laboratory diagnostics, a general urine test is important, where blood, protein and other nonspecific signs are detected, which indicate the presence of a pathological process in the kidneys, but are not diagnostic signs of hydronephrosis.

For example, protein in the urine of a child after a cold may indicate a past illness, the presence of pyelonephritis and glomerulonephritis, but can also be detected in hydronephrosis. Therefore, if, after a general urine test, the doctor suggests using additional research methods to clarify the cause of the pathology, then you should not refuse.

Among additional research methods, hydronephrosis is confirmed:

• During ultrasound examination
• When performing contrast radiography
• By computed tomography
• On magnetic resonance imaging.

Many mothers are interested in the question: is the examination harmful? To which we can safely answer in the negative. After all, the diagnosis of hydronephrosis mainly involves the use of non-invasive diagnostic methods. Of course, X-ray examination carries a certain radiation load, but it is insignificant. After hydronephrosis is detected, the doctor prescribes a comprehensive treatment, which is selected individually for each child.

Possible complications of hydronephrosis

The most common complication of hydronephrosis is the addition of a secondary infection. Due to stagnation of urine, bacteria have the opportunity to grow and reproduce. Getting into the kidney from the underlying parts of the urinary system, they cause pyelonephritis, which further worsens the condition of the body.

Symptoms of pyelonephritis are:

• Temperature rises to 38-39 degrees
• Pain in the lower abdomen when urinating
• Urinary retention
• Urination in small portions.

Hydronephrosis of the 3rd degree in children without appropriate treatment is complicated by chronic renal failure. This is a very serious pathology that requires regular monitoring and lifelong treatment. The only way to get rid of kidney failure is to perform an organ transplant.

The worst complication is that there is a possibility of dying from hydronephrosis if it is not treated. Death occurs due to chronic renal failure and poisoning of the body with harmful products that are normally excreted in the urine. Moreover, it should be remembered that hydronephrosis of the kidney cannot resolve spontaneously without treatment.

Hydronephrosis of the kidney in children develops gradually, but it is impossible to say when exactly the function of the urinary system will begin to be irreversibly impaired. Therefore, treatment of the disease should begin immediately after the discovery of the pathology, because in one child the pathology in stage 1 may exist for 10 years, while in another, renal failure will occur within 2-3 years without treatment.

• Classifications and stages of the disease

Hydronephrosis is a kidney disease. Its appearance is due exclusively to a significant increase in the size of the renal calyces and pelvis. Hydronephrosis in children occurs with much greater regularity and frequency.

The disease is provoked by disturbances in the structure of this organ, which interfere with the natural flow of fluid inside the kidneys. As a result, the following picture takes place: the hygroscopic pressure in the cavities of the pelvis and calyces grows at a rapid pace, their walls stretch, which subsequently leads to impaired functioning of the kidney and painful sensations in the patient.

Hydronephrosis is a multistage pathological process, with damage observed predominantly in the left kidney.

From the point of view of the causes of the disease, the following groups of diseases are distinguished:

• congenital;
• acquired.

Congenital hydronephrosis in children is a consequence of disturbances in the structure of the kidneys, namely: narrowing of the urinary tubules, changes in their course, and torsion. In some cases, the disease is caused by a hereditary factor.

Acquired nephrosis occurs against the background of any inflammatory diseases of the urinary system. This disease can be provoked by absolutely any injury associated with the lumbar region, which subsequently leads to impaired urine conduction. Depending on the location of the sore point, the following classification is distinguished:

• unilateral;
• bilateral.

This disease is quite serious and has its own stages of development:

1. Kidney function is practically unchanged. There is an expansion of the renal pelvis.
2. Significant change in the size of the pelvis. Its walls are very thin. The kidney itself is increased in size by at least 20%. There is a significant decrease in kidney function.
3. The kidney takes on the appearance of a multi-chamber cavity. There is a complete (or significant - up to 80%) loss of the excretory function of this organ. After a certain period of time, a process of decay begins in this organ, which poses a serious threat to the child’s body.

