Hydronephrosis of the kidney in a newborn treatment. Renal hydronephrosis in newborns. Surgical treatment of hydronephrosis in newborns

Complete collection and description: renal hydronephrosis treatment in infants and other information for human treatment.

Hydronephrosis is a disease in which the ureter is blocked by a calculus, tumor, blood clot, or urine flow from the kidneys is impaired as a result of an abnormality in the development of the urinary organs.

In newborns, a congenital pathology usually occurs that affects one of the kidneys (most often the left one). But there is also a bilateral lesion (in 11% of cases of the total amount of the detected disease). With this option, it is necessary to apply urgent surgical intervention, otherwise, as a result of the development of insufficiency, the death of the baby may occur. The combination of enlargement of the renal pelvis and ureter is called ureterohydronephrosis.

With a diagnosis such as hydronephrosis in newborns, treatment is carried out mainly by surgery, all conservative methods are used only to alleviate the condition and to prepare for surgical intervention. Medicines are also used in the postoperative period to reduce the likelihood of complications.

Boys develop this disease three times more often than girls. The reason for the development of pathology is the unhealthy lifestyle that the expectant mother leads during pregnancy, as well as the diseases suffered during this period.

Manifestations of hydronephrosis

This ailment is dangerous in that it begins to manifest itself more often only at the third stage. And the timely detection of hydronephrosis in a newborn lies entirely with the parents of the baby. You should pay attention if the child becomes capricious, poorly eaten, his sleep is disturbed. With the development of pain in the tummy, he can twist his legs and pull them up.

It is especially important to pay attention to the quality and condition of urine. You should go to the doctor immediately if bleeding appears on the diapers.

The main symptom of this disease is an enlargement of the kidney, which is easy to palpate with a bimanual palpation examination, or with an ultrasound scan. A strong kidney enlargement in a baby can be seen on an enlarged belly. Accession of an infectious complication, which often accompanies hydronephrosis, an increase in temperature is observed. In this case, an increased content of leukocytes is found in the urine.

The reasons

In newborns, hydronephrosis can develop for several reasons:

Narrowing of the junction of the pelvis into the ureter.

Narrowing of the junction of the ureter into the bladder. In this case, not only hydronephrosis develops, but also an accumulation of fluid in the urethra (megaloureter) occurs.

Development of vesicoureteral reflux. In this condition, fluid from the bladder back into the ureter occurs. It occurs as a result of congenital underdevelopment or lack of valves that prevent urine backflow.

Non-obstructive hydronephrosis. This pathology is rare. With it, there is a violation of the excretion of urine by the kidneys without visible mechanical obstacles.

Polycystic renal dysplasia.

The presence of a posterior valve of the urethra.

Ureterocele.

Traumatic injury or tumor process.

Types of treatment depending on the degree of the disease

In a newborn baby, three degrees of the disease are distinguished:

The first degree is called pyeloectasia. It develops as a result of a slight violation of urine excretion from the kidney, while its functional capabilities are fully preserved. There may be some enlargement of the cavities.

The second stage is called hydrocalicosis. It usually takes several months from the beginning of the first stage. In the tubules and pelvis, there is a significant accumulation of fluid, which presses on the parenchyma, and causes impaired renal function.

The final, or terminal third stage leads to irreversible changes in the renal parenchyma. At the same time, the function of the organ is significantly changed, or stops completely

Indications for surgery

Renal hydronephrosis in newborns can go away on its own. For example, pyelectasis is not an indication for surgery. In some cases, it is physiological in nature, and can go away on its own. Such a child should be registered with a doctor, and are regularly examined. The question of a radical solution to the problem may arise in the case when the first stage begins to progress and goes into the second and third. These variants of the disease are considered pathology, and require urgent action.

Modern methods of treatment make it possible to provide significant assistance with minimal postoperative complications. The indications for surgery may be the following deviations:

expansion of kidney cavities;

the presence of calculi in the kidneys;

significant narrowing of the ureter;

tumor formation in the pelvis.

