Pyeloectasia of the right, left or both kidneys in the fetus and the baby: causes, symptoms, treatment

The main purpose of kidney structures is the removal of water-soluble substances and liquid from the body. In addition, they participate in blood and blood formation, regulate acid-base balance in the body, etc. Therefore, the disruption of the activities of these organs can cause serious problems. Genitourinary and renal pathologies are now considered quite common among the population. Quite often among them is pyeloectasia.

Kidney pyeloectasia

Renal pyelonectasia is a pathological condition characterized by the expansion of renal pelvis in which the urine is pre-collected before being sent to the urinary structures. Pathology is relatively common in children, and in girls it is found 3-5 times less often than in boys. Although in boys, congenital pyelonectasia passes much faster. The disease is often detected with an ultrasound examination of the fetus in the mother's womb, but treatment is prescribed only after birth. To reveal a pathology it is possible at pregnant women at planned US already with 17 weeks of pregnancy.

Pathology can affect one of the kidneys, or both. The mild forms of the right or left kidney may eventually go away on their own, but if pyeloectasia of both kidneys is detected, then the treatment is only surgical. The disease often becomes a provoker of kidney infections or inflammations. In the international classification of pyelonectasia diseases, the ICD-10 code is assigned to Q62.

Causes and Concomitant Diseases

Usually, abnormal enlargement of pelvis appears with various abnormalities of the urine flow, which occurs for a number of reasons:

• Narrowing of the lumen of the urinary tract;
• Their clogging;
• Twisting of the ureter canal.

Due to these reasons, the accumulated urine is unable to escape from the loch compartments, which expand under its pressure. In early childhood, pyelonectasia is formed due to anomalies in the development of a kind of inflection or congenital narrowing of the ureteral lumen. Also, the expansion of pelvis leads to urolithic pathology, in which the concrement can linger not only in the ureter itself, but also in the renal pelvis.

In general, specialists identify four etiological categories that trigger the development of pyeloectasia:

1. Congenital organic factors associated with abnormalities in the physiological development of the urinary tract, ureter, or the kidney itself;
2. Congenital dynamic causes such as neurogenic urinary disorders or compression of the ureter against a phimosis process;
3. Organic acquired when the ureter narrows due to a traumatic factor. On the background of urolithiasis, renal omission, tumor processes in neighboring structures or inflammatory lesions in the urinary canals, cicatricial changes occur, which leads to narrowing of the lumen;
4. Acquired dynamic factors arising from ureteral spasms, infectious lesions, tumor prostatic or urethral processes. In addition, there can be included cup-pelvic inflammatory lesions and hormonal changes.

If it is a pathology in the fetus, which is quite rare, the reasons are:

• Muscle weakness;
• ureter deformity by organs or vascular pathways due to their anomalous structure;
• Abnormal development of valves at the junction of the pelvis with the ureter;
• Genetic predisposition to disease;
• The presence of abnormal enlargement of the pelvis in the mother during pregnancy;
• Severe pregnancy, especially the first half;
• If a woman in a state of pregnancy suffered acute renal inflammation.

But practice shows that the fetal bilateral pathology is purely physiological in nature, therefore, it passes by itself to the birth. If pyeloectasia exceeds 1 cm, then they speak of renal hydronephrosis. Also pyeloectasia can be accompanied by pyelonephritis.

Forms of severity and consequences

There are several types of renal pyeloectasia: right-sided, left-sided or bilateral. By severity, a mild, moderate or severe form of pyeloectasia is isolated. The degree of severity of the pathological process is determined by the preservation of the functions of the organ, while concomitant and complicating diseases are taken into account.

In general, the expansion of lohans themselves is asymptomatic, and the appearance of pathological signs is caused by concomitant, provoking pathology or the development of complications.

The most common renal pyelonectasia is accompanied by complications such as:

1. Bladder ureter reflux is most common in children, urine is urine at the back of the urinary cavity and back to the renal pelvis;
2. Ureterocele - when the place of docking of the bladder with the ureter expands, i.e. bloating of the ureter;
3. Ureteral prolapse - typical for severe forms of pyeloectasia, in which the ureter grows into the urethra in men or the vaginal wall in women;
4. Valve function disorders in the urethra, which is typical for male patients;
5. Megaureter is a pathological condition, characterized by an increase in ureters in the presence of urinary tract disorders from the lower urinary tract or from the urinary structures;
6. Atrophy of the renal tissues - when there is a pathological decrease in the size of the organ;
7. Acute pyelonephritis is an inflammatory process in the kidney tissues;
8. Reduction of renal function;
9. Dying of renal tissues( renal sclerosis).

In a child, renal pyelonectasia is dangerous because in the future it can cause a malfunction in the normal functioning of the kidneys. The urinary tract obstructs, the tissues of the kidney are compressed, leading to renal atrophy and impairment of the organ. The weak excretion of urine leads to infectious processes and the formation of pyelonephritis, which leads to a decrease in renal function and the development of sclerosis.

Diagnosis

Recognition of pyelonectasia in a newborn is possible by:

• Hyperthermia;
• Lack of appetite;
• Tearfulness;
• Dyspepsia( diarrhea, vomiting).

In older children, abnormalities in abdominal or lumbar region appear with abnormal expansion of pelvis.

Ultrasonic diagnosis of the kidneys and abdominal cavity will confirm the diagnosis. If necessary, an additional examination is performed by means of cystography or urography, radionuclide renography, etc. If abnormal pelvic enlargement is detected in the fetus, then the baby is required to perform an additional ultrasound examination.

Treatment of

The appropriate specialist should be engaged in the necessary treatment and only after a thorough preliminary diagnosis. The main goal pursued by therapy is the elimination of the underlying cause of pathological enlargement.

If pyeloectasia is characterized by a congenital etiology, then the treatment is possible only by surgical methods:

• Urolithiasis - obstructive urinary excretion is removed surgically or conservatively, which is caused by the size of the stone and its sensitivity to stone-adsorbing drugs.
• Constriction of the ureter - in the place of abnormal narrowing, a frame bezel is implanted, which in the professional language of physicians is called stenting.

After the treatment it is necessary to take all possible measures to prevent the recurrence of abnormal enlargement of the renal pelvis. To do this, you must adhere to the optimal drinking regime, avoid unauthorized and uncontrolled intake of diuretics, do not abuse products with a diuretic effect, as well as salty, fatty and fried foods. If pyeloectasia is timely detected and cured, then the risk of developing characteristic pathological complications will be almost minimal, and renal structures will function smoothly.