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How to recognize the disease: signs of hydronephrosis

Hydronephrosis in children occurs as a result of anatomical disorders that block or significantly reduce the outflow of fluid from the kidneys. There is no single symptomatology, since everything depends on the stage of the disease. At the very beginning, this disease may not manifest itself in any way. However, over time, the following symptoms are observed:

• pain in the abdominal area;
• disturbance of the urination process;
• presence of blood in the urine;
• visual swelling in the back area in the hypochondrium on the side of the affected kidney;
• urinary system infections;
• a significant increase in body temperature (observed along with infection).

It is very important to detect these symptoms in time and promptly consult a specialist. Otherwise, pyelonephritis occurs. If left untreated, there is a risk of death.

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Features of diagnosis and treatment process

In babies, this disease in most cases is diagnosed even at the stage of intrauterine development, namely at 3-4 months of pregnancy, and has the same symptoms. Kidney hydronephrosis in the fetus is determined based on ultrasound data. Treatment of hydronephrosis in children has specific features. At the stage of intrauterine development, the baby’s body is just forming. In this regard, all changes that occur are solely temporary. Quite often, the cause of hydronephrosis disappears one month after the baby is born. In a situation where the disease does not go away on its own, it is necessary to immediately begin treatment, which is precisely aimed at eliminating its cause. The treatment regimen is determined by the complexity of the disease and the timeliness of its detection. If necessary, the use of various painkillers is permitted. Anti-inflammatory, antihypertensive, and antibacterial agents are in most cases used at the first stage of hydronephrosis.

This disease has irreversible causes, so surgical intervention (surgery) is the appropriate cure. Drug treatment provides a favorable environment in this situation. Surgery is the only way to restore kidney function. At this stage, it is very important to eliminate the causes of the disease and restore full fluid flow in the renal vessels. Only after this should you immediately take measures for anti-inflammatory and antibacterial therapy.

The process of treating an ailment such as kidney hydronephrosis in a child must be fully agreed with the doctor.

Kidney hydronephrosis in children is a pathological condition that most often refers to a type of congenital developmental anomaly. This disease is characterized by pronounced dilation of the renal pelvis as a result of difficulty or complete cessation of the outflow of urine into the cavity of the ureters.

Acquired pathology occurs as a result of injury to the lower back, the anatomy of the organ is disrupted, inflammation appears in the urinary system, scars form and the process of rotting occurs, which prevents full urination.

In children, this pathology occurs more often than in adults; in infants, symptoms may not be observed; the disease progresses with age. But now it is possible to diagnose a child’s pathology with an ultrasound examination of the mother during pregnancy. In this case, it is better to start treatment immediately after the birth of the baby.

Causes of hydronephrosis in newborns

The reason for the development of this condition may be the anatomical narrowing of the lumen of the ureter in the area of ​​its origin from the pelvis, as well as insufficient contractility of the muscle fibers in their membranes. The most common cause of hydronephrosis is considered to be anatomical defects.

Anatomical factors:

• The presence of valves in the ureteral cavity
• Abnormal choroid plexus dehiscence and accessory vascular branches
• Anomalies in the location of the ureters in relation to the renal parenchyma
• The presence of strands of embryonic origin, which provokes compression and bending of the ureters

If a child has congenital hydronephrosis, its cause lies in a structural disorder of the kidney. Even in the uterine period, during the formation of the internal organ, the urinary tubules may be incorrectly positioned, twisted, or narrowed, which will cause a delay in the outflow of urine.

Numerous studies indicate that the main cause of pathology in most cases is the mother’s poor lifestyle while carrying a child, namely smoking and alcohol. Another cause of congenital hydronephrosis is genetics. The disease is inherited.

Why is hydronephrosis dangerous?

Long-term retention of urine outflow leads to ischemic damage to the renal parenchyma with subsequent atrophic changes. The rate of formation of the pathological process depends entirely on how obstructed the urinary duct is.

