The appearance of fluid in the kidneys: causes and treatment methods

Kidneys are internal organs that cleanse the blood by removing toxic substances dissolved in urine and maintain the body’s water-salt balance. In a healthy person, the kidneys do not allow excess water to be retained in the body.

A variety of reasons lead to a slowdown in the removal of fluid from the body. Fluid in the kidneys fills the renal pelvis and calyces, creating additional stress on the organ, leading to the development of a disease called hydronephrosis.

Etiology

Initially, it is worth noting that a distinction is made between congenital and acquired hydronephrosis. Congenital hydronephrosis can occur as a result of the following factors:

• urinary tract obstruction;
• incorrect channel location.

As for the acquired form of this kidney disease, as a rule, it can develop against the background of the following diseases:

• inflammatory processes in the genitourinary tract;
• urolithiasis disease;
• tumors of the uterus, urinary tract, prostate and ovaries;
• metastases, malignant processes in the abdominal cavity;
• spinal cord injuries that lead to disruption of the natural outflow of urine.

In addition, disturbances in the process of natural outflow of urine may be due to anatomical features.

Causes of the disease

The causes of the disease are insufficient functionality of the ureteral valves, leading to reverse flow of urine.
Doctors find it difficult to determine the causes of the disease with 100% probability, but there are many factors that provoke the accumulation of fluid in the paired organ:

1. Obstructions and/or genetic disorders of the direct flow of urine formed in the ureter, bladder;
2. Insufficient functionality of the ureteral valves, leading to reverse flow of urine.

Important! Congenital hydronephrosis has the following main diseases: dysthenesia, abnormal development of the urinary system, obstruction. The acquired disease basically contains urolithiasis, benign/malignant neoplasms, and other urological pathologies

Stages of development

There are three stages of hydronephrosis of the left (right) kidney:

• compensated stage - at this stage, urine accumulates in the pelvis system in small quantities. Kidney functions are preserved almost completely.
• hydronephrosis of the 2nd degree - there is a strong thinning of the tissue, which leads to a decrease in the performance of the organ by 40%;
• third stage - the organ almost completely fails to cope with its functions, chronic renal failure occurs.

Hydronephrosis: definition, classification of pathology

Hydronephrosis or the accumulation of water in the kidneys is a pathology in which expansion of the renal collecting system occurs, leading to atrophy of the parenchyma
Hydro - water, nephro - kidney, in Latin the translation of the name of the disease speaks for itself: the concentration of fluid at a local point. Moving into the acute stage, the pathology leads to the destruction of renal functions, disruption of metabolic processes and infection of the patient’s entire body.

The disease can be diagnosed immediately after birth - a congenital variant or during life - acquired. The pathology can affect one or both kidneys, while bilateral inflammation disrupts the outflow of urine in the lower reaches of the urinary tract: the ureter, urethra.

The disease is classified into three degrees:

1. The first degree is manifested by a slight expansion of the pelvis due to increased pressure on its walls. At the same time, the organ still retains 100% of its functions.
2. The second degree is a moderate or significant expansion of the pelvis and cups. The accumulated fluid in the kidneys puts pressure on the parenchyma, blocks the tubules, the functionality of the organs is preserved by 40-45%;
3. The third degree is characterized by atrophy of organ tissue, and the process is already irreversible, leading to complete death of the kidney and a threat to the patient’s life.

Symptoms

At the early stage of the disease, there are practically no symptoms. In some cases, the patient may complain of the following symptoms:

• colic;
• more frequent urination, which does not bring adequate relief;
• a feeling of heaviness in the area where the organ is located.

Symptoms of hydronephrosis

As congenital or acquired hydronephrosis develops, a dull, aching pain in the lumbar region may be felt. The localization of pain depends on which kidney is affected. The following symptoms can be observed:

• lower abdominal pain;
• weakness;
• elevated temperature;
• nausea;
• attacks of pain in the area where the organs are located;
• bloating;
• high blood pressure.

