The causes of congenital hydronephrosis can be various developmental abnormalities genitourinary system, among which:
- narrow lumen of the ureter,
- pathological torsion and abnormal direction of the ureters,
- abnormal size and structure of the vessels, due to which they wrap around the ureters and narrow their lumen.
Older children and adolescents may develop acquired hydronephrosis. The reasons for its appearance may be:
- lower back injuries,
- inflammatory processes urinary organs and primarily in the ureters,
- urolithiasis disease,
- postoperative complications.
Symptoms
There are three degrees of development of hydronephrosis. The clinical picture is increasing.
So, the first degree is asymptomatic, affecting the kidney.
The second stage means impaired renal function, its signs:
- pain in the lumbar area,
- decrease in daily urine volume,
- the appearance of bloody clots in the urine,
- increased blood pressure with headaches, nausea, vomiting and general weakness,
- intoxication of the body, accompanied by an increase in body temperature.
The manifestation of the disease of the third degree coincides with the almost complete death of the kidney. In this case, children experience:
- increase in body temperature,
- drowsiness,
- apathy,
- decreased daily urine output,
- significant amount of blood in the urine, enuresis,
- swelling of the body with very dry skin,
- significant pressure surge.
Congenital pathology can be detected by screening ultrasound after the 14th week of pregnancy.
Diagnosis of hydronephrosis in a child
Additional research is needed to confirm the diagnosis and determine the causes in older children and adolescents. The main ones are:
- general and biochemical blood test,
- clinical urine test,
- Ultrasound of organs abdominal cavity,
- x-ray with contrast injection,
- MRI or computed tomography,
- nephroscintigraphy.
Complications
The consequences of hydronephrosis in a child can be divided into physiological and psychological.
The first group includes many infectious lesions of the genitourinary system, the most dangerous among them:
- urolithiasis disease,
- renal failure,
- chronic cystitis,
- recurrent pyelonephritis.
Psychological problems can arise in conscious childhood due to manifestations of the disease, such as enuresis, severe swelling. And when a catheter is installed, communication with peers can become problematic.
Treatment
What can you do
In most cases, hydronephrosis is congenital. It's difficult to prevent to the expectant mother worth giving up bad habits since the moment of pregnancy planning.
During pregnancy, screening ultrasounds should be performed, which can indicate the presence of the disease. In this case, as the disease progresses, it is possible to perform surgery even in the prenatal period and several months after birth.
Do not refuse surgery under any circumstances, this is the only effective option treatment of hydronephrosis of the second and third degrees.
If the disease was detected during preventive examination at the first stage, then it is possible to use conservative treatment. It is important to take the medications exactly as prescribed by the doctor, observing the dosage, frequency and duration of the course.
What does a doctor do
When clinical picture for childhood hydronephrosis it is necessary to carry out additional research. Blood and urine tests can make a diagnosis only in the last stages of the disease.
When making a diagnosis, it is important to study the reasons for its occurrence, after which the specialist develops an individual treatment regimen.
Pharmacotherapy is possible only at the first stage of the disease. The doctor may prescribe a course of antibiotics and medications.
If hydronephrosis is detected in a child in the second stage, surgical intervention is necessary. Depending on the causes and course of the disease, several surgical options are possible:
- plastic surgery - creation of an artificial connection between the ureter and kidney,
- ureteral stenting - strengthening the entrance of the ureter with a tube of the appropriate diameter,
- nephrostomy - insertion of a catheter into the kidney, which will collect urine into an external urinal.
At the third stage of the disease, it is possible to install a catheter; if the kidney is significantly damaged, it is recommended to remove it to avoid intoxication of the body.
Prevention
Hydronephrosis in children is in most cases a congenital pathology that is difficult to prevent. For prevention, a pregnant woman should give up bad habits, healthy image life and eating right.
The best prevention is timely diagnosis of the disease and its speedy treatment. Hydronephrosis of the first degree in children is easily treatable.
During treatment and after its completion, it is important to follow a diet to prevent relapses or exacerbation of the disease. A dietary feature of children diagnosed with hydronephrosis is drinking plenty of water and limited use salt and spices.