With a pronounced disturbance of urinary outflow, the renal pelvis still copes with urinary function for a short amount of time, but after a certain period of time, hypertrophy of muscle fibers begins to develop.

Increased pressure in the renal pelvis and ureters can lead to rupture of their membranes, with urine pouring into the retroperitoneal cavity. Due to prolonged stagnation of urine in the upper parts of the urinary system, infectious and inflammatory processes can develop.

Hydronephrosis of the kidneys in children. Symptoms

Symptoms depend on the degree of the disease; in the initial stages, renal hydronephrosis in children proceeds unnoticed.

Hydronephrosis of the first degree in a child.

At this stage, there are no disturbances in the functioning of the kidneys, the internal organs are functioning normally, the pathology does not make itself felt, but internal changes occur. When performing an ultrasound, you can notice a slight expansion of the renal pelvis. A skinny baby may develop a belly bump, which parents should pay attention to.

Hydronephrosis of the second degree in a child

During this period, the disease makes itself felt. An ultrasound examination reveals a significant dilation of the renal pelvis and calyces. The second stage of hydronephrosis entails compression of the renal parenchyma due to a large amount of urine. This is followed by atrophy of the kidney tissue, which further reduces the function of the diseased kidney.

The main symptom at this stage is severe pain localized in the lumbar region, irradiation can spread to the periumbilical region. The severity and duration of the pain syndrome depend on whether the inflammatory process of the urinary system has joined the underlying disease.

Hydronephrosis of the second degree is also characterized by a change in laboratory test parameters in favor of impaired filtration capacity of the renal parenchyma. The child’s urine becomes cloudy, and laboratory results indicate that the urine contains a large number of leukocytes and red blood cells. In infectious diseases, an elevated temperature is observed.

Frequent urinary tract infections in children may indicate the presence of hydronephrosis.

During palpation, you can feel a tumor-like formation, which can be easily felt even through the anterior wall of the abdomen. Increased blood pressure is also observed.

Hydronephrosis of the third degree in a child

This is the last stage of the pathology, at which all the symptoms appear more clearly. Protein ceases to be processed normally due to an imbalance in water and electrolyte balance. The kidney parenchyma is affected, the second degree symptoms include swelling of the extremities, severe enlargement of the abdomen, and spotting during urination.

How to treat?

Treatment of hydronephrosis in children is carried out using surgical methods; this is the only way to restore normal urine flow. If the functional capacity of the affected kidney is still preserved, patients are advised to undergo surgery to restore normal patency of the ureters. If the kidney has completely ceased its ability to function normally, such children are indicated for a radical surgical procedure. The prognosis for further life activity depends entirely on the severity and neglect of the child’s underlying condition.

There are cases when hydronephrosis in newborns can go away on its own up to a year. The baby is examined every three months, with the first and second degrees of hydronephrosis; if the disease has reached stage 3, it is necessary to urgently treat the child. Surgery for hydronephrosis in children is in most cases carried out endoscopically. This technique is less traumatic for children than the abdominal method.

During the operation, two small incisions are made through which an endoscope and the necessary devices are inserted. If urinary obstruction is caused by the ureter, plastic surgery is performed. If a large amount of urine has accumulated in the kidney, it will be removed using a catheter. The efficiency of the operation is very high.

Modern technologies make it possible to perform surgery on a child still in the womb, but the risks of this technique are very high and can lead to miscarriage.

Rehabilitation period

At the end of the operation, the surgeon places an internal or external drainage system on the child. With the internal system, the baby can be discharged from the hospital within a week. But with the external one you will have to spend about a month in the hospital. During the rehabilitation period after hydronephrosis, antibiotics and uroseptics are prescribed. The child is registered with a urologist. For six months, you must take a general urine test every two weeks. Even if 6 months have passed since the operation, leukocytosis may be detected in the urine, do not worry about this, this is normal.

Kidney hydronephrosis in children is a serious disease, the treatment of which is urgent. If you suspect that your child's kidney function is impaired, be sure to share your suspicions with your doctor.

