Multicystosis of the kidney - a disease that is also called multicystic dysplasia, refers to congenital malformations of the fetus, is observed in 1.5% of cases of all the abnormalities of the urinary system. Boys get sick 2 times more often than girls.
Multicystosis of the kidney
With multicystic dysplasia, the working tissue of the organ( parenchyma) is replaced by numerous cysts. Multicystosis kidney was assigned the code Q61.4 for ICD-10.
Violation is detected in the fetus during screening, which is carried out at 12, 20, 32 weeks. In bilateral injury, it is recommended that the pregnancy be terminated, since with a similar violation, the newborn has no way of surviving.
With unilateral lesion in 55% of cases, multicystosis develops on the left side. The defeat of the right kidney in 5-10% of cases is accompanied by hydronephrosis, in 15% of cases there is vesicoureteral reflux. There are also developmental defects such as absence of ureter, deformed pelvis.
In half of the cases, multicystic kidney dysplasia is accompanied by anomalies in the development of other organs.
The multicystic kidney is small in size at birth, but as urine accumulates in the tubules and cysts, it increases, which is determined by palpation of the abdomen.
Cysts are small-diameter cavities filled with a glomerular filtrate - a light liquid, partially reabsorbed, capable of swelling and causing complications.
Reasons for
The cause of the pathology is a violation of the outflow of urine, resulting from a developmental malformation. This condition is characterized by the formation of structures secreting urine, in the absence of an excretory apparatus.
This phenomenon occurs in 4-6 weeks of pregnancy. To cause multicystosis of the fetus are unfavorable external factors accompanying the bearing of the child.
The course of the disease
In adults, multicystosis is often detected accidentally during an ultrasound examination during treatment of another disease. With such a disease a person can live without knowing about the disease. It is not uncommon for cases when congenital pathology is detected only after death at autopsy.
The child's blood pressure rises, the stool is broken. With a more favorable course of multi-cystic dysplasia, the diseased kidney contracts, diminishing in size. The sore organ does not function, and the whole load on urinary excretion falls to the share of a healthy organ.
Diagnostics
Diagnostic value has a kidney ultrasound, which allows you to find in its place a conglomerate consisting of a number of closed cavities( cysts) of various diameters. Cysts reach a diameter of 0.8-4 cm at the end of the gestation period of the child.
In the fetus and in the child, instead of the kidney, a variety of closed cavities are found, unconnected, filling the entire volume of the kidney. In adults, sometimes there is no kidney in ultrasound, which may indicate multicystic dysplasia at birth.
Diagnostics also uses:
- computed tomography;
- excretory urography examining the work of the kidneys;
- radionuclide scanning;
- arteriography.
Multicystosis is diagnosed according to arteriography data, which indicates that there is no renal artery in the organ, there is no blood circulation. According to computed tomography, one can see a conglomerate of many separate cavities clearly separated from each other.
Urine examination includes analyzes for the content of leukocytes, protein, erythrocytes, specific density of urine. On developing renal failure may speak a decreased protein in the blood.
Multi-cystic dysplasia is differentiated with malignant formations, polycystosis.
Treatment and predictions of
Can multicystosis resolve? Indeed, the one-sided multicystic kidney in adults disappears with time and is not determined by ultrasound. With the unfavorable course of the unilateral form of the disease, the cysts grow in the child, the surrounding organs are squeezed, causing pain in the lumbar spine.
Multiple cysts in the damaged kidney are not able to resolve, on the contrary, with age they are calcified, and, in addition, there is a danger of inflammation of the contents of the cysts, their growth, malignancy with the formation of nephroblastoma.
In case of danger of such complications, the altered kidney is surgically removed using:
- laparoscopic nephrectomy - gentle endoscopic intervention performed through point punctures;
- of open nephrectomy - an operation that is performed through an open incision requires a prolonged postoperative period.
In any method of nephrectomy and provided a healthy collateral kidney, the patient after the operation can lead a normal life, following a diet, avoiding hypothermia, infectious diseases.
Danger of pathology
The kidney can greatly increase in size in a child after birth, sometimes it reaches huge sizes. The organ presses on the tissues nearest to it, nerve endings, squeezes blood vessels.
Cysts can become inflamed and inflamed. The accumulation of pus can cause a rupture of the cyst and pus in the surrounding tissues.
Multi-cystic dysplasia of the kidney can be complicated by high blood pressure, unresponsive to medication. A similar condition is eliminated when a multicystic organ dysplasia is removed.
There is a danger of complication of Williams malignancy, which develops from the connective tissue of the kidney. Even with complete replacement of the parenchyma with cysts, the risk of nephroblastoma remains, which makes the operation of removing the multicystic kidney desirable.