Also protect your children from hypothermia, back and lower back injuries, and monitor the daily volume of urine.
As a teenager, talk to your child about health, the need to take care of it, preventive measures and their importance.
Diseases in children are often associated with intrauterine development, during which a disorder occurred. Hydronephrosis of the kidney in children is diagnosed relatively often - pediatric pathology is more common than in adults. Typically, in infancy and early age There are no signs of kidney hydronephrosis; the pathology develops gradually. As a result of pathology, it expands pelvis, which prevents urine from being excreted normally. The disease can be detected during an ultrasound examination of a pregnant woman. In this case, treatment should begin immediately after the birth of the child.
Hydronephrosis is a kidney pathology that develops and can be diagnosed already in the uterine period.
Classification
Hydronephrosis of the kidneys in children is a fairly common pathology, as a result of which the function of the organ is impaired. This is caused by a violation of the outflow of urine with subsequent expansion of the renal pelvis. Depending on the reason for which the pathology arose, a primary and secondary type of illness is distinguished.
Pathology of a primary or congenital nature begins to develop in utero in the fetus. If a child has congenital hydronephrosis, then the cause lies in a structural disorder internal organ. During the process of formation, the urinary tubules can become twisted, narrowed, or incorrectly positioned, which will cause incorrect outflow of urine.
Hydronephrosis in children congenital type often has a hereditary nature.
Secondary or acquired pathology occurs due to inflammation in the urinary system. With this type, the child is found to have scars or rotting processes that prevent urine from leaving the body. Secondary hydronephrosis occurs due to injury to the lower back, which disrupts the anatomy of the organ.
Doctors classify pathology according to where the damaged kidney is located. In medicine, hydronephrosis is classified into unilateral and bilateral types. In the first case, one kidney is injured; as a rule, doctors observe hydronephrosis of the child’s left kidney. Pathology with right side occurs in rare cases. With bilateral damage, the disease develops in both organs.
Causes and mechanism of development
Congenital
Congenital hydronephrosis in children is much more common than acquired hydronephrosis. Pathology is often associated with the presence of another artery, vein in the kidney, or an additional ureter. The resulting pathology during intrauterine development can affect the formation of hydronephrosis, in which the kidney or ureter is compressed. This leads to the fact that urine is not completely excreted.
As the pathology progresses, the renal pelvis expands and thins, which provokes a disruption in the normal functioning of the organ. The kidney loses its excretory and filtration functions, which leads to the accumulation of harmful substances V children's body. Without treatment, hydronephrosis leads not only to disruption of the kidney, but also to other internal organs. Congenital hydronephrosis of the kidney is in most cases unilateral. The disease is more often observed in boys, and the organ on the left side is injured.
Noncongenital renal hydronephrosis develops due to secondary diseases or injuries. Acquired
Secondary hydronephrosis results from trauma and various diseases. This type of hydronephrosis is caused by stones in the kidneys and bladder, and formations in the organs of the genitourinary system. If the pathology is observed in a boy, then its source may be a disease prostate gland. Injuries in the ureter lead to the development of hydronephrosis. Pediatric hydronephrosis of the secondary type occurs in rare cases. As a rule, with this form, difficult urination occurs, which injures the kidney tissue.
Symptoms of kidney hydronephrosis in children
Hydronephrosis 1st degree
During this period, the pathology does not make itself felt externally; changes are still occurring internally. Ultrasound diagnostics reveal a slight dilation of the renal pelvis and a slight enlargement of the internal organ. If the child is thin, then parents may notice a slight increase in the abdomen. Hydronephrosis of the 1st degree is not characterized; internal organs continue to function normally.