Hydronephrosis of the kidneys is a disease in which the outflow of urine worsens due to an increase in the calyx and pelvis of the organ. When a baby is sick, the kidneys cannot fully cope with the task: not all metabolic products are eliminated, and toxic substances are retained in the body. If you do not start treating your child in time, there is a risk of developing kidney failure and problems with the central nervous system. Diagnosis is complicated by the fact that the acquired disease is detected at a later stage, since in the initial stage it is asymptomatic.

Periodic lower back pain and other negative symptoms from the urinary system should alert parents and prompt a thorough medical examination

Causes of hydronephrosis and mechanism of development

The development of a unilateral form of hydronephrosis in newborns occurs when one ureter is affected; a bilateral form affects the bladder or two ureters and is very rare.

Boys are more susceptible to the disease due to the special structure of the urinary organs. Most often, hydronephrosis in children is a congenital pathology.

Congenital pathology

Reasons for the development of hydronephrotic transformation of the kidneys:

• Chromosomal changes. In addition to specific facial deformities and heart defects, Down syndrome often causes hydronephrosis, which affects two kidneys.
• Fetal hypoxia. Insufficient oxygen supply causes thrombophilia, early aging of the placenta, and anemia. These pathologies lead to unilateral hydronephrosis.
• Intrauterine infection. Kidney damage is often caused by cytomegalovirus. Viruses such as ureoplasma and chlamydia also affect the pathological formation of the urinary system, but cause less harm.
• Dysplasia of the ureters and pelvis.
• Smoking, drinking alcohol during pregnancy.

Acquired form

The acquired form of hydronephrosis develops due to the following factors:

• organ injuries (ureters, urethra, bladder and abdominal organs);
• infectious or inflammatory diseases of the urinary tract;
• kidney stones;
• In boys, hydronephrosis develops due to inflammation of the prostate gland.

The functioning of the kidney during hydronephrosis in children is impaired due to the expansion of the renal pelvis. Harmful substances accumulate in the body because the organ is not able to secrete and filter urine. When a large amount of urine accumulates, the walls of the pelvis and cups stretch. If treatment for the disease is not started in time, this can lead to disruption of the functioning of other organs.

Degrees of hydronephrosis and characteristic symptoms

The kidneys are an excretory organ, but in addition to their main function, they stimulate the production of red blood cells and regulate blood pressure. Diagnosis of hydronephrosis is difficult because symptoms do not always clearly indicate the presence of pathology. There are 3 degrees of development of hydronephrosis.

1st degree

It is asymptomatic, since changes occur inside the kidneys. The organ enlarges slightly, the pelvis expands. Most often, grade 1 is diagnosed when an infection occurs.

2nd degree

It is characterized by a significant enlargement of the kidney and difficulty in its functioning. Stage 2 symptoms:

• periodic lower back pain;
• colic in the kidneys that occurs periodically;
• increase in body temperature due to infection;
• abdominal enlargement;
• increased blood pressure;
• weakness, dizziness;
• nausea;
• swelling of the face;
• bloody discharge when urinating.

As hydronephrosis progresses, the number of symptoms increases, so at the first suspicion of the disease, you should seek advice from your treating pediatrician

3rd degree

It is the most dangerous stage, as the functioning of the organ is reduced by 50 percent. With grade 3, symptoms of grade 2 are more pronounced, and the following is added to them:

• severe abdominal enlargement;
• severe chronic pain in the lower back;
• swelling of the limbs;
• persistent high blood pressure;
• decreased urine output;
• constant nausea, vomiting;
• skin itching;
• weakness, loss of consciousness.

Clinical picture of right- and left-sided hydronephrosis

Hydronephrosis is 2-2.5 times more often diagnosed in boys. It is usually a unilateral lesion that affects the left kidney. This clinical picture is associated with the anatomical features of the structure of the organs. Bilateral hydronephrosis occurs in 5-9% of cases.