If the patient has an elevated temperature (more than 37 oC), this indicates the onset of an infectious process, especially when hydronephrosis is suspected in children.

In some cases, the patient does not experience the symptoms described above, except for one thing – urine mixed with blood. Such a violation requires immediate examination by a doctor.

Diagnosis of hydronephrosis (kidneys)

Modern diagnostic methods (ultrasound, fluoroscopy, CT, MRI), as a rule, allow not only to identify hydronephrosis, but also to determine the cause of the development of hydronephrosis, as well as to plan surgical intervention.

Hydronephrosis of the left kidney

Hydronephrosis of the left kidney is one of the most common diseases of the genitourinary system. The main trigger is a stone, which can block the flow of urine. In this case, if the stone enters the urinary canal, bilateral hydronephrosis is considered.

The first and most common symptom of this disease is pain on the left side, which radiates to the leg. There is also a painful outflow of urine mixed with blood and mucus. In some cases, the patient cannot urinate, although the urge to urinate is present.

If these symptoms occur, you should immediately consult a doctor for an accurate diagnosis and immediate treatment. Surgery is almost always prescribed.

Laboratory research

To identify the first signs of the disease and make a preliminary diagnosis, laboratory tests are used: blood test, urine test, Zimnitsky and Nechiporenko tests. A urine test for hydronephrosis shows an excess amount of red blood cells and protein. When the amount of creatinine and urea in the blood is increased, there is likely to be a deterioration in kidney function, with urine retention in the body. The Nechiporenko test determines inflammation, and the Zimnitsky test is used to assess the condition and function of the kidneys.

Hydronephrosis in children

As a rule, hydronephrosis in children is a congenital disease. This pathology can occur in newborns if hydronephrosis was diagnosed during pregnancy. In newborns, pathology often affects both kidneys at the same time.

Using special diagnostics, hydronephrosis can be diagnosed in the fetus. Therefore, the congenital form of hydronephrosis in children is diagnosed much more often.

Hydronephrosis in the fetus and the reasons for its development of such a pathology can be determined in the early stages, which makes it possible to begin treatment in a timely manner, which means it will be more effective. This disease in newborns can be caused by the following factors:

• stenosis of the pelvic system;
• high ureteral discharge;
• narrowing of the bladder neck.

Hydronephrosis in children is treated more successfully than in adults, as it is diagnosed in the early stages.

Treatment of hydronephrosis in children

Treatment of hydronephrosis in children and newborns is carried out only after accurate diagnosis and confirmation of the diagnosis. The mandatory diagnostic program includes the following:

• general analysis of urine and blood;
• Ultrasound of the kidneys;
• X-ray examination of the kidneys.

X-ray for hydronephrosis of the kidneys

As a rule, treatment of hydronephrosis in children is carried out only surgically and takes place in two stages:

• excision of tissue to widen the passage;
• anastomosis - suturing the ureter to the pelvis.

Such an operation does not pose a threat to life, provided the surgeon is competent. The rehabilitation period does not last long, but during this period a diet is required. This circumstance does not apply to newborns.

Instrumental methods

Instrumental methods for analyzing kidney function are the most effective and, accordingly, often used. Used to assess the functionality of the kidneys, their anatomical and morphological indicators, as well as the functions of the urinary tract. These include ultrasound, X-ray, radionuclide methods and biopsy. Let us consider step by step what the types of instrumental methods are.

Ultrasound or ultrasound examination

Ultrasound examination is done almost first among others to find out the functioning of the kidney. An ultrasound will immediately determine the location and shape of the kidneys, whether the calyces and pelvis are deformed, and will tell you about the size of the parenchyma. If you use color Doppler mapping, the value of ultrasound will increase, since it will be possible to study the vascular bed of the organ. Together with the results of other studies, ultrasound shows how to confidently make a choice in favor of the method of surgery.