Pathology 2 degrees
The second stage of renal hydronephrosis has vivid symptoms and develops rapidly. Hydronephrosis of the 2nd degree in children manifests itself quite actively. During this period, an even greater expansion of the pelvis and calyces of the kidney is observed. Pathology can be easily detected by instrumental examination child. At the second stage of the disease renal parenchyma compressed due to significant accumulation of urine. This leads to atrophy of the kidney tissue, which causes a significant decrease in the function of the internal organ. Hydronephrosis degree 2 is manifested by the following symptoms:
- swelling of the face;
- enlarged belly in a child;
- dull pain in the lower back and abdomen;
- bloody discharge when urinating (does not always appear at this stage);
- increased arterial pressure.
If an infectious disease is added to hydronephrosis of the 2nd degree, then the child experiences an elevated body temperature. This is due to general intoxication of the body, and strong painful sensations in the lumbar region. The child’s urine becomes cloudy, and lab tests indicate an excess of red blood cells and white blood cells. Frequent infectious diseases urinary tract may indicate hydronephrosis, since healthy children are not prone to frequent infections. The progression of renal hydronephrosis in young children can result in death.
The most common complication due to hydronephrosis becomes. Noticeably worsening general state health, body temperature rises to 39 degrees, urine retention is observed. On last stage due to advanced hydronephrosis, renal failure occurs. This complication is especially dangerous for children under one year of age. In this case, there is only one way out - donor organ transplantation. If hydronephrosis is left unattended, it is fatal. It happens for a reason renal failure V chronic form, as a result of which the body is poisoned by accumulated toxins and harmful substances.
Treatment in children should be carried out in mandatory, since hydronephrosis will not go away on its own. Treatment should be done immediately when pathology is detected or when the first symptoms appear. Since this disease occurs unpredictably, one child may have hydronephrosis at the first stage for several years, while another will develop hydronephrosis to stage 3 within a year.
Hydronephrosis in a child is one of the most common renal pathologies, often forming in utero. Damages the pyelocaliceal system of the urinary organ as a result of its enlargement due to impaired urine outflow. The danger of the disease depends on the degree of its development.
Hydronephrosis is divided into 3 stages of development.
- The first stage is characterized by an increase in the volume of the pelvis, but the functioning and integrity of the organ remains normal.
- At the second stage, the kidney becomes slightly larger (the pelvis is enlarged, its walls are thinned, the organ’s performance is reduced by 40%).
- With the development of the third stage, the parenchyma of the organ atrophies, functioning almost completely stops, and the kidney increases significantly.
Hydronephrosis of the 1st degree, if diagnosed in a timely manner, does not harm the urinary organ. Outcome at adequate treatment positive.
The disease is also divided into unilateral and bilateral, acquired and congenital hydronephrosis in children. In newborns, in most cases, primary (congenital) is detected. kidney disease resulting from an abnormal development of an organ or its vessels.
Damage to two kidneys at once is diagnosed only in 5-15 percent of cases. But this type of pathology often leads to the death of the child.
Provoking factors
The formation of the disease is detected during pregnancy if the fetus has developed congenital hydronephrosis. The causes of the disease in a newborn include small lumen of the urinary tract, twisting of the ureters due to incorrect direction. An abnormal vessel that compresses the urinary tract, disrupting the normal outflow of urine, also becomes a provoking factor.
An older child or a teenager is diagnosed with a secondary pathology, the causes of which are injuries in the lower back, urinary tract infections, an inflammatory process in the ureters, and blockage of the urinary tract during surgical treatment.
Manifestations of the disease
Congenital hydronephrosis of the left kidney in a child (or right organ) may be asymptomatic long time. Acute stage pathology often begins with the formation of microliths, which subsequently provokes inflammation.
As a result of the development of pyelonephritis, the following symptoms of the disease appear:
- pain in the area lumbar region and when emptying the bladder;
- increased body temperature with chills;
- hematuria;
- general malaise, tearfulness.
Such signs are a good reason to seek help from a doctor. Hydronephrosis of the kidneys of 2 and 3 degrees can also be manifested by the appearance of blood in the urine and lower back pain. Hematuria at an early stage of the disease is practically invisible and is detected when laboratory research. When the disease is advanced, the urine changes its color to a persistent reddish color.
Pathology at the first stage of development is mainly detected by chance. This can happen during a routine ultrasound or during a routine examination.