With a left-sided inflammatory process, pain is felt on the left side in the lower back and radiates to the leg; a characteristic change in the color of the urine to a cloudy, pinkish color. The right-sided lesion has symptoms similar to the left-sided one, but the pain spreads to the entire lumbar region.

Other signs of pathology depend on the degree of damage. Most often, right-sided hydronephrosis occurs in elderly people and alcoholics.

Treatment of the disease

Treatment of hydronephrosis in newborns should begin as early as possible. Modern methods make it possible to diagnose the disease at an early stage. The following types of examination are required for diagnosis:

• general blood test;
• urine analysis (according to Zimnitsky and Nechiporenko);
• ultrasound examination of the ureters and kidneys;
• urography;

Treatment methods are selected depending on:

• degree of disease development;
• stages of the inflammatory process;
• the presence of other pathologies.

Features of therapy for newborn babies

If the kidney pathology is congenital, it is diagnosed before the baby is born

Congenital hydronephrosis of the kidneys in newborns is diagnosed during an ultrasound examination of the fetus at 16-20 weeks of pregnancy. Immediately after birth, the baby needs to undergo an ultrasound of the kidneys. Often, organ function is restored without any intervention. Kidney function is checked after 3 months and then every six months. The procedures are carried out for up to 3 years, if the dynamics are positive.

Children born prematurely or by caesarean section also need systematic examination. Their urinary system may not have time to fully form and fully perform its functions.

Conservative treatment methods

Conservative treatment methods are used for the treatment of grade 1 and 2 hydronephrosis, if infections are not added to the disease, and the doctor observes positive dynamics. This method uses:

• anti-inflammatory drugs - to reduce pain;
• antibiotics - to prevent the spread of infection;
• medicines that lower blood pressure;
• vitamins, iron-containing preparations;
• diet – it is necessary to exclude carbonated drinks, smoked foods, sauces from the diet, limit salt and protein intake;
• consuming large amounts of water per day.

During the treatment period, it is important to monitor the child’s drinking regime.

The child should be observed by a doctor and undergo the necessary ultrasound examinations of the kidneys in a timely manner. To determine the dynamics of the disease, it is necessary to take blood and urine tests.

Surgical intervention

If conservative treatment methods do not bring positive results, or in cases where the disease is detected late, surgical therapy is used. There is no need to be afraid of surgery, since modern medicine allows the procedure to be performed without large incisions and scars.

The most gentle method is laparoscopic plastic surgery. This operation is carried out using a special tube with a camera. The laparoscope is inserted through small incisions. The method helps to completely restore kidney function. This operation is performed on children of any age. Restrictions:

• low birth weight newborns;
• premature babies;
• babies who have severe concomitant illnesses.

Postoperative rehabilitation goes very quickly, the main thing is to monitor the child’s nutrition and follow all the doctor’s recommendations

The recovery period takes about a week. After surgery, you need to monitor your diet and be examined by a urologist every 3 months. The use of medications will restore all functions of the organ.

Prognosis for recovery and possible complications

The outcome of most operations is successful. About 95 percent of children can live a full life after surgery. Unilateral hydronephrosis at an early stage is easier to treat, and the prognosis for recovery of such patients is more favorable. At stage 3 and with bilateral damage, the disease is much more difficult to cure.

Possible consequences after surgery:

• inflammatory processes due to infections;
• bleeding;
• When the operation is performed in the prenatal period, termination of pregnancy and premature birth are possible.

Complications rarely occur due to modern surgical methods, the use of absorbable sutures, and the use of antibacterial agents. Most often, young patients suffer from the consequences.

Kidneys are one of the most important organs of the human body, performing a lot of vital functions. – a serious problem, a dangerous condition that can cause serious harm to health.

Hydronephrosis is one of these pathologies. In children this disease occurs quite often(mainly in boys), is accompanied by a violation of the outflow of urine, and can lead to kidney atrophy. The pathology can be either unilateral or bilateral (more complex form).