Urethroscopy

Urethroscopy (analysis of the urethra, urethra) is performed for urethral stones and developmental anomalies. For this method, the patient is prepared: you need to empty your bladder and inject a local anesthetic into the urethra. The examination itself is done in a chair in a lying position and with legs bent and apart at the knees. After such a procedure, a course of antibiotics for 3-5 days is possible to protect yourself from infections.

Nephroscopy

Nephroscopy belongs to the endoscopic methods for examining the renal pelvis and cups. Can be done in two ways. The first is when the endoscope is inserted into the ureter and thus passed into the system. The second, used more often, is when an analysis is performed through an incision in the pelvis under local anesthesia.

Cystoscopy

Examination of the bladder from the inside for diagnosis is called cystoscopy. The cystoscope is inserted through the urethra into the bladder. In women, this procedure, due to its anatomical features, does not cause problems and is not painful. The patient lies in a urological chair. After administration, residual urine is released, determining its quantity. It is possible to wash the bladder before the procedure if blood or pus was previously detected there.

Chromocystoscopy

Such an examination is effective in clearly understanding how often and quickly urine is excreted from the ureter. The doctor injects the patient with a special solution that turns the urine blue. Conducts research and sees when and how colored urine begins to be released into the bladder. From these data obtained in this way, he draws a conclusion about the work, functionality and condition of the urinary system.

X-ray diagnosis of hydronephrosis

In diagnosing the disease of hydronephrosis, doctors call X-ray examination methods the main ones. They are considered relatively safe and very effective. An x-ray determines the pathology of the size of the kidney, the secretory function of the parenchyma, the evacuation activity of the ureter and pelvis of a healthy and affected kidney, and there is already an idea of ​​the presence of stones and sand. If hydronephrosis is at stages I-II of development, then x-ray diagnostics shows shadows of the kidney cavities. And after 30-60 minutes, the dilated pelvis and calyces are visible in the picture.

Renal angiography

The renal angiography method is good when other x-ray diagnostic studies do not provide the necessary information and cannot accurately answer the doctor’s questions. Especially when you need to make a decision on operational tactics and the choice of operation. Such an examination accurately detects additional renal vessels, location and quantity, location of origin from the aorta, and zones of the renal parenchyma. Practice shows that almost half of the patients who underwent renal angiography had multiple arteries.

Vaccine cystography

This is an x-ray way to study the functioning of the bladder and other organs of the entire system during urination. First, a contrast agent is injected into the patient through a catheter, and an X-ray is taken. Afterwards the patient urinates and then another picture is taken. This is a valuable method of analysis, since in the case of pathology, the image will show at what stage the substance is located, and from this we can conclude how urine passes into the ureters.

Computed tomography (CT)

To get a complete picture of possible kidney swelling or organ blockage, one type of X-ray examination should be performed - computed tomography (abbreviated as CT). The procedure will give a clear picture of what is happening in the body, and will help the doctor prescribe the right treatment. Although the method belongs to X-ray, nevertheless, harmful rays in a particular case are necessarily amenable to computer processing and with the help of this they create a three-dimensional image of the kidneys.

Computer diagnostics can be carried out either with or without a contrast agent. Without the substance, no special preparations are made. With a contrast agent, it is recommended to do a biochemical blood test (to avoid suspicion of kidney failure), not eat for three hours, and notify the doctor about allergies (if any). Before the procedure, the patient must remove all metal jewelry or items, lie down on the X-ray table, and remain motionless while the scanner takes pictures. When finished, the doctor asks the patient to stay for a few minutes to check the quality of the images.

Magnetic resonance imaging (MRI)

The data obtained from MRI gives doctors a clear understanding of the condition of the upper urinary tract and the causes of hydronephrosis. As is known, the disease has 4 stages, implying the degree of distension of the collecting system. The MRI method can clearly determine the stage of the disease. In addition, this procedure also provides better data regarding the thickness of the cortical layer. However, with magnetic resonance imaging it is not always possible to accurately see the length of the narrowed section of the ureter. The positive aspects include the fact that the procedure itself lasts no more than 90 minutes and does not use ionizing radiation.