Methods for identifying the disease
Diagnosis of hydronephrosis in children is carried out through ultrasound. Hereditary congenital hydronephrosis can be detected in newly born babies by palpation, since in newborns the organs can be palpated very well.
In case of suspicion pathological process doctors prescribe additional diagnostic procedures. There are three main techniques: radioisotope study, intravenous urography and voiding cystourethrography. Using the first examination, the degree of development of the disease is determined and the performance of the urinary organ is assessed.
Intravenous urography shows the degree of obstruction of damaged kidney structures. If reflux is suspected or there are problems with urine output, an x-ray is performed using a contrast agent. If necessary, the child is sent to computed tomography.
Diagnostic results can accurately confirm the pathology after the baby is one month old. Until this point, the size of the pelvis may vary depending on the amount of liquid the baby drinks. After making a diagnosis, the doctor prescribes treatment or monitoring of the baby.
Therapy for hydronephrosis
Hydronephrosis of the kidney in children is treated various methods. The explanation for this is simple: treatment of the pathology depends on the degree of its development.
At the first stage of the disease it is prescribed conservative therapy. It includes taking antibiotics, anti-inflammatory drugs and blood pressure lowering drugs. A diet with limited salt is also prescribed, and the daily volume of fluid consumed is increased. Such treatment requires mandatory monitoring of the condition of the diseased organ.
At the second stage, surgical intervention is performed. For this purpose, pyeloplasty, nephrostomy or ureteral stenting are used. At the third stage, treatment is also surgical (pyeloplasty, less often nephrostomy).
If pathology of the right or left kidney is detected in the womb, surgical treatment can be carried out before the birth of the baby.
Complications in children
The most common consequence of lack of treatment is pyelonephritis. It develops due to the accumulation of bacteria, causing inflammation organ. Ignoring hydronephrosis at the third stage leads to the development of chronic renal failure. This pathology poses a threat to the baby’s life. Chronic renal failure can be completely cured only through an organ transplant.
Possible preventive measures
It is impossible to prevent the development of a congenital type of disease. You can only conduct an ultrasound examination of the child’s kidneys at one month in order to diagnose the disease on time.
To avoid the development of a secondary (acquired) disease, you need to eat right and not overuse table salt. If a person is predisposed to the development of hydronephrosis, it is necessary to protect the lower back from injury, avoid hypothermia, and control the daily volume of fluid consumed.
Kidney enlargement in children in most cases is congenital. It manifests itself in advanced stages, which is why treatment is often radical. If the disease is ignored, death inevitable.
pediatric urologist-andrologist, Ph.D.
With hydronephrosis in children, the ureter does not form correctly. This is a congenital condition that may appear on different stages intrauterine development starting from the first trimester.
Types of hydronephrosis in children
Hydronephrosis may be non-obstructive and does not require surgical treatment.
Also common corrected hydronephrosis. This is when, after plastic surgery of the ureteropelvic segment, the kidney still does not contract, the dilated calyces remain quite wide, but the outflow of urine is restored. This often happens when a kidney with very poor function is operated on. The main thing we are fighting for is not narrowing of the pelvis, but restoration of outflow from the kidney. In such cases, it is sometimes necessary to perform a second operation when the child grows up.
There is an international classification according to degrees of hydronephrosis– SFU (Society of fetal urology, International Society of Prenatal Urology). According to this classification, there are 5 degrees of hydronephrosis (from 0 to 4). SFU grades 2 and 3 hydronephrosis in most children resolve spontaneously in the first year of life as they grow. This happens because infant mainly lies down, he has a weak and undeveloped muscle of the pelvis. As the child grows, the urinary tract begins to “mature.” The smooth muscles of the intestines mature, the skeleton and muscles mature, the same thing happens with the smooth muscles of the upper urinary tract. IN vertical position the urinary tract is much easier to work with. That is why hydronephrosis in young children is recommended to be observed during the first year (if kidney function is preserved, if there is no inflammatory process, if it is a unilateral process).
