Kidney reflux in children and adults: causes, degrees, symptoms, diagnosis, treatment

Renal reflux in nephrology is infrequent, with more inherent in childhood, although in adults it is also sometimes diagnosed. Pathology is quite dangerous with its consequences, so treatment should begin as early as possible.

Renal reflux

Renal reflux is a disease in which urinary backflow is observed. There are two main forms of the disease - renal-pelvic( pyelorenal) and vesicoureteral reflux. In the first case, the contents of the pelvis penetrate the tissue of the kidney, into its vessels. The second type of pathology is associated with the reverse movement of urine into the ureters from the bladder, the other name for this type of disease is vesicoureteral reflux. Together, both types of disease are often referred to as "vesicoureteral and pelvic reflux".

Degrees of severity of pathology are as follows:

• First degree - reflux reaches the ureter, without affecting the pelvis.
• 2 degree - casting of urine reaches the pelvis.
• 3 degree - the ureter expands.
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• Fourth - the ureter because of urine reflux begins to wriggle, the kidney function decreases by 30-60%.
• Fifth - the kidney function is disrupted( by more than 60%) due to the thinning of the parenchyma, the development of a chronic inflammatory process.

Classification of

Renal reflux is divided into the following types:

• Fornicinal - urine enters the parenchyma of the kidney due to the permeability of the mucosa in the fornix region.
• . Tubular - urine is thrown from the tubules into the interstitial renal tissue without tearing the calyx shell

By typeThe course of reflux is permanent or transient. Active is the transfer of urine into the ureter when the bladder is emptied( with the participation of pressure), passive - with a filled bladder.

Also, the classification implies the division of pathology into the following types:

1. Primary kidney reflux - is associated with congenital abnormalities of the structure of the urinary system, appears in early childhood.
2. Secondary reflux is due to kidney and bladder surgery, chronic inflammation and other acquired problems. More typical for adults.

More often reflux is one-sided( left-sided or right-sided), but sometimes it is found and bilateral.

On video about vesicoureteral reflux:

Reasons for

The reasons for the development of the primary form of the disease may be as follows:

• Pathology of urethral sphincters.
• Defects of the wall of the bladder.
• Disturbances in the structure of the ureters.
• Yawning of the ureter in the bladder. Dystopia of the ureteric orifice.
• Duplication of the ureter.
• Bladder wall protrusion near the ureter.

All of these causes are more likely to provoke urine reflux in children. Nevertheless, secondary reflux in children up to a year is also possible - for example, when carrying a severe form of acute respiratory viral infection or influenza. Secondary reflux in children and adults arises from diseases that disrupt the outflow of urine from the bladder and change the tone of its muscular wall. Also, the causes may be associated with changes in the intramural ureter. To provoke a disease capable of:

• Hypertrophy of the seminal tubercle;
• Weakness of the urethral valve;
• Fibrosis, sclerosis of the neck of the bladder;
• Phimosis( in children);
• Stenosis of the bladder;
• Cancer, prostate adenoma in men;
• Chronic cystitis;Structures of ureters, urethra;
• Tuberculosis of the bladder;
• Hyperactive Bladder.

Symptoms of

It is especially difficult to suspect the development of the disease in infants. They can not point to an emerging malaise, so it is possible to prescribe the kidney reflux only by performed instrumental studies or by changes in urine tests.

In older children and adults, there are signs of the disease:

• Changing the shade of urine to a darker one.
• Blood in the urine, the appearance of foam.
• Increased temperature( with the development of inflammation).
• Sometimes - the smell of acetone in the urine.
• Thirst.
• Pain after urination and during it.
• Painful syndrome of diffuse type( throughout the abdomen).
• Pressure, constriction in the lumbar region.
• Edema on the feet, face, body.

For adults and adolescents, a chronic increase in pressure is characteristic, although a symptom may also occur in children. With the prolonged existence of reflux without treatment, there are signs of intoxication.