Radioisotope renography (kidney scintigraphy)

This method is one of the rare ones used in nuclear medicine. These studies provide more than just information about urinary obstruction. This method works in the following way: the patient is given a drug treated with radioisotopes, and then the accumulations in the kidneys are monitored. There are no restrictions or preparatory stages during the procedure.

Hydronephrosis during pregnancy

Hydronephrosis during pregnancy has the same symptoms as listed above. It is worth noting that hydronephrosis in this position more often develops in the right kidney than in the left. This is due to the fact that the ureter is compressed due to the expansion of the uterus.

It is very important to determine whether this disease developed during pregnancy or was congenital. The fact is that hydronephrosis during pregnancy can cause the development of pathology in the newborn.

Surgical intervention in this situation is impossible. As a rule, conservative treatment is prescribed with minimal consumption of medications. In this case, treatment with folk remedies is appropriate, but only as prescribed by a doctor. It is important to follow a diet, but without harming the child.

Traditional medicine in the treatment of hydronephrosis

Folk remedies are used to treat hydronephrosis as an addition to drug therapy with mandatory medical supervision. Proven folk recipes below.

Recipe 1. Mix dry herb:

• Knotweed – 1 tbsp. spoon.
• Horsetail – 1 tbsp. spoon.
• Bean shells – 1 tbsp. spoon.

Add 5 tablespoons of birch leaves. 2 tbsp. Place spoons of the mixture into a thermos and pour 200 ml of boiling water. Leave for 7 hours. Drink in 2 doses 20 minutes before meals.

Recipe 2. Take in equal proportions:

• Adonis,
• oat grains,
• hop cones.

2 tbsp. spoons of the mixture are poured with 1 glass of boiling water, leave for 7 hours. Drink in 2 doses 20 minutes before meals.

Diagnostics

During the examination, the doctor can preliminarily diagnose hydronephrosis through palpation. There is compaction in the area of ​​the organ. The patient's symptoms and general health are also taken into account. To make an accurate diagnosis, instrumental and laboratory tests are prescribed:

• general analysis of urine and blood;
• Ultrasound of the kidneys;
• X-ray examination of the kidneys.

Ultrasound for hydronephrosis of the kidneys

Based on the tests, an accurate diagnosis is made and the correct course of treatment is prescribed. If it is impossible to make an accurate diagnosis based on the results of such studies, the doctor may prescribe a CT and MRI scan.

Stages of hydronephrosis (kidneys)

During hydronephrosis, it is traditional to distinguish three stages that have characteristic objective signs.

• At stage I of hydronephrosis, dilation of the renal pelvis (pyelectasia) is detected.
• Stage II of hydronephrosis is characterized by expansion of not only the pelvis, but also the calyces of the kidney. At this stage, the kidney tissue begins to suffer, its damage and atrophy begins.
• Stage III is the final stage of hydronephrosis development. The kidney completely atrophies, ceases to function and turns, in fact, into a thin-walled sac.

Treatment

In most cases, surgery is prescribed. Especially if the disease is diagnosed in children.

As for the treatment of the disease in adults, both conservative treatment and surgery are used. It all depends on the degree of development of the disease and the general condition of the patient. It is important to follow a diet during the treatment period.

Conservative treatment is appropriate only at an early stage of the disease. As part of therapy, drugs with the following spectrum of action are prescribed:

• pain reliever;
• anti-inflammatory;
• to lower blood pressure;
• antibacterial (if there is an infection).

However, as practice shows, even at an early stage, surgery gives the best results.

Symptoms of hydronephrosis

Clinical picture.