Causes of hydronephrosis in children
The cause of the development of hydronephrosis can be an intrauterine defect: stricture, stenosis of the ureteropelvic segment, accessory vessel, high ureteric outlet, stone, tumor, external adhesion.
Symptoms of the disease
If hydronephrosis was not diagnosed in utero, then it may not appear for a long time (if hydronephrotic transformation is not associated with acute renal obstruction). That is why, as part of the medical examination of children in the first year of life, an ultrasound scan of the abdominal organs, including the organs of the urinary system, is mandatory. This is a screening ultrasound that will allow you to suspect a malformation of the urinary system and identify it before complications arise, for example, an acute inflammatory process due to a violation of the outflow of urine from the kidney.
If this is hydronephrotic transformation without impaired renal function, it is almost impossible to suspect it. Therefore, we encourage parents not to neglect the medical examination of their children and to carry it out in full. Those. underwent urine tests and ultrasound examinations.
Diagnostic methods
Taking into account the possibilities of prenatal diagnosis, fetal ultrasound often makes it possible to establish a diagnosis before birth.
However, doctors do not always detect this pathology in the fetus during ultrasound examinations during routine screenings at 20–22 and 31–33 weeks of pregnancy. But if a disorder is detected, then, as a rule, it is called not hydronephrosis, but intrauterine pyelectasia - dilatation of the pelvis.
Quite often we come across the fact that prenatal diagnostic specialists, seeing a one-sided process, a slight dilation of the pelvis, tell mothers that the child will be born, “registered”, and everything will pass. Perhaps this is correct from the point of view of keeping the pregnant woman calm. But any mother who was informed during pregnancy about the abnormal formation of the fetus’s kidney and urinary tract should understand that 5-7 days after the birth of the baby, it is necessary to conduct ultrasound screening. It is on days 5-7, and not earlier, because in the first days after birth a sufficient amount of fluid does not yet pass through the baby’s ureter, the kidneys secrete little urine and ultrasound diagnostics will not be as informative. It is on days 5–7 after birth that the baby develops diuresis. Therefore, if we are not talking about the critical condition of the child, a bilateral process or poor performance biochemical analysis blood, ultrasound screening is advisable to carry out on days 5-7 of a child’s life.
Ultrasound- this is a screening method that allows you to suspect a developmental anomaly (incorrectly developed kidney, dilated pelvis, dilated calyces, etc.). But to establish a diagnosis of hydronephrosis, this study is not enough.
The most important thing in diagnosing hydronephrotic transformation is to determine functional state kidneys and upper urinary tract. That is, the preservation of kidney function (secretory, responsible for the formation and accumulation of urine and excretory) and urodynamics of the upper urinary tract (an indicator of how quickly urine enters the upper urinary tract) are important. bladder). Excretory urography, adopted in our country in most clinics, even performed on the most modern digital equipment, according to its methodology will not allow diagnosing hydronephrosis; this study gives an idea only of the anatomical state of the kidney.
Dynamic scintigraphy - this is the only method, which allows you to assess the picture of the disease, understand whether the disease is obstructive in nature and whether it requires surgical correction. In some cases, in addition to ultrasound and dynamic scintigraphy we do computed tomography (CT) to determine the cause of hydronephrosis, kidney anatomy and planning surgical intervention.
Treatment of hydronephrosis in children
There is no drug therapy for hydronephrosis. But it is important to prevent inflammatory complications. If an infection attaches to the dilated pelvis, the outflow of urine from it will be disrupted, and an inflammatory process may form - pyelonephritis.
After the diagnosis has been established, when the doctor has seen that hydronephrosis is obstructive, that the outflow of urine from the kidney is indeed impaired, he begins to formulate a treatment plan. Surgery is aimed at eliminating the narrowing area in the ureter and performing plastic surgery between it and the pelvis. Exist different kinds interventions:
- classic operation through an “incision” (lumbotomy),
- laparoscopic (operation through “punctures” in the abdominal wall),
- retroperitoneoscopic surgery,
- robot-assisted plastic surgery.