Diagnosis

To diagnose a child or an adult you need to visit a nephrologist. The doctor will conduct a physical examination - measurement of pressure, temperature, palpation of the kidneys. From laboratory tests, an overall urinalysis( showing protein, red blood cells, leukocytes in increased amounts), a general blood test( reflecting increased ESR, increased leukocyte count) is mandatory. At the advanced stage of the disease, kidney tests will be pathologically altered in the kidney biochemistry, which can mean a serious decrease in the function of the organs.

Other diagnostic methods for renal reflux:

1. ultrasound. To suspect a pathology it is possible by expansion of a renal pelvis.
2. Kidney biopsy. It is necessary for differentiation with other pathologies, in children it is rarely performed.
3. Cystogram. After filling the bladder with a contrast drug, make a series of images, revealing reflux.
4. Excretory urography. Using X-rays, you can reliably identify all types of pathology.

Treatment

If possible, treatment should be aimed at eliminating the cause of reflux - only in this way it is possible to cope definitively with the disease. The duration of therapy is also determined by the cause of reflux: so, with congenital anomalies, it will be the time before surgery. If the cause of reflux is chronic inflammation, therapy can last up to 8 months.

Also the goals of treatment are:

• Restoration of normal urodynamics, passage of urine.
• Reduction of unpleasant symptoms.
• Prevention of complications.
• Removal of the inflammatory process.

Treatment of any type of reflux involves a system of therapeutic or operational measures that will help get rid of both the cause of the disease and its consequences.

Conservative therapy

To reduce the burden on the kidneys and normalize the pressure should follow a diet with a decrease in the amount of salt in the diet to 3 grams or less. The water volume for a particular patient is set individually. In nutrition, you need to give up spicy, fatty and fried foods, do not take alcohol, irritating, sour food and drinks.

In complex therapy baths with sea salt are also used, treatment in sanatoriums. Locally, with the development of cystitis against a background of renal reflux, installations with silver in solutions are performed, with Nitrofural, Solcoseryl, Hydrocortisone. Courses usually make 5-15 procedures.

Of the drugs most often with all types of reflux antibiotics are prescribed, which help reduce the risk of inflammation in the kidneys or its elimination. In a child and adult antibiotics in preventive doses can be applied for several months or years. Usually cephalosporins are prescribed( Cefuroxime, Cefaclor) or penicillins( Amoxiclav, Panklava).Also, instead of antibiotics, it is not uncommon for long courses to recommend uroantiseptics - Furomag, Furagin, fluoroquinolones - Nalidixic acid, Nitroxoline.

Operation

Indications for surgery are:

• No effect of conservative treatment.
• The last( 4-5) stages of the disease.
• Decreased kidney function by 30% or more.
• Rapid progression of renal failure.
• Persistence of the inflammatory process. Relapses of cystitis, pyelonephritis.
• The presence of anomalies in the structure of organs.

Now the preferred surgical methods are endoscopic. Bioimplants are applied, which are injected under the ureteral mouth, forming a valve and, thereby, stopping the return of urine. Such operations can be done at any age, even in infants. They do not require general anesthesia and take only 10-15 minutes.

In more severe cases, ureterocystoneostomy or other surgical interventions may be necessary. Through the operation, strictures are cut, other "problem areas" are removed - scars, stitches, etc. Reconstructive operations can be performed with and without the opening of the bladder, the duration of such interventions - up to 1.5 hours, even longer - if you have to operate bilateral pathology.
On the video about the symptoms and treatment of vesicoureteral reflux:

Prognosis and complications of

Usually timely conservative treatment and surgical techniques give good results. Even after a successful operation, a patient is observed for at least 5 years with half-yearly examinations and urine tests every 3 months. A forecast is doubtful for a serious reason that provoked a kidney reflux( swelling, tuberculosis, etc.).In the absence of treatment, a number of complications are possible:

• Hydronephrosis( dilated capillary system of the kidney);
• Pyelonephritis( inflammation of the kidney of acute, chronic, recurrent nature);
• Nephrolithiasis;
• Bleeding;
• Atrophic processes in the kidney;
• Persistent hypertension;
• Renal failure.