Laparoscopic intervention

The most gentle and modern method is laparoscopic plastic. It consists in the fact that through small incisions a laparoscope is introduced in the form of a tube, at the end of which there is a screen. Such an intervention can be performed at any stage of the disease, and regardless of the patient's age. Its implementation is contraindicated only in premature infants, and if they have other malformations. The child's stay in the hospital after surgery lasts for one week.

It is very important that the baby must then register with a urologist, whom he must visit with his parents at least 3-4 times a year. For the prevention of complications, he takes uroseptics for some time. The duration of such a course is up to two weeks, sometimes the doctor can extend it, if necessary. In addition, a urinalysis should be taken within the first year after surgery, twice a month.

The rehabilitation period can be lengthened depending on the presence of concomitant pathology, other diseases, and the degree of likelihood of complications. After the urine begins to flow freely into the bladder, the size of the kidney becomes normal, and the damaged tissues restore their structure and function. It is possible to determine the normalization of blood circulation at the periphery of the organ using dopplerography.

With a diagnosis such as hydronephrosis of the kidneys in newborns, treatment with the laparoscopic method sometimes gives some complications, among which there is an addition of infection or bleeding. It should be noted that the likelihood of their development during surgery in a newborn is slightly higher than in an adult.

In some cases, surgical treatment may be offered even before the baby is born. However, such manipulation can lead to premature birth, so the woman is usually warned about the possibility of such an outcome of the operation.

The success of the operation depends on the degree of renal impairment. The likelihood of an unfavorable outcome remains high if the treatment is carried out in a child whose age does not reach six months.

It is possible to diagnose a disease in a fetus at 14-20 weeks of its intrauterine development. The incidence of prenatal hydronephrosis is one in every hundred pregnancies. The study has shown that the incidence of this pathology is about two percent, prenatal diseases mainly affect boys. In this case, an operation is also possible. But this may end in premature birth, which the doctor must inform the mother about.

Often this condition can be transient, and pass without a trace after childbirth, or after some time.

Forecast

Modern methods of surgical intervention guarantee a high probability of recovery. Minimally invasive techniques do not require a long hospital stay and help minimize the development of complications. The chances of a successful cure are somewhat reduced in the presence of concomitant kidney disease (for example, polycystic disease).

Such a serious ailment as hydronephrosis is characterized primarily by the fact that, due to various reasons, the outflow of fluid from the renal pelvis and its cups is disrupted.

As a result of this defect, the cavity system of this organ expands, the pressure in the kidney increases, which ultimately can lead to a slowdown in blood circulation and even to atrophy of the parenchyma itself. In other words, kidney function is impaired, sometimes irreversibly.

This disease can be acquired or congenital, and at times doctors can diagnose hydronephrosis in the fetus. Unfortunately, today, malformations of the genitourinary system are quite common even at the embryonic stage, including such as congenital hydronephrosis.

It is very important to diagnose it on time, that is, even during pregnancy. Since if this pathology is detected already in utero, having been born, the child may well recover and lead a normal full life.

According to statistics, hydronephrosis of the kidneys in the fetus is detected in 5% of cases of this disease.

Interestingly, boys are much more likely to suffer from this disease. And in a quarter of children with hydronephrosis, the lesion is bilateral.

Causes of congenital pathology

In a 4-month-old embryo, the kidneys are almost the same as in a newborn - there is an excretory system, a parenchyma, a pelvis, and a calyx. The fluid is already draining, the fetus empties its bladder several times a day.

Congenital hydronephrosis in an unborn baby develops due to the defects of the genitourinary system that have arisen at the prenatal stage. Most often, the lumen of the ureter is blocked in one way or another, therefore the excretory function is impaired.

Basically, pathology occurs for the following reasons:

abnormal development of a horseshoe-shaped kidney;
multicystosis (usually of the left kidney);
the presence of an additional vessel in the kidney;
incorrect discharge (location) of the ureter.