We operate not on the ureteral pelvis, but on the child. Therefore, the method of surgical treatment is selected individually. A good urologist surgeon must be proficient in all surgical techniques, and the clinic must have all the necessary equipment and tools.
Of course, before open operations Laparoscopic techniques have a number of advantages: more accurate results, shorter recovery period, no scars, less risks postoperative complications. The robotic console allows surgeons to create an anastomosis with pinpoint precision and minimal tissue trauma. The width of the anastomosis in a child is 1.5 - 2 cm, and about 15 - 20 sutures are applied to this area.
But it may turn out that robot-assisted technology is not suitable for a particular child. It all depends on age, general somatic condition, anthropometric indicators, which may not allow the installation of a robotic console. When planning a laparoscopic intervention, it is important whether adequate anesthesia can be performed, because this also has its own characteristics.
Thus, the type of operation is determined not individually by the surgeon, but by a team that includes an anesthesiologist, pediatrician, and surgeon from the perspective of what will be most effective and safe for a particular child.
But there is no need to be afraid of scars. The question is not about the size of the incision, but about ensuring that surgical treatment is performed as effectively and safely as possible for a particular patient.
Features of the treatment of bilateral hydronephrosis
A two-way process is a more serious situation. Already from discharge from the maternity hospital, such children are taken under observation by pediatric urologists and are planning surgical intervention. It is rare that operations are performed on both sides at once. Sometimes drainage is placed on one side, and plastic surgery is performed on the other. But this is very individual.
Prognosis and possible complications
If we talk about classic unilateral hydronephrosis with preserved renal function, the prognosis is very good, and most of our patients adolescence have no restrictions.
If hydronephrosis is not treated, the kidney will lose its function and will have to be removed.
Recovery after surgery
Within 3-7 days after any reconstructive plastic surgery, the patient has drainage, nephrostomy, and a stent. At this time, the patient is observed by a urologist in a full-day hospital setting, or day hospital depending on the patient's condition.
When the child does not need infusion therapy, pain relief and continuous monitoring, we discharge him from the hospital. Of course, we remain in touch with our patients and are ready to advise and provide assistance around the clock.
After using robot-assisted technology in a child, the recovery period is only 3 days instead of 6-7 days after laparoscopic surgery.
In the future, the child must undergo regular examinations, allowing you to evaluate how the created anastomosis works, how the kidney works, how the ureter grows, etc. We see children up to 18-20 years old to be sure that the operated organ has time to grow with the child.
Nutrition
Physical exercise
If a child is engaged in sports sections, restrictions on physical activity after surgery must be observed for about 1 month. If they operated small child, then there is no talk of restrictions. Already on the second day after surgery, babies walk, run, jump and behave as usual.
Advantages of treatment at EMC
- EMC is the only clinic in Russia where urological surgeons perform robotic operations for defects of the upper urinary tract in children, that is, for the treatment of hydronephrosis and ureterohydronephrosis, renal duplication and any anomalies of the ureters and upper urinary tract.
A professor at EMC performed ureteroplasty on a two-year-old child in 2017. Currently, robot-assisted interventions for children are performed in our clinic as planned.
- We perform any reconstructive plastic and robot-assisted surgeries for children of all ages.
- EMC pediatric urologists completed internships at the best clinics Europe and USA.
- At EMC, patients can undergo diagnosis and treatment in the shortest possible time.
- We use only modern international diagnostic and treatment protocols.
Photo from doorinworld.ru
Treatment is predominantly surgical. Pharmacological drugs are used only to eliminate painful symptoms. They are also shown in postoperative period to speed up the child's recovery.
Causes
Congenital hydronephrosis in children is often diagnosed at the initial stages of intrauterine development using ultrasound screening. Its development was provoked high blood pressure in the ureter or pelvis. Similar pathological condition is accompanied by a decrease in the functional activity of glomeruli and tubules, disorders of venous and arterial circulation, and disturbances of lymph flow. Most often, the following negative factors cause the development of kidney hydronephrosis in a child:
- after urine concentration, it does not completely enter the bladder, but is thrown into the ureter - a hollow tubular organ;
- an obstruction forms in the urinary system, impeding the optimal outflow of urine.
