Kidneys take an active part in hemopoiesis, metabolic and endocrine processes, in the regulation of acid-base balance, and they also concentrate urine. For a minute, the kidneys are cleaned about a liter of blood. Therefore, violations of their activities can adversely affect the state of the body. One of the renal pathologies is hypoplasia, which seriously disrupts renal activity. The disease has an innate origin and is found in 0.08-0.19% of cases.
Hypoplasia of the kidney
Hypoplasia of the kidney is a congenital anomaly of the urinary system, which is characterized by a reduced body weight and size, but the structural structure is normal. From the point of view of histology, the hypoplastic kidney is completely normal and can fully fulfill its functions, only their mass and dimensions are below normal. The study of such a kidney under a microscope shows that the organ has a normal anatomical structure, its innervation and blood supply is normal, the histology is not changed, the normal tubules and glomeruli are clearly distinguished. The code for the international classification of pathologies ICD-10 - Q60.5.
Causes of
Underdevelopment of the kidney, like other anomalies of this kind, are considered by doctors as a deviation during pregnancy. The processes of organ formation in the embryo are disrupted under the influence of internal or external factors affecting the pregnant woman's body.
Among the external factors experts identify:
- Tobacco smoking;
- Alcohol abuse;
- Contusions and traumatic abdominal injuries;
- Radiation exposure;
- Sun abuse;
- Heredity;
- Malaria or deficiency of amniotic fluid;
- Infectious pathologies in pregnancy;
- Venous blockage in the kidneys;
- Abnormal fetal presentation;
- Secondary inflammation;
- Intrauterine pyelonephritis or pathology in children under one year old.
Renal hypoplasia occurs during the intrauterine period. In fact, the kidney is fully functional, but has an insufficient methanephrenic mass with the number of nephrons half the norm.
Forms of
Hypoplasia is classified into several different forms:
- Simple or normonephrosis hypoplasia - the number of cups, nephrons and weight parameters is slightly less than the prescribed one;
- Hypoplasia with dysplasia - underdevelopment is accompanied by structural disturbances in development;
- Oligomeganefrotic is a rare form in which not only the size and weight are reduced, but also the number of lobes and glomeruli. The vascular walls of the kidney thicken, fibrous growths, enlargement of the glomeruli and dilatation of the tubule of the kidney;
- Bilateral - with this form of hypoplasia in both kidneys;
- Unilateral hypoplasia of the right or left kidney.
Concomitant diseases
Renal hypoplasia in half the cases is combined with concomitant pathological conditions such as:
- Cryptorchidism - non-descent into the scrotum of one testicle;
- Bladder exstrophy is an abnormal condition in which defective development of the anterior wall of the peritoneum takes place, and the mucous membrane of the urinary bladder falls out;
- Narrowing of the renal artery;
- Abnormal localization of the urinary canal.
Symptoms of
In practice, if a healthy kidney functions normally and copes with the volume of tasks assigned to it, then a person can live a lifetime without even assuming an anomaly exists. If the healthy kidney begins to work with interruptions, then the underdeveloped kidney is exposed to various pathologies like pyelonephritis, inflammatory processes. There is hypertensive disease, chronic nephropathic hypertension.
Hypoplastic kidney abnormalities can manifest and are more pronounced:
- Patients are concerned about chronic diarrhea;
- Hyperthermia of subfebrile type is observed;
- The child noticeably lags behind in mental and physiological development;
- There are manifestations similar to rickets, such as softening of bones, flat occipital part, bloated abdomen, protruding parietal and frontal parts, curvature of limbs and alopecia;
- Puffiness of the limbs and face, pale skin;
- Frequent signs of nausea, vomiting;
- Hypertensive disease.
If hypoplasia of both kidneys is diagnosed, that is, bilateral, there is no chance of survival after birth, because none of the kidneys are working, and they are not subject to transplantation.
In newborns,
Newborns tend to have an increased incidence of abnormal urinary tract development. Among all the congenital malformations of fetal development, kidney hypoplasia accounts for about a third of cases. Bilateral hypoplasia of the kidneys is usually found shortly after birth, because both kidneys do not work.
The neonate is rapidly developing kidney failure, which often ends in a fatal outcome in the first few days after birth.
Hyperplastic kidney is usually manifested by such symptoms:
- Diarrhea;
- Rickets Clinic;
- Subfebrile temperature;
- General organic intoxication;
- Congenital reflexes like protective, supporting, Galant, etc.;
- Continuous vomiting.
Unilateral hypoplasia is characterized by low concentration function of the working kidney, but the blood thus has normal chemical indices. Arterial hypertension develops somewhat later, already at pubertal age.
In children
In patients of childhood( from year to older), hypoplasia may not be expressed in any way. In such cases, the pathology is usually detected in the diagnosis of acute pyelonephritis or hypertension. You should contact a specialist if the child has such manifestations: jumps of blood pressure, convulsions, a constant desire to drink. Children complain of urine retention, frequent or profuse urination, painful manifestations in the lumbar region or abdomen. There is a characteristic lag in physiological development, etc.
In children, the skin is dry, earthy-pale, around the eyes, edema is formed, other parts of the body are exposed to fluid accumulation. The child complains of severe headaches, his pressure often rises, and in the urine there may be an admixture of blood. In boys, cryptorchidism is a common sign of hyperplasia. Quite often, pathology is revealed when a child's examination passes during registration in a kindergarten or school.
In adults,
In adults, hypoplasia of the kidney is usually manifested only when the influence of certain factors is a violation of the functionality of a healthy kidney. They begin to worry about the pressure, puffiness of the face and limbs, stool disorders and other characteristic symptoms. Constant pressure against the background of a hyperplastic kidney in an adult requires removal of the affected organ, since it can not be cured by medications, and abnormally altered tissues are a favorable medium for the development of malignant tumor processes.
Diagnosis
When examining a patient, a pathologically reduced kidney with a normal or small ureter is detected.
To determine the pathology, various diagnostic procedures are used:
- MRI;
- Urographic study - X-ray of kidney structures with contrast;
- Nephroscintigraphy study of an organ using radioactive materials;
- Radioisotope diagnostics - the radioactive composition is administered intravenously;
- Ureteropyelography - contrast agent is administered by catheterization into the ureter;
- Angiographic diagnosis - when large contrast agents are injected into large vessels.
Treatment of
The exact treatment strategy depends on the patient's condition and individual indicators. Persistent hypertension requires compulsory treatment, if therapy does not work, then removal of the hypoplastic organ is indicated. Such removal is only for adults.
Children with a similar kidney anomaly, provided that a healthy kidney copes with a double load, shows constant monitoring by a doctor, regular examinations and the necessary symptomatic treatment.
In severe forms of pathology with bilateral hypoplastic lesion, surgical treatment is used. The patient is removed from both kidneys, transferred to hemodialysis, and then transplanted to him.
Forecasts
Congenital hypoplastic anomaly can not be corrected. But if a person strictly follows the diet, keeps a healthy lifestyle, observes a sleep-rest regime, then pathology can not bother until the end of life, since a healthy kidney will cope with the tasks assigned.
But if bilateral hypoplasia is very pronounced, the child usually dies from decompensated myocardial insufficiency and uremia. In such a situation, the forecasts are unfavorable, children live about 8-16 years.
Usually children with a hypoplastic kidney are given a disability. If the affected kidney is removed, and with age, as one grows up and adapts to the life with one kidney, disability is removed.