Hydronephrosis, a disease that can lead to kidney loss

Hydronephrosis – This is a dangerous condition that develops against the background of obstruction of the urinary system. The pathological process consists in the expansion of the pyelocaliceal system of the kidneys, which is rapidly progressing.  The main danger of hydronephrosis is that the symptoms of the disease do not bother the patient at the first stage, when the process can still be reversed, and begin to appear only at the stage when the kidneys are close to stopping their function. The most susceptible to the development of hydronephrosis are young people aged 20 to 50 years, and, according to statistics, women suffer from hydronephrosis almost 1.5 times more often than men. In most cases, one of the kidneys is affected, but in almost 10% of cases a bilateral pathological process develops.

Classification and etiological factors in the development of hydronephrosis

The causes of hydronephrosis include a variety of obstructive processes in the urinary system.  The cause of blockage can be as the presence of stones or foreign bodies in the urinary tract & nbsp; paths, as well as a variety of anomalies of the structure: adhesions, abnormally located blood vessels, pathologies of the structure of the ureters or neoplasms.

There are four types of hydronephrosis according to the etiology of the disease:

• obstruction in the ureteropelvic segment;
• obstruction along the ureter;
• lower urinary tract obstruction;
• violation of the innervation of the organs of the urinary system.

There are two main types of hydronephrosis: primary – due to the presence of a congenital obstruction in the urinary tract, and secondary, the cause of which is an acquired complication of another pathology of the urinary system. In addition, one- and two-sided hydronephrosis, aseptic or infected, are isolated. and closed (complete obstruction), open (partial obstruction) or intermittent (intermittent obstruction, depending on the position of the body in space) process.

Clinical presentation of hydronephrosis: most common symptoms

During the course of hydronephrosis, it is customary to distinguish three stages:

1. Pyeloectasia – the most favorable stage, in which there is an expansion of only the renal pelvis, and the function of the kidney is absolutely not disturbed. At this stage, there are no symptoms, and, accordingly, there are no complaints from the patient.
2. Prehydronephrosis – in this stage, there is an expansion of both the renal pelvis and the calyces of the kidney. In this case, thinning of the parenchymal tissue of the kidney occurs, which leads to a violation of its function. At this stage, patients complain of intense pain in the kidney area, and the pain can be either constant, dull, aching, or manifest as renal colic. During an attack of colic, the kidney can be palpated, it is tense and painful on palpation. Frequent symptoms of the second stage are fever, chills and even micro- and macrohematuria.
3. The hydronephrosis stage is the third and most dangerous stage of the disease. In the third stage, atrophic changes occur in the parenchyma of the kidney, the renal pelvis loses its tone, as a result of which the kidney turns into one large cavity, dystrophy of its nervous tissue develops, and the kidney dies. In the stage of hydronephrosis, another important sign joins the main symptoms – deformation of the abdominal wall with a significantly enlarged kidney. In some cases, the capacity of such a pathologically altered kidney can reach more than two liters.

Laboratory and instrumental methods for diagnosing hydronephrosis

In the diagnosis of hydronephrosis, the most important information is provided by instrumental research methods. Laboratory methods are informative in the case of infected hydronephrosis, when signs of an inflammatory process are determined in urine tests.

Urography – X-ray contrast examination of the urinary system, which provides information on the degree of expansion of the pyelocaliceal system of the kidney, helps to visually determine at what level the obstruction occurred. Angiography provides information about the state of the kidney vessels, which, in the case of hydronephrosis, become thinner and arched out. The most highly informative methods for diagnosing hydronephrosis are ultrasound and computed tomography, as they can be used to obtain the most detailed information about the state of the entire urinary system.

Peculiarities of hydronephrosis treatment: conservative and surgical methods

The choice of treatment for hydronephrosis directly depends on what caused the blockage of the urinary tract. Moreover, the sooner the cause of the obstruction is eliminated, the less irreversible changes will occur in the tissues of the kidney, and, accordingly, the prognosis for the patient will be better.  In case of obstruction of the urinary system with calculi, lithotripsy is performed – stone crushing procedure. The most popular today is the laser method of lithotripsy.  The surgical operation ureterolysis is used in case of external obstruction of the ureters by fibrous tissue, and to eliminate the obstruction, the vessels are moved or the creation of a pelvic-ureteral anastomosis. In the presence of strictures of the ureters, balloon dilatation or bougienage is used.  In that case, when atrophic changes develop  in the kidney parenchyma,  without fail, nephrectomy is performed in order to avoid the development of infectious complications of hydronephrosis.