In some cases, the development of hydronephrosis is caused by an abnormal location renal artery, which constantly compresses the ureter, reducing its lumen. Congenital motility disorder of the urinary tract and its narrowing, the development of the inflammatory process, and trauma also lead to impaired urine outflow. These factors often cause not only hydronephrosis, but also pathological persistent dilatation of the ureter.
Classification
In pediatric urology, primary (congenital) and acquired (dynamic) pathologies are distinguished. The latter type of kidney hydronephrosis in children is diagnosed quite rarely. The impetus for its development most often comes from diseases already present in the child’s body.
If the outflow of urine is detected in one kidney, then the pathology is considered one-sided. When both bean-shaped organs are affected, bilateral damage is detected. Hydronephrosis of the left kidney in children is somewhat more common. Right-sided pathology is diagnosed in 40% of cases.
Hydronephrosis in a newborn is detected immediately after birth, usually in an acute form. It responds well to treatment - all kidney functions are completely restored. Chronic illness flows more severely and with numerous complications.
Hydronephrosis on the left or right in a child can be aseptic and infectious. The latter develops due to constant stagnation of urine and its backflow into the ureters. This is a favorable environment for the growth and active reproduction of pathogenic microorganisms - pathogenic bacteria (Escherichia coli, staphylococci) and fungi.
Symptoms
Depending on the course of kidney hydronephrosis in a newborn, it can be mild, moderate, or severe. Each degree is characterized not only diagnostic signs, but also features of symptoms. Hydronephrosis in a newborn is almost not clinically manifested.
In older children acute form The pathology is manifested by cutting pain in the lower back, which can spread to the buttocks, thighs, and radiate to the groin. Drops of fresh blood or dark blood clots are found in the urine. Digestive disorders are noted - attacks of nausea, lack of appetite, excessive gas formation.
Hydronephrosis in children is a kidney disease that progresses quite quickly. In the absence of medical intervention, pathology takes chronic course. At the initial stages of development and in a state of remission they do not appear vivid symptoms. But gradually the mild discomfort of hydronephrosis is replaced by pronounced signs. The main symptoms of kidney hydronephrosis in children:
- any physical activity, such as sports training, is accompanied by severe pain in the child's lower back. After a long rest they become aching, pressing, dull;
- working ability decreases, lethargy, weakness, apathy occur, fast fatiguability, sleep is upset.
Infectious hydronephrosis is especially difficult in children under one year of age. During the process of growth and reproduction, pathogenic bacteria release their metabolic products into the surrounding space. After their penetration into the systemic bloodstream, symptoms of general intoxication of the body occur. Body temperature rises above subfebrile values, digestion and peristalsis are disrupted.
Which doctor treats hydronephrosis in children?
A pediatric urologist treats renal hydronephrosis in newborns. Parents are not able to independently determine the cause of pain in the sacrum and urination problems. Therefore, it would not be a mistake to contact your pediatrician directly. The doctor will prescribe all the necessary diagnostic studies. And after studying them, the child and parents will be referred to a pediatric urologist for further treatment.
Diagnostics
Prenatal ultrasound diagnosis of hydronephrosis in newborns allows for timely diagnosis and surgical treatment. Ultrasonography most informative both in the first days of life and in subsequent stages of the child’s growing up.
The resulting images visualize the cause of the disturbance in the outflow of urine, for example, an adhesive process or anomalies in the development of the renal artery. But even with confirmation of hydronephrosis of the left or right kidney in a newborn, as with bilateral lesions, additional testing is required. X-ray contrast instrumental techniques are used more often.
Treatment
Photo from the site o-krohe.ru
An integrated, step-by-step approach to the treatment of both acute and chronic pathology. Conservative methods effective, but not taken pharmacological drugs treatment is rarely necessary. Hydronephrosis of the right and left kidneys in a newborn responds quite well to treatment.
