There are some diseases that are considered finds. That is, they can only be detected by chance, when examined for other pathologies. These "hidden" ailments include renal pyelectasis. The accidental discovery of this pathology raises many questions - what it is, where it came from and how to treat it. You will learn about all this from this article.
What it is
Kidney pyelectasis is a condition in which the renal pelvis, and sometimes the calyx, expand. In itself, this is not dangerous, but the expansion causes certain changes in the work of the genitourinary system, provoking inflammatory processes. The outflow of urine is impaired, which is a prerequisite for the development of various diseases of the kidneys and urinary system.
You cannot feel the pathological enlargement of the pelvis, the disease is completely asymptomatic, which is why it is considered an "accidental find".
The very fact of detection makes it possible to explain why the child has other problems with the genitourinary system. In other words, pyelectasis is considered as the root cause.
School knowledge in the field of physics is quite enough to understand how exactly the expansion of the pelvis occurs. If the outflow of urine in some segment of the urinary tract is disturbed, the paths are narrowed, there are obstructions, then the pelvis overflows and, as it were, stretches. From here it becomes clear why in boys, pathology is more common than in girls by about 4 times... The girl's genitourinary system is designed so that stenosis is possible only in rare cases, while in a boy, narrowing of any part of the urinary tract is not at all uncommon, and quite often it is normal, that is, physiologically determined.
Pyeloectasia can be found in the fetus for ultrasound in the antenatal clinic. Less often, pathology can be found in newborns, since ultrasound diagnostics is not included in medical examinations in the first month of a baby's life. But in infants, it is quite easy to detect enlargement of the renal pelvis, if at 3 months or 1 year old, during a compulsory scheduled medical examination in a polyclinic, the child is given an ultrasound of the kidneys.
But this type of study is not always done, and therefore often pathological enlargement can be found much later, when the baby begins to disturb something and an ultrasound of the kidneys is required. Many people learn about this diagnosis only in adulthood.
Causes
In about one in ten children with pyelectasis, the causes are congenital. They are formed under the influence of some unfavorable factors even while the child is in the womb:
- narrowing of the lumen of the urethra;
- lesions of the central nervous system, which are reflected in dysfunction of urination;
- anomalies in the development of the kidneys, ureters, urethra due to "mistakes" when laying organs;
- urethral stenosis;
- disturbances in the work of the circulatory system.
We should also say about phimosis. For newborn boys, narrowing of the foreskin is a physiological congenital norm.
For most of them, this phimosis goes away on its own. A small percentage of children with persistent phimosis is the risk group for the development of pyelectasis.
More often, pyelectasis is acquired in nature. The pelvis and cavities of the kidneys are able to expand under the influence of certain internal processes:
- violation of hormonal levels;
- inflammatory diseases of the genitourinary system (cystitis, pyelonephritis and others);
- acute infectious diseases, poisoning with chemicals and toxins that increase the burden on the kidneys;
- trauma to the pelvic organs;
- tumors;
- diabetes;
- urolithiasis and salt deposition.
Stenosis (narrowing) can occur in one of five areas:
- urethra and bladder;
- external pressure on the ureter;
- kink of the ureter;
- a narrowing or other obstruction in the lumen of the ureter;
- changes in the structures of the walls of the ureter and upper sections.
Acquired reasons can be due to and quite physiologically - premature babies have a weak abdominal wall, the muscles of the urinary tract are not well developed, therefore, pathology is often found in children who were born earlier than the prescribed obstetric term. Organs in newborns grow unevenly, in some cases, the load on the kidneys, which "do not keep pace" with the growth rates of other organs, becomes so great that the pelvis begins to expand due to the accumulation of fluid.
The most "dangerous" age from the point of view of the development of pyelectasia, when the growth of the child is the most rapid, is 5-6 months, 1 year, 3 years, 5-7 years.
Types of disease and symptoms
Since the kidneys are a paired organ, the disease can be unilateral or bilateral. The unilateral form is more often represented by pyeloectasia of the left kidney. Pyelectasis of the right kidney occurs 45% less frequently. Pathological enlargement of the pelvis of both kidneys (bilateral form) is quite often characteristic of children. The one-sided form is also not uncommon in childhood, but more typical for adults.
There are three degrees of ailment, they are determined by the degree of damage: mild, moderate and severe. If not only the renal pelvis, but also the cups of these organs (cavities) are expanded, then the ailment is called calicopyelectasis.
With a unilateral disease, there may be no symptoms at all, because with pyeloectasia of the right kidney, the left kidney takes over its functions and vice versa.
The compensatory abilities of the child's body are incredibly high. Some signs that should become a "wake-up call" can be observed (but not necessarily!) Only in bilateral pathology. In this case, the likelihood of complications increases. And as soon as they begin, the child is taken to see a doctor who prescribes an ultrasound of the kidneys and the fact of pyelectasis becomes obvious.
Most often, the expansion of the pelvis causes:
- pyelonephritis;
- urethrocele;
- prolapse of the ureter.