Hydronephrosis often develops asymptomatically and appears during an outbreak of infection, injury, or is accidentally discovered during palpation of the abdominal cavity. There are no symptoms unique to hydronephrosis. The most common pain is in the lumbar region of varying intensity, a constant aching nature, and in the early stages - in the form of attacks of renal colic. Pain due to hydronephrosis can occur both day and night, regardless of which side the patient sleeps on.

Attacks are accompanied by nausea, vomiting, bloating and increased blood pressure. Patients often note a decrease in the amount of urine before and during attacks and an increase in its amount after an attack. In advanced stages of hydronephrosis, acute pain is uncharacteristic.

An increase in temperature during attacks of pain is possible only with infected hydronephrosis.

An important symptom of major hydronephrosis is a palpable tumor formation in the hypochondrium.

Sometimes the only symptom is hematuria (micro- and macroscopic), more often observed in the initial stages of hydronephrosis. Macroscopic hematuria is observed in 20% of patients with hydronephrosis, microhematuria is much more common.

In the terminal stage of the disease, kidney function is severely impaired. Signs of renal failure appear mainly with a bilateral process.

Diet

Diet plays an important role in treatment. The diet is prescribed by a doctor individually. The following foods should be excluded from your daily diet:

• salty;
• fat;
• smoked;
• sweets;
• alcohol;
• fried meat and spicy dishes.

Instead, the diet should include the following:

• vegetables and fruits;
• dairy products;
• proteins.

This diet, combined with proper treatment, gives positive results. By the way, diet can help improve metabolism, which is beneficial for the whole body.

Conservative treatment

Conservative treatment for this disease is used extremely rarely, because the cause of hydronephrosis is a mechanical obstruction in the urinary tract, so it is impossible to cure the disease otherwise than by removing them and ensuring proper urine outflow.

However, if the process is accompanied by inflammation, it is necessary to carry out symptomatic therapy, namely:

• taking anti-inflammatory drugs;
• taking antibiotics;
• taking medications for hypertension.

In addition, a special diet is prescribed with limited consumption of table salt, rest, and a gentle regime.

Surgery

During surgery, an obstruction in the urinary system, such as a tumor, can be removed.

When the ureter is narrowed, surgical treatment of hydronephrosis can be carried out in three ways:

1. By installing a stent - a tube that will be placed in the ureter, connecting the kidney and bladder, ensuring the unimpeded outflow of urine. The size of the stent is selected by the surgeon based on the anatomical characteristics of the patient. Typically, all stents have a diameter of 1.5 cm and a length of up to 30 centimeters. The ends of the tubes have a curved shape - this is necessary so that the tube is securely fixed in the patient’s body.

The procedure is most often performed under general anesthesia. A cystoscope is inserted into the bladder to visualize the opening of the ureter in the bladder. A stent is inserted there under the control of a radiographer.

It is recommended to remove the stent within a period of up to 8 weeks, and even if the stent is installed for life, it must be changed 4 times a year.

1. Using a nephrostomy - inserting a thin tube into the kidney through a puncture in the lower back. It is necessary for removing urine from the kidney in order to protect the organ tissue from damage when it is full of urine. Nephrostomy is a temporary and emergency method that is used during surgery or when a patient is admitted to the department during emergency hospitalization, so that urine is removed from the body until the patient undergoes surgery.
2. Using ureteroplasty - the latter option is increasingly used for hydronephrosis due to narrowing of the junction of the pelvis and the ureter. The operation is absolutely non-traumatic: the surgeon makes punctures in the patient’s abdomen, removes the narrowed section of the ureter and stitches the edges of the urinary tract. On average, such an operation lasts no more than one hour.

If the operation is performed correctly, the effect can be lifelong.

Thus, there are two options for surgical treatment for hydronephrosis: ureteroplasty and stent installation. The advantage of the stent is its ease of installation and low price, but the disadvantage is the need to replace the tube every 3-4 months.

Ureteroplasty provides a long-lasting and reliable effect, but such an operation requires more serious surgical intervention, the search for a reliable doctor and, possibly, financial expenses.