Medicines for hydronephrosis in children
Nonsteroidal anti-inflammatory drugs (NSAIDs) are used to relieve pain in children with hydronephrosis. This group of drugs is characterized by pronounced analgesic properties due to the ability to suppress the production of prostaglandins. NSAIDs stop acute and low-grade inflammatory processes, reduce body temperature, and eliminate swelling. The most effective in treating hydronephrosis are: medicines, How:
- Diclofenac.
- Ketorolac.
- Ibuprofen.
- Meloxicam.
- Nimesulide.
NSAIDs are not intended for use longer than 2-3 weeks due to the high likelihood of ulceration of the gastric mucosa. When calculating single and daily dosages, the urologist takes into account the weight and age of the child, the severity of the pathology.
Identifying a kidney infection requires antibiotics. They are prescribed after biochemical determination of the type of pathogenic microorganisms and their sensitivity to drugs. Macrolides, cephalosporins, and semisynthetic penicillins protected with clavulanic acid may be prescribed.
Surgical intervention for hydronephrosis in children
Emergency care involves performing a percutaneous nephrostomy to evacuate urine and reduce renal pressure. The method of planned surgery is chosen by the doctor taking into account the cause of the disease. Surgical treatment of hydronephrosis in children is:
- reconstructive;
- organ-preserving;
- organ-removing.
If the parenchyma has not lost its functional activity, then reconstructive plastic surgery is performed. More often, surgeons with hydronephrosis resort to endoscopic methods. Through several skin punctures into the area surgical field Miniature instruments are inserted, and doctors monitor the progress of the intervention on a computer monitor.
Diet for hydronephrosis in children
With kidney damage, blood pressure rises from time to time, especially after drinking large amounts of fluid. Therefore, it is necessary to exclude foods rich in spices and salt from the diet. They provoke the formation of edema, which significantly worsens the child’s well-being. IN daily menu Cereal porridges, clear vegetable soups with pasta, dried white bread, vegetables, with the exception of legumes, should predominate.
Traditional methods of treating hydronephrosis in children
Prescription products traditional medicine, are strictly prohibited in the treatment of any diseases in children and adolescents, including hydronephrosis. They are ineffective and often provoke local and systemic allergic reactions. The exception is the use of cranberry juice, which can be attributed to dietary nutrition with hydronephrosis. To prepare it, squeeze the juice out of a glass of berries, and add a couple of tablespoons of sugar and half a liter of water to the dry residue. Simmer for 10 minutes, strain. Mix with juice, take 100 ml 2-3 times a day.
Physiotherapy for hydronephrosis in children
For young patients, urologists prescribe inductothermy or ultrasound treatment. After they are carried out, blood circulation improves, smooth muscle muscles are strengthened, and the damaged tissue. It is recommended for children with chronic hydronephrosis Spa treatment. IN medical institutions radon and hydrogen sulfide baths are actively used, mineral water, physical education and gymnastics.
Prevention
There are no preventive measures to prevent hydronephrosis, as children are usually diagnosed with congenital pathology. Its timely detection allows treatment before complications develop.
In pediatric urology, defective development of a certain section of the ureter is usually encountered, causing its narrowing. Less commonly, the formation of an additional vessel is detected, which disrupts the process of urination. Obstructions to the outflow of urine during hydronephrosis are sometimes dense and voluminous blood clots, neoplasms, and accumulations of salt crystals. All these factors can be successfully eliminated through surgery. Therefore, you should consult a doctor if any sign of hydronephrosis is detected.
Useful video about the treatment of hydronephrosis in children
List of sources:
- V. I. Efimova, S. G. Vrublevsky, N. A. Al-Mashat N.A. Endosurgical pyeloplasty for hydronephrosis in children // Pediatric surgery. 2012.
- E.V. Portnyagina, V.A. Yurchuk, S.V. Titova, D.A. Dergachev, E.V.Portnyagin, I.T. Eyubov, S.I. Yakimova Morphofunctional changes in the kidneys in congenital hydronephrosis in children // Siberian Medical Review. 2011.
- B.D. Dorzhiev, V.V. Mantatov Features of diagnosis and treatment of congenital hydronephrosis in children // Acta Biomedica Scientifica. 2011.