In order to prevent such and other equally serious diagnoses, at the first suspicion of a malfunction in the kidneys, you should immediately take the child to a doctor... Parents should be alerted to signs such as swelling of the arms and legs, face, especially in the late afternoon, cloudy urine, blood in the urine, frequent or rare urination, pain when emptying the bladder, deterioration in the child's general well-being, frequent headaches, pulling pains in the lumbar region.
Diagnostics
You can notice a pathological expansion of the renal pelvis in a child on an ultrasound examination, from 18-20 weeks of pregnancy... An attentive diagnostician is able to discern pyeloectasia in a baby boy already from the 17th week of pregnancy... An expectant mother in no way needs to panic if such a conclusion has been voiced. The fact is that in many cases the expansion of the renal pelvis can be physiological and will go away on its own.
Sometimes the problem is first discovered in the fetus shortly before delivery - at 34-36 weeks of gestation... In this case, you should not be nervous either.
For a pregnant woman, after establishing the fact of a possible pyeloectasia in a child, enhanced monitoring is carried out.
After the birth of a child, neonatologists must be examined with the involvement of a urologist and nephrologist. Often the observation is maintained until the child is one and a half years old. It is by this age that many babies have the problem solved by itself. If this does not happen, the question of treatment is decided.
Medical diagnostic control for children with a mild degree of the disease is carried out every six months - they do an ultrasound scan, evaluate the dynamic indicators of urine tests. The average degree of pathology needs to be diagnosed every three months. And only a severe form of the disease requires urgent medical measures and follow-up.
Echographic signs of pathology - expansion of the size of the pelvis. Normally, the size of the pelvis in the fetus up to 31-32 weeks of gestation should not exceed 4 mm. At 36-37 weeks, the renal pelvis normally increase to 7 mm. If the expectant mother is told that the fetal renal pelvis exceeds 10 mm, this is an alarming signal that indicates the possible development of pyelectasis.
The size of the kidney pelvis for children after birth - 6-7 mm, a slight excess of up to 8-9 mm can be considered an individual inherited feature. In children over 3 years old, the size of the pelvis can be within 8 mm. Exceeding the threshold of 10 mm at any age is the basis for visiting a nephrologist and urologist.
Treatment
An easy degree of pathological enlargement of the pelvis does not need special treatment, dynamic monitoring of the child's condition is sufficient, he can be prescribed a referral for urine tests a little more often than other children. The average degree does not always require treatment. Quite often, doctors choose observation tactics, because the problem in a growing child's body may well be resolved on its own.
Severe and moderately severe forms of pyeloectasia most often require surgical intervention, even in an infant. Surgical intervention is recommended in the case of moderate bilateral expansion of the pelvis or in the case of severe pyelectasis of the right or left kidney.
The main goal of the operation is to restore the patency of the urinary tract, so that nothing more interferes with the passage of urine, so that fluid does not accumulate in the pelvis and does not expand them.
The operation itself is not considered traumatic; it is performed without direct incisions. To achieve the goal, the endoscopic method is sufficient.
Miniature instruments are inserted directly through the urethra, all manipulations are performed by the surgeon, checking the picture on the monitor, which is "broadcast" by a microscopic camera located on the endoscope. The narrowed paths are widened, the obstacles (salt deposits) are removed. If the ureters are curved, they are returned to normal. After the operation, which is carried out under general anesthesia, the child receives a course of anti-inflammatory drugs to avoid infection and the development of postoperative inflammation.
If the operation was performed at an early age, there is a possibility of a relapse of the diseaseand. During the period of rapid growth (at 5-7 years old), pyelectasis often returns, but this usually occurs in a less complex and severe degree. therefore reoperation is not always necessary.
There are no specific drugs for the conservative treatment of pyelectasis. In some cases, the doctor may prescribe symptomatic treatment - drugs to relieve swelling, diuretics, antibiotics. But usually there is no need for them in milder forms of the disease. And in severe cases, the drugs are powerless, it is the operation that is needed.
Folk remedies, herbs and homeopathic medicines cannot cure this ailment. Therefore, you should not give your child parsley broths and give homeopathic drops advertised as "the best remedy for all kidney problems."
Recommendations for parents
If the child has mild or moderate pyelectasis, do not panic. Doctors will provide competent monitoring of the baby's condition. And from themselves, parents can only make sure that the load on the kidneys is minimized as much as possible. For this:
- the amount of fluid consumed should be limited, the amount drunk should not exceed the age norm;
- it is imperative to keep track of how much the baby is peeing - ideally, the amount allocated is slightly less than or equal to the amount drunk;
- the child should not be hypothermic, sit on cold surfaces;
- all infectious diseases (ARVI, influenza and others) should be treated under medical supervision, since the load on the kidneys increases during the period of illness, self-medication is completely excluded;
- special attention should be paid to taking medications. Many tablets and syrups for children with kidney problems are contraindicated or dosed strictly individually.
For how the kidneys work, see the next video.
