The sick body is different from the healthy one because it shows changes. There are 2 types of this phenomenon - diffuse and focal changes. Diffuse affects the entire body, greatly reducing its functionality. Such damage to the kidney is no less dangerous than focal.
Diffusive changes in the kidney parenchyma
The kidney consists of a parenchyma and a system of accumulation and excretion of urine. The outer part of the parenchyma consists of glomeruli, surrounded by a developed circulatory system, and the internal part - from the renal tubules. The latter form the so-called pyramids, through which the liquid enters the calyx and pelvis - the components of the excretory system.
The thickness of the parenchyma varies with age - thinning. For young people, a thickness of 16-25 mm is considered the norm. In the older age group - more than 60 years, the thickness of the parenchyma rarely exceeds 1.1 cm.
Despite the fact that the kidney is protected by a fibrous capsule, the renal parenchyma is quite vulnerable. The incoming blood carries the products of decay, metabolism, toxins and so on, so that the kidneys often react first to changes in the body.
Diffuse changes are usually accompanied by changes in the size of the organ itself, to the same extent in both children and adults. As a rule, with acute diseases the parenchyma thickens, and with chronic diseases it becomes thinner. And in old age thinning is observed and because of purely age-related changes. Thinning of the parenchyma in childhood testifies to the seriousness of the situation.
Diffuse changes in the kidney in a newborn can be caused by a variety of causes, like congenital malformations - polycystosis, congenital nephrotic syndrome, and acquired pyelonephritis, secondary organ damage. Due to the peculiarities of the newborn's body, changes are rapid and especially dangerous.
On the other hand, up to 3 years the kidney of the child has a lobular structure, which on ultrasound is visualized very specific. If no signs of an ailment are observed, then the process is not pathological. If there are other signs of the disease, diagnosis is necessary.
Causes of
Diffuse changes can be caused by different reasons, but in any case this is a reason to be carefully inspected.
Beginning urolithiasis - at the first stage in the pyramids formed by the tubules, plaques form. Later they can turn into stones. On ultrasound, they appear as hyperechoic inclusions.
A special place is occupied by calcinates - accumulating particles of dead kidney tissue, covered with deposits of calcium salts. Such changes are diffuse, do not depend on age or sex. The appearance of calcites is not the disease itself, but a sign that indicates an abnormal diet, a metabolic disorder, or the appearance of an inflammatory disease. Single calcinate does not pose a danger, but their multiple appearance may be a sign of cancer.
- Congenital changes - the same polycystosis, for example.
- Age-related changes - the parenchyma is thinned and partially changes the structure. Thinning in young people indicates an untreated or slow chronic inflammation and needs treatment.
- Chronic inflammatory diseases - glomerulonephritis, for example, urolithiasis, of course, affect the condition of the parenchyma.
- Overgrowth of fatty tissue - fatty formations block the outflow of fluid, which leads to its accumulation. And this, in turn, provokes inflammation of adipose tissue and blood vessels. The disease leads to hyperechogenous parenchyma.
- Cysts - in parenchymal tissue they are a great danger compared to cysts in other areas. The cyst is a limited cavity with fluid or serous secretion. The dimensions of the usual do not exceed 8-10 cm. Education compresses surrounding tissues, which leads first to their dysfunction - a violation of the outflow of urine, and then to death. If the cyst is single and does not increase, only observe it. If the formation is multiple, then an operation is scheduled for removal.
Children have a congenital form, in adults, as a rule, over 50 years old - acquired. Usually, cysts affect one kidney, most often the left kidney. With congenital polycystosis, both kidneys are damaged. In 2/3 of cases, children with this disease are born dead. Benign tumors - adenoma, oncocytoma. They are accompanied by the appearance of blood in the urine, painful symptoms in the lower back, oligouryuria.
Regardless of age or sex, damage can occur in both or one kidney. Risk factors are overweight, smoking, diabetes and malnutrition. If after examination serious violations are not revealed, it is the diet and smoking cessation that becomes the guarantee of the restoration of the functionality of the organs.