If we talk about the specific causes of hydronephrosis, then it occurs as a result of:

narrowing of the internal lumen of the ureter;
squeezing it from the outside with a vessel, inflamed tissue or tumor;
impaired urine patency due to reflux, the presence of a stone, or the presence of trauma;
a special pathological structure of the ureteral mucosa.

Why certain defects in the fetus develop during pregnancy is not exactly clear. However, experts name factors that can lead to a certain risk, among them:

environmental pollution and other environmental problems;
ionizing radiation;
burdened heredity.

So, gynecologists refer families planning a new pregnancy to genetics, in which a baby with a defect has already been born, in order to exclude various congenital pathologies of the unborn child.

Classification

Hydronephrosis in children is divided into congenital (it is called primary) and acquired (this is the so-called secondary hydronephrosis). Naturally, in a fetus it can only be of the first type.

The disease can be one-sided, this occurs in most cases and affects either the right or left kidney; and there are also cases of bilateral hydronephrosis, when changes affect both organs. This is diagnosed in about 5% or 9% of all cases of this disease.

Congenital hydronephrosis, however, like acquired, proceeds in three stages (degrees):

The first (pyelectasis). Urine presses on the kidney cavity, accumulating due to a violation of the outflow. As a result, the organ slightly stretches, becomes larger, but continues to function normally.
The second (hydrocalicosis). This stage begins after a few months. Urine accumulates in the tubules of the parenchyma, presses on it, disrupting the functioning of one or both kidneys. The organ is enlarged, its walls are thinned.
Third (terminal). Here irreversible atrophy of the parenchyma itself already occurs. The kidney is very large, like the pelvis with cups, the organ stops functioning. A child with such a problem may even lose a kidney.

Manifestations of hydronephrosis in the fetus

As a rule, hydronephrosis, even in newborns, and even more so in the fetus, can be detected only in the process of special diagnostics. It is not possible to determine from a pregnant woman that a child may suffer from a similar ailment. However, sometimes hydronephrosis leads to lack of water, and the woman experiences pain when the child moves.

But the fact that the disease has no clinical signs does not mean that it can be ignored. Due to hydronephrosis, other disorders in the development of the embryo can occur.

For example, the placenta is poorly supplied with blood, fetal hypoxia sets in, the child is born weakened, with numerous dysfunctions, including respiratory.

There is also a risk of infection still in utero. That is why women who are expecting a child are constantly monitored by a doctor, conducting routine examinations, including ultrasound.

Diagnosis in utero

Usually, a pregnant woman undergoes three screenings in the process of carrying a child - in each trimester one ultrasound. True, if there is a suspicion of a defect, the doctor may prescribe additional examinations.

Already from the 16th week, the kidneys begin to work in the embryo, therefore, at the second ultrasound scan (which is carried out from the 18th to the 20th week inclusive), the doctor checks whether the embryo has congenital kidney pathologies, as well as the bladder and ureters. If the screening shows only the presence of fluid, but neither the cup nor the pelvis has increased, such a deviation is not considered hydronephrosis.

Also, the diagnosis is not made if the pelvis has increased by only 5-8 millimeters. But when the expansion is greater, we can talk about hydronephrosis. Most often in the fetus, it is one-sided.

It is also possible that a child has a severe and advanced stage of hydronephrosis in the womb. In this case, when performing sonography, it is seen that the kidney tissue is significantly thinned, which subsequently leads to renal failure.

Embryo treatment

The tactics of a doctor who has discovered hydronephrosis in a fetus is based on the fact that a pregnant woman is examined very often, and in most cases, even hospitalized. However, the treatment of an ailment in an unborn baby by conservative methods is not carried out.

In the most extreme case, an operation may be prescribed. They usually go for it when there is a serious risk that the kidney will rupture. However, such intervention is fraught with premature birth.

A common practice for such a pathology is that a catheter is placed in the fetal bladder to drain urine from its kidneys. This procedure helps to avoid the appearance of various complications.