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General information

Hydronephrosis is a disease caused by increased urine pressure on kidney structures.

If this situation is protracted, changes occur in the structures of the kidney (renal pelvis, calyx).

They expand, increasing in size. This leads to further disruption of the urine outflow process, an even greater increase in hydrostatic pressure of urine, organ atrophy. Moreover, the greater the pressure, the more extensive the deformation processes become, the more the functionality of the kidney is impaired.

Often the disease is caused congenital anomalies development of the urinary system, which develop during the period of intrauterine development of the fetus. In this case, the pathology, which manifests itself after the baby is born, can be unilateral or bilateral.

The kidneys are a paired organ, therefore, with unilateral hydronephrosis, symptoms of the pathology may be absent for some time, since the functions of the affected kidney are taken over by the healthy organ.

At bilateral form of the disease, the clinical picture is more vivid and pronounced.

Reasons for development

Hydronephrosis is most often congenital in nature, therefore, the main cause of its occurrence is considered abnormalities of intrauterine development of the urinary tract child's body:

1. Narrowing of the lumen of the urinary canals.
2. A change in the position of the ureters, as a result of which a reverse outflow of urine is observed (reflux effect).
3. Disturbances in the structure of the vascular system of the kidneys, as a result of which extra vessels are formed that wrap around the ureter, thereby reducing its patency.

If we are talking about an acquired form of pathology, the following can lead to its development: unfavorable factors:

1. Injuries in the lumbar region.
2. A metabolic disorder in the body that provokes the development of urolithiasis.
3. Inflammatory processes in the area of ​​the ureter, leading to scarring in the tissues of the organ.
4. Unsuccessful surgical operations during which the ureter was damaged.

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Classification of the disease

The development of hydronephrosis occurs in several stages. The following stages are distinguished:

• initial. Kidney functions are preserved, there is a slight expansion of the renal pelvis while maintaining the integrity of this structural element;
• at the second stage kidney functions are gradually lost, the walls of the renal pelvis become thinner, and it increases in size even more. There is an increase in the size of the kidney as a whole;
• third the stage is characterized by a significant (or complete) loss of kidney functionality, a strong increase in the size of the organ, and atrophy of the renal parenchyma.

According to the degree of damage, hydronephrosis can be unilateral (the right rather than the left kidney is more often affected) or bilateral (a rare phenomenon, diagnosed in only 10% of cases).

The disease has a congenital form (the most common) and acquired.

Pathogenesis

As a result of developmental disorders of the urinary system, the outflow of urine from the body slows down. This is most often due to anomalies in the structure of the urinary canals, which, in this case cannot fully perform their function.

As a result of such disorders, the pressure exerted by accumulated urine on the structural elements of the kidneys increases. This leads to the development of inflammatory processes, an increase in the size of the organ and its elements, and impaired kidney function.

This, in turn, further aggravates the problem, since the hydrostatic pressure of urine in this case only increases.

Symptoms and signs

It is important to remember that with a unilateral form of pathology, its symptoms may do not appear for a long period of time.

At the initial stage of development of the disease, it can also occur asymptomatic. However, over time, the clinical picture becomes more and more pronounced, such signs How:

The third stage is characterized by the appearance of the following symptoms:

• dryness and pallor of the skin;
• increased blood content in urine;
• decrease in the volume of urine excreted (almost complete absence of urination);
• hyperthermia;
• lack of appetite, severe weakness;
• nausea.

Complications and consequences

Hydronephrosis in children is a disease that doesn't go away on its own, which means that the small patient requires special treatment.

Otherwise, development may occur serious complications, such as pyelonephritis, renal failure, significant intoxication of the body, increased temperature to dangerous levels.

These phenomena are considered very dangerous, especially for children in the first year of life, and can lead to death.