Types of
Several classifications are used to determine diffuse changes.
According to the change in the parenchyma,
- is distinguished by an increase in the size of the kidney due to inflammation. The parenchyma is usually compacted;
- decrease in size, which is typical for chronic ailments;
- thickening of the parenchyma - it should not exceed 25 mm;
- thinning - allowed in old age, but is a sign of damage in groups under 50 years old. This includes deterioration of the sinus structures - compaction due to the formation of stones or the deposition of atherosclerotic plaques or the formation of a cyst.
In acute disease, the symptoms are completely hidden by the signs of the underlying ailment:
- Enlargement of the kidney in size causes almost any inflammation. For adults this is most often glomerounelritri acute pyelonephritis. Within 8-10 days the disease is asymptomatic, then there is vomiting, nausea, dyspnea, pain in the heart, headaches. At this stage, the ailment can already be diagnosed with ultrasound or a puncture biopsy. Characterized by the appearance of puffiness. In chronic course, the clinical picture is blurred, but the hyperechoic nature of the kidneys can suggest the cause of the poor condition.
- A decrease in size is a consequence of almost any chronic disease, the same pyelonephritis, for example. At the same time there is a change in the size of the organ, asymmetry, thinning of the parenchyma - as a rule, uneven. These signs indicate the progression of the disease, even if the external signs are poorly expressed.
- Thickening of the parenchyma and asymmetry of the organs accompanies the appearance of a cyst, for example. The first signs of it are edemas. The latter cause disturbances in the capillary permeability, which leads to an increase in pressure.
Because of AD, stagnant phenomena develop, the absorption of the fluid decreases, as a result, urination is impaired. There is severe pain, burning sensation when urinating, there is hematuria. The kidney with the cyst increases in size and the fibrous capsule begins to squeeze it. This causes the appearance of low back pain.
When forming tumors, there are similar signs. The pain is given to the hypochondrium, the asymmetry is sometimes so great that it is found when palpating. Chills and fever are added.
Thinening of the parenchyma - both age-related and conditioned by the transferred diseases according to the symptoms is similar to renal insufficiency. The death of a part of nephrons leads to a decrease in the functionality of the organs, which provokes a typical for insufficiency of symptoms - nocturia, a decrease in diuresis, a change in the composition of urine and blood, and so on. Treatment in this case is urgently needed, since diffuse changes, if ignored, can easily lead to chronic kidney failure.
ultrasound as a method of investigation in this case is so significant that there exists and applies a classification indicating the degree of visualization of the change on the monitor with ultrasound. A healthy kidney tissue is characterized by normal echogenicity. Elevated hyperechoogenicity is characterized by damaged tissue.
On this feature diffuse changes are distinguished:
- are clear and fuzzy;
- weak( moderate);
- expressed.
Diagnosis
The determining method of examination is ultrasound. In fact, these changes are recorded only with the help of this study. On the monitor of the device, changes are visualized as areas with increased echogenicity. It can be cysts, tumors, stones, sand and so on. A healthy tissue has a homogeneous structure and the same echoes.
The decoding of ultrasound is performed only by a doctor. Whatever the averaged indicators, when decoding and the more diagnostics it is necessary to take into account the patient's anamnesis and its condition.
If any abnormalities in the structure are observed, the doctor describes them in conclusion:
- Echocardiosis, microcalculosis - in the organs, stones or sand are found.
- Voluminous formations - cysts, tumors, abscesses.
- Echo-positive formation - most often a cancer tumor is implied. It has uneven contours, is heterogeneous, that is, areas with increased and reduced echogenicity are combined. Echonegative sites due to hemorrhage or necrosis may also be observed.
- Hyperechoic - cyst, lipoma, adenoma, fibrolipoma and so on. These formations are homogeneous in structure, similar to paranephric fiber.
- In relation to the cyst, the term "anehogenous formation" is also used. Moldings have clear contours, are filled with homogeneous contents.