If a pregnant woman gets to an experienced doctor on time who conducts competent treatment, the prognosis for hydronephrosis of her child's kidneys is quite favorable.

Hydronephrosis in newborns

Features of this disease in infants are that it can develop in different ways. To date, there is still no exact method that allows doctors to make a reliable prognosis. Therefore, the urologist, as a rule, never prescribes an operation immediately, even if the child was given hydronephrosis in the intrauterine stage.

They watch the kid, watch the dynamics. Sometimes the genitourinary system can develop, tissues and organs can ripen, pathologies can disappear by themselves. It happens that due to unstable water metabolism at this age, the work of the kidneys changes, the size of the pelvis returns to normal 3-4 weeks after birth.

On the other hand, a serious deterioration may occur in just a couple of months, so you may be late with surgery. Therefore, it is so important to constantly monitor the course of renal hydronephrosis in newborns.

In most cases, the pathology is due to congenital abnormalities and anatomical features, both external and internal. Internal reasons include, for example, congenital underdevelopment of the lumen of the ureter, leading to its narrowing.

An external cause may be the formation of an additional vessel, which compresses the ureter, coupled with an abnormal discharge of the latter from the pelvis.

Symptoms

Pyelectasis (enlargement of the renal pelvis) is one of the main symptoms that is detected by ultrasound diagnostics. In addition, hydronephrosis can be manifested by hematuria (blood in the urine) or difficulty urinating, acute pain in the abdomen, fever, concomitant infections of the genitourinary system, and the presence of an impressive size formation in the abdominal cavity.

Diagnosis in children and babies

Hydronephrosis in newborns, whether it was detected earlier or after the birth of a child, in any case requires a number of studies. Unfortunately, children of this age are not yet able to talk about what symptoms they are experiencing. An older child may complain of aching pain in the side, nausea; the baby simply becomes extremely restless at times.

That is why, in addition to standard palpation, as well as urine and blood tests, which will show the presence of inflammation, blood in the urine or other hidden signs of complications, the diagnosis is also made on the basis of:

Ultrasound... The specialist looks at the bladder and kidneys - full and after urination. Screening reveals parenchymal pathologies, obstruction of the pelvis and ureter. If the results are in doubt, diuretics are used in the study, the patient is given plenty of water to drink.
Excretory urography... A contrast is injected into the vein of the newborn, and then it is observed how this substance is excreted. This is how a conclusion is made about the ability of the kidneys and the entire system to filter, about the degree of obstruction.
Computed tomography and MRI... Both of these studies, to varying degrees, allow one to see a three-dimensional image of all urinary structures and draw conclusions about whether newborns have hydronephrosis, and if so, to what stage and degree. If they are done to an infant, then only under anesthesia.
Nephroscintigraphy... This study is carried out using radioisotopes. During this procedure, the specialist assesses how the kidneys work, how much the outflow of fluid is impaired.
Vocal cystography... This study is done if there is reason to suspect the presence of vesicoureteral reflux (urinary reflux), or there is simply a poor outflow of fluid from the bladder. The child is also injected with contrast, but not into the vein, but into the urethra. The bladder fills, and when urination occurs, the doctor takes an x-ray. The picture shows if, as a result of pathology, the contrast returns to the ureters.

Treatment

It depends on the stage of the disease. If the child's hydronephrosis is still of the first degree, then conservative therapy is performed. It consists, first of all, in stimulating the outflow of fluid.

In addition, symptomatic treatment is needed. So, in the case of an infection, antibiotics, anti-inflammatory drugs are prescribed. If necessary, drugs that reduce pressure and relieve swelling of the ureters.

As already mentioned, the ailment often goes away on its own, but in order not to miss its progression, children are regularly given ultrasound. Babies up to 3 years old - once every 3 or 6 months, older patients - once a year.

Both positive and negative dynamics can be observed in the second and third degree of the disease. Screening in this case is carried out every 2-3 months. If the condition of the organ worsens, and as the pelvis grows and expands as it is observed, surgery is indicated.