Diagnostics

Questioning the patient, assessing the clinical manifestations of the pathology, and also helps the doctor make a diagnosis. a number of laboratory tests:

1. Blood tests for the presence of inflammatory processes in the body, the content of urea and creatinine in the blood.
2. Urine tests for the content of blood elements.
3. Determination of kidney functionality using the Rehberg test.
4. Ultrasound of the excretory system to determine the stage of development of pathology.
5. MRI, CT to identify the causes of the disease.

Treatment methods

As a rule, at the initial stage of development of the disease, no therapy is required, however, the child should be under the supervision of a doctor.

The second and third stages require adequate therapy.

Conservative treatment is used; in some cases, if drug therapy does not give the expected effect, the child requires surgical intervention.

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Drug therapy

To treat hydronephrosis, the doctor prescribes the patient to take the following groups of medications:

1. Anti-inflammatory means eliminate inflammatory processes and relieve swelling.
2. Antibacterial medications necessary if an infection is added to the underlying disease. Antibiotics prevent the spread of pathogenic microflora throughout the body.
3. Enterosorbents to eliminate manifestations of intoxication in the body.
4. Since with hydronephrosis there is an increase in blood pressure, it is necessary to take drugs that lower blood pressure.

Diet

A proper diet is a necessary condition for successful treatment. The patient is prescribed special diet, characterized by increased caloric content and nutrient content.

At the same time, salt consumption must be significantly reduced.

It is important to maintain a fluid regime; it is recommended for the child drink as much clean water as possible. This helps cleanse the body and restore the process of urine outflow.

Surgical intervention

Radical methods treatment (surgery) is prescribed if the following indications exist:

• significant disturbances in the process of urine outflow;
• extensive inflammatory processes in the kidney area;
• severe pain;
• significant impairment of kidney function;
• renal failure.

Surgical operations can be different:

1. Open surgery. It is performed under general anesthesia. The doctor makes an incision in the hypochondrium, through this incision access is made to the affected organ. During the operation, damaged kidney tissue is removed, and the renal pelvis is excised. Healthy areas of the organ are connected using sutures. It is necessary to check the tightness of the urinary canals to prevent leakage of urine.
2. Endoscopy. It is used if there is a narrowing of the urinary canal. Special rods and tubes are inserted into the ureter through the urethra, which are necessary to increase the lumen of the canal. If the organ tissue is affected by scars, endotomy is used - laser removal of scar tissue.
3. Laparoscopy- the most effective method. The operation is performed under general anesthesia. 5 punctures are made in the hypochondrium area. An endoscope is inserted into one of them, which is connected to a video camera. This allows the doctor to see the whole picture in detail. Through another puncture, carbon monoxide is introduced into the patient's body. This is necessary to increase the internal space in the patient’s body, which makes the surgeon’s work easier. Then the doctor, using special instruments, removes all the affected areas of the organ and connects the renal pelvis with a healthy area of ​​the ureter. As a rule, subsequent stitches are not required, however, a sterile bandage treated with an antiseptic must be applied to the puncture area.
4. Nephrectomy– complete removal of the affected organ. It is prescribed only if the disease has a unilateral course. Currently, it is used extremely rarely, only in emergency cases when there is complete destruction of the organ. If at least 10% of the kidney is preserved, this treatment method is not used.

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Forecast

The chances of successful recovery depend on the form of the disease (with unilateral hydronephrosis the prognosis is more favorable), as well as on how timely treatment was started.

Hydronephrosis at an early stage of development responds well to treatment, in 90% of cases the child recovers, returns to a full life. If the pathology has moved to stage 2 or 3 of development, the prognosis, alas, is ambiguous. If left untreated, death may occur.

Hydronephrosis is a kidney disease that affects the flow of urine. Pathology can be either congenital or acquired; its development is influenced by many factors.

Depending on the stage of development, the disease manifests itself in different ways, if at the first stage there may be no symptoms, then at stages 2 and 3 the clinical picture is very noticeable. Hydronephrosis requires mandatory treatment. This can be drug therapy or radical treatment methods.

About the causes and treatment of hydronephrosis in children in this video:

We kindly ask you not to self-medicate. Make an appointment with a doctor!