In amyloidosis, there is an increase in the echogenicity of the cortical and cerebral substance, and in the areas of hyperechoogenicity, the boundaries between them are indistinguishable, and in zones with normal echogenicity are clearly traced. This sign-the indistinguishability of the boundaries between the layers-is considered characteristic of the diffusion change.
In addition to the above, ultrasound data can record:
- changes in the sine of the kidney;
- disorders in blood supply and vasoconstriction;
- thromboses and even signs of its formation;
- presence of fluid in the pelvis;
- lack of circulation in the renal veins or the presence of a reverse blood flow.
- MRI or CT - localizes the location of stones, tumors, cysts and any other formations. If necessary, surgical intervention, this method is the most informative.
- Excretory urography is an x-ray method of investigation, which involves the introduction of special contrast agents. The latter are assimilated by a healthy and damaged tissue in different ways, which allows to establish the functionality of the organ with very high accuracy.
We can not discount the laboratory studies. For example, pyelonephritis does not give any clear picture with ultrasound - CT provides better results. But the standard sample Zimnitsky - urine analysis for 24 hours, is very indicative.
With pyelonephritis or chronic insufficiency, the urine density is noticeably lower than the blood plasma density, indicating insufficient water absorption:
- Urinalysis provides important information about the functionality of the kidneys. The detection of erythrocytes, protein, leukocytes, excess or lack of creatinine - all these factors indicate a particular ailment that can cause diffuse changes in the kidneys.
- Blood test - the most important indicator is the ratio of serum creatinine and urea levels with the concentration of the same substance in the urine. On the deviation from the norm, a primary diagnosis is established.
- To refine it, more specific studies are used - functional tests, biopsy and so on.
Diffuse changes in renal parenchyma on ultrasound:
Treatment of
Diffuse changes in the parenchyma and sinuses of the kidneys are not the disease itself, but only its consequence. It is necessary to treat a primary illness, whatever it may be.
With urolithiasis, therapeutic methods are preferred. Selection of medicines and diet - the last is mandatory, depends on the nature of the stones: ring, phosphate, urate. When it comes to sand and stones with a size of no more than 0.5 cm, the drug course is usually sufficient. In the presence of stones of greater magnitude, they resort to ultrasonic crushing. At the initial stage of the disease - the deposition of plaques in the pyramids, sometimes it turns out that there is enough nutrition.
In children, the appearance of stones is extremely rare.
Usually it is associated with congenital anomalies or with a urinary tract infection:
- Cysts - a single stable cyst of the right or left kidney needs only observation. If the formations set or cyst reached a large size - more than 5 cm, resort to treatment. In relatively mild cases, drugs are prescribed. If necessary, resort to surgical. This laparoscopy - the removal of the cyst with the installation of drainage in the retroperitoneal region, is more often assigned when the formation is unsuccessful. Puncia - a puncture of the cyst, in which the liquid from the cavity is aspirated and filled with alcohol.
- Glomurolonephritis, acute pyelonephritis and other inflammatory diseases. Treatment necessarily includes an antibiotic - fluoroquinolones, ampicillin. Children are more often prescribed cephalosporin. If necessary, after receiving the results of bacteriological inoculation, the antibiotic can be replaced. Operative intervention is possible only if the conservative patient has not given results.
- In the formation of tumors, an individual program is assigned. If the tumor is benign, does not increase in size and does not affect the functionality of the organ, then only observe the formation. Otherwise, a resection is prescribed-elimination, or nephrectomy-excision of the kidney.
- Treatment of cancerous tumors is necessarily supplemented by chemotherapy.
- Treatment of chronic diseases - renal failure, chronic pyelonephritis and so on, is determined by the stages of the disease and the patient's condition. However, antimicrobial therapy is also its basis.
Diffuse changes in the parenchyma are not an independent disease. This is a consequence of other diseases, possibly only at an early stage, but having an effect on kidney function. For this reason, how to treat depends on the underlying form of the disease.