Medicine knows many anatomical abnormalities that are innate or acquired. Among congenital malformations of the kidneys, there is sometimes aplasia - a fairly serious disease that can lead to death.
Aplasia of the kidney
Renal aplasia is a congenital anomaly in which one of the kidneys does not develop fully and instead of it there is an underdeveloped anlage in place of the organ, it lacks a normal structure, which makes the kidney unable to perform its functions. In such a situation, a healthy kidney assumes the responsibilities of underdeveloped, resulting in hypertrophy of its tissues due to compensatory activity.
In the international classification of diseases according to ICD-10, the code of renal aplasia is Q60.Twice more often, pathology occurs in male children. In general, the incidence of renal aplasia is 1 case per 700-1200 newborns. Aplasia is characterized by the absence of a leg and a pelvis, or they are not completely formed.
In some sources, aplasia is equated with agenesis, however, these conditions are somewhat different.
Aplasia can be of a one-sided nature, often hitting the left kidney. Although there are cases of bilateral defeat. In this case, the child is not viable. Such newborns at birth have an acute shortage of weight and soon die.
Cause of development of
To determine why in a certain period of fetal development the kidney has ceased to develop in the fetus, it is impossible. For unknown reasons the metanephros canal does not grow to a metanephrogenic blastema. Usually the ureter with renal aplasia remains normal, although sometimes it is also underdeveloped or completely absent.
In boys, along with the absence of the ureter, there are problems such as a decrease in the absence of the testicle, cystic formations on the testes and the absence of the vas deferens.
Specialists note that the development of pathology is influenced by factors like:
- Genetic predisposition to pathology;
- Radiation therapy of a pregnant woman;
- If the pregnant woman has diabetes;
- Availability in the first trimester of pregnancy pathologies of an infectious origin such as rubella or influenza;
- Presence of an anamnesis of pregnant syphilis and other pathologies of venereal origin;
- Alcohol dependence;
- Uncontrolled use of hormonal contraception.
Actually renal aplasia is a congenital anomaly of an innate nature. In severe cases, the fetus may die before delivery. With compensated forms, aplasia can not manifest itself in any way, and pathology is detected only upon examination. Sometimes aplastic changes progress gradually and are detected already in a fairly mature age.
There are several varieties of renal aplasia:
- Two-sided form of anomaly is considered absolutely incompatible with life, children with such a lesion die soon after birth. You can save a child by kidney transplantation or by regular hemodialysis;
- Right kidney aplasia is considered most favorable, from a prognostic point of view. Usually, in such a situation, the left kidney assumes all the responsibilities of the right organ, so negative symptoms may be absent. Sometimes right-side aplasia is detected in the diagnosis of nephropathology or persistent hypertension;
- Aplasia of the left kidney is considered more unfavorable, because with this underdevelopment of left kidney function, the right kidney takes on itself, which is considered less functional and more mobile. Renal aplasia on the left in men is usually accompanied by underdevelopment of neighboring structures such as the bladder, prostate, vas deferens or testis. A feature of left-handed aplasia is its frequent compatibility with underdevelopment of the lung. In women, a similar anomaly is detected much less often, but it is also accompanied by abnormalities of neighboring structures, for example, a two-legged uterus or aplasia of the uterine body, absence of a ureter or appendages, doubling of the vagina, underdevelopment of the partitions within the uterus.
Aplasia occurs less pronounced than agenesis. In some cases, the kidney development does not manifest itself in any way, only sometimes the patient can feel some soreness in the lumbar region. Left-sided aplasia is somewhat brighter than the right-sided aplasia.
In general, with such a defect, the following manifestations are noted:
- Oligoanuria - decrease in the amount of urine and even its complete disappearance;
- Ureteral underdevelopment;
- Adrenal gland anomalies;
- Renal colic from the lesion caused by proliferation of fibrous tissues;
- Stretching soreness in the lower abdomen;
- Persistent hypertension;
- Sometimes you may be concerned about pain from the normal kidney, which doctors associate with the increase in its size.
If aplasia is severe, then kidney failure develops, or the organism becomes intoxicated with its own metabolites. Then the patient's condition worsens, almost all body systems begin to function with interruptions.
Diagnostic procedures for the detection of renal aplasia, regardless of the side on which the abnormality is located, include:
- Radiography of kidney;
- Angiography of the kidney;
- Laboratory tests of urine;
- Spiral computed tomography;
- Magnetic resonance angiography, etc.
Treatment and predictions of
Treatment as such for renal aplasia is not required. The patient is necessarily assigned a lifelong diet, whose goal is to reduce the load from a healthy kidney. If the pathology is accompanied by persistent hypertension, then treatment with light diuretic drugs is necessary.
It is also necessary to follow preventive measures against bacterial infections of the kidneys. The immune system also requires support so that the likelihood of entry into the body of viral agents or pathogenic bacteria is minimal. In especially severe cases, transplantation is necessary.
In patients with renal aplasia, disability can be established in the case where the single kidney is reduced in functionality, which is accompanied by a vivid symptom of kidney failure. Although disability with such a pathology is not always given, from the army of patients are released, crediting immediately to the reserve.