Usually, the expansion of the calyx-pelvic system in babies develops asymptomatically and is detected during an ultrasound examination. These pathologies can occur with various complications and require adequate treatment.
What it is?
A disease in which the renal pelvis is enlarged and enlarged is called pyeloectasia. It is quite common in pediatric urological practice. Routine clinical examination of a child does not detect this clinical sign. It is possible to establish a diagnosis only after conducting auxiliary diagnostic studies.
The pelvis is a structural anatomical element of the kidney. Normally, it is needed to excrete urine.
The pelvis contains a large and small cups. In their cavity, urine accumulates in order to subsequently drain into the urinary tract through the ureter.
Various provoking factors can lead to the development of an enlarged pelvis. In some cases, the condition may be congenital. The first disorders of urination in this situation occur already in a newborn baby or in a baby. Pathology can be in the left kidney or in the right. In some cases, there is an expansion of the calyx-pelvic system of both kidneys.
This state is isolated and not dangerous. It can only cause some adverse effects in the child. In the presence of concomitant diseases of the organs of the urinary system, the presence of pyeloectasia significantly worsens the course of the disease in the future. This often leads to urinary disorders and functional malfunctions of the kidneys.
Norm
The size of the pelvis in babies changes and depends on age. There are special age tables of normal values that allow doctors to identify abnormalities during ultrasound examination. So, the size of the calyx-pelvic system in a baby at 1 month will be significantly less than in a baby at 4 years old.
Normally, the pelvis looks like a funnel with a slit opening for the passage of urine. Modern diagnostic methods make it possible to determine its size even during pregnancy. Usually, it is possible to measure the parameters of the pyelocaliceal system already at 16-18 weeks of intrauterine development of the baby.... This is achieved using high-resolution ultrasound.
Usually, in a newborn baby, the size of the renal pelvis does not exceed 10 mm. On average, it is ½ cm. The size of the pelvis in a girl may differ slightly from that in boys. The open form of the organ is needed to drain urine into the ureter. As the child grows up, the size of the pelvis also increases. With an increase in these indicators, they talk about children's pyelectasis.
Factors
Several reasons can lead to the development of this condition in babies. If signs of enlargement were detected during the mother's pregnancy or immediately after birth, then in this case they speak of the presence of congenital pyelectasis. This condition is recorded more often in those mothers who have various pathologies during gestation or suffer from chronic kidney disease.
Among the most common causes leading to the development of pyeloectasia in a child are the following:
- Various anatomical defects in the structure of the ureter... These pathologies contribute to the physiological excretion of urine and provoke the expansion of the pelvis. Violation of urination contributes to the development of arterial hypotension in the child in the future.
- Bladder dysfunction. They can be caused by various reasons. They often manifest as impaired urination. In this condition, the total amount of urine excreted increases, as well as the urge to urinate significantly increases.
- Various neoplasms and obstructions in the urinary tract for urine excretion... Most often, this is caused by tumors or cysts that significantly block the lumen of the urinary tract. These conditions contribute to the accumulation of urine, which leads to a pronounced expansion of the pelvis.
- Excessive accumulation of fluid inside the body. This condition occurs with various diseases of the internal organs, which are characterized by a tendency to form edema. It can also be a manifestation of problems in the work of the heart and blood vessels.
- Infectious diseases. Many bacterial infections, rapidly spreading throughout the body, reach the kidneys and urinary tract through the bloodstream. Once in these organs, they cause a strong inflammatory process there. The consequence of this condition is a violation of urine excretion. Long-term and chronic bacterial infections often cause persistent pyelectasis.
- Weakness of the genitourinary muscles... This condition is typical for premature babies. In such children, intrauterine organogenesis is impaired. The longer the term of prematurity, the higher the risk of developing pyelectasis and renal diseases in the child in the future.
Symptoms
Most children's pyelectasias are asymptomatic. Typically, these forms account for more than 75% of cases.
An asymptomatic course is also characteristic of the early stages of expansion of the calyceal-pelvic system, when there are still no functional disorders.
In the later stages of the disease, adverse symptoms appear.
The most characteristic signs of enlargement include various urinary disorders. In this case, the portions of urine may change. Certain medical conditions cause the child to have strong and frequent urges to urinate. If the baby began to wake up often in the middle of the night and run to the toilet, then this should alert the parents and motivate them to seek the advice of the child from a pediatric urologist.
Bacterial kidney disease can occur with an increase in body temperature and symptoms of intoxication. They are also accompanied by a violation of urination. In some cases, the child develops soreness while using the toilet. The severe course of the disease is accompanied by a change in the baby's behavior. He becomes more moody, lethargic and apathetic.
Diagnostics
The main diagnostic method that allows you to accurately diagnose is ultrasound examination of the kidneys. This study can be carried out in children from the first months after birth. Ultrasound does not bring any pain or discomfort to the child.
During the study, the doctor will be able to identify all existing abnormalities in the structure of the kidneys and urinary tract. With the help of ultrasound, you can describe the size and structure of the pelvis, as well as determine the volume of residual urine. On average, 15-20 minutes is enough to conduct a study.
An ultrasound examination of the kidneys and excretory tract should be carried out for all babies with predisposing risk factors.
In difficult clinical cases, doctors resort to the appointment of MRI. Using this method, it is also possible to obtain a very accurate characterization of the structure and size of all anatomical components of the kidneys. The study has a number of contraindications and is carried out for differential diagnosis. A significant disadvantage of this test is its high cost.
To assess functional disorders in the work of the kidneys, a general urine test is prescribed. This simple and routine test provides a baseline for kidney function. To detect kidney failure, you need to know the level of creatinine. An excess of this indicator above the age norm indicates the presence of serious problems in the work of the kidneys. and the entire urinary system.
Treatment
Finding signs of enlargement of the renal pelvis in a child should in no way horrify parents. This condition is quite often recorded in children's practice.
If pyelectasis is detected during the period of intrauterine development of the baby, then expectant tactics are used.
In this case, obstetricians-gynecologists during the entire pregnancy control the growth and development of the fetus in order to prevent the development of complications or physiological pathologies.
Usually babies under three years old also do not undergo specialized treatment without special indications... So, if there are no significant functional disorders in urine excretion, then the appointment of therapy is not required. The child's condition is monitored by a pediatric urologist or nephrologist. Usually, a baby with pyeloectasia should see a doctor at least once a year.
In the presence of inflammatory kidney disease, accompanied by signs of enlargement of the pelvis-calyx system, symptomatic therapy is required. Diuretics are used to improve urinary excretion. Course or regular use of them helps to improve urination. They also improve kidney function and help prevent dangerous complications.
If, during the diagnosis, bacteria were detected in the urine, which provoked the appearance of pyeloectasia, then a conservative treatment regimen is prescribed. It necessarily implies the appointment of antibacterial drugs. Usually these medications are prescribed for 10-14 days. After carrying out, a repeated urine culture is required to establish the effect of the therapy.
If tumor formations or cysts are the cause of pyeloectasia, then surgical treatment is often required.
The decision on the operation remains with the urologist. It is he who decides the need for surgical treatment. Usually, such operations are performed on babies at an older age. After the operation, the kids remain on the dispensary with a urologist for several years.
For what pyelectasis is and what complications it can lead to, see the next video.