Indications for surgery

More severe stages of hydronephrosis - starting with the second - do not in themselves serve as an indication for surgical intervention. The operation is necessary if, during the examination, the child found both an enlargement of the pelvis and a narrowing of the ureter, moreover, in its parochal segment.

Fortunately, nephrectomy - removal of a kidney - only has to be done in the worst cases. They occur quite rarely, since urologists observe the child and do not allow hydronephrosis to progress dramatically.

The most common type of surgery is pyeloplasty. It is carried out by different methods, the most effective of which is the Heins-Andersen method. It consists in the fact that in the process of intervention, the narrowed section of the ureter is excised, and along the way, its normal connection with the pelvis is formed.

A blank catheter with a drainage tube brought out or a thin stent with an internal fluid outlet is installed in the area of \u200b\u200bthe new connection. In the first case, a small patient after surgery is in the hospital for an average of three weeks. In the second case, no more than 9 days.

To install a catheter or a stent - the surgeon decides, depending on the situation, the degree of damage and other factors.

It is believed that pyeloplasty is quite effective. It leads to significant improvements in 92-95% of all cases of its implementation. Usually, the function of a diseased kidney is restored within six months or a year after pyeloplasty.

Date: 17-02-2015
Rating: 11

The onset of the disease
Stages of development of hydronephrosis
Symptoms of the disease and methods of diagnosis
Healing activities

Renal hydronephrosis is a rather unpleasant disease that prevents urine from flowing from the collecting system of the kidneys. This entails serious consequences, including disruption of the proper functioning of these organs. This disease covers all age categories of the population. It affects both the right and the left kidney.

The onset of the disease

In a newborn, such a disease is most often caused by congenital rather than acquired factors.

The main causes of pathology:

incorrect position of the ureter;
dyskinesia of the urinary tract;
incorrect location of the arteries in the kidneys, because of which they press on the ureter;
the ureter moves away from the pelvis incorrectly;
the existence of an additional vessel that presses on the ureter;
congenital narrow ureter in a child due to underdevelopment of the lumen.

I would like to note the fact that the last of the above reasons in medical practice occurs much more often than others.

Manifestations of hydronephrosis

It is especially important to pay attention to the quality and condition of urine. You should go to the doctor immediately if bleeding appears on the diapers.

The main symptom of this disease is an enlargement of the kidney, which is easy to palpate with bimanual palpation, or with. A strong kidney enlargement in a baby can be seen on an enlarged belly. Accession of an infectious complication, which often accompanies hydronephrosis, an increase in temperature is observed. In this case, an increased content of leukocytes is found in the urine.

The reasons

In newborns, hydronephrosis can develop for several reasons:

Narrowing of the junction of the pelvis into the ureter.

Narrowing of the junction of the ureter into the bladder. In this case, not only hydronephrosis develops, but also an accumulation of fluid in the urethra (megaloureter) occurs.

Development of vesicoureteral reflux. In this condition, fluid from the bladder back into the ureter occurs. It occurs as a result of congenital underdevelopment or lack of valves that prevent urine backflow.

Non-obstructive hydronephrosis. This pathology is rare. With it, there is a violation of the excretion of urine by the kidneys without visible mechanical obstacles.

Polycystic renal dysplasia.

The presence of a posterior valve of the urethra.

Ureterocele.

Traumatic injury or tumor process.

Types of treatment depending on the degree of the disease

In a newborn baby, three degrees of the disease are distinguished:

The first degree is called pyeloectasia. It develops as a result of a slight violation of urine excretion from the kidney, while its functional capabilities are fully preserved. There may be some enlargement of the cavities.

The second stage is called hydrocalicosis. It usually takes several months from the beginning of the first stage. In the tubules and pelvis, there is a significant accumulation of fluid, which presses on the parenchyma, and causes impaired renal function.

The final, or terminal third stage leads to irreversible changes in the renal parenchyma. At the same time, the function of the organ is significantly changed, or stops completely

Indications for surgery

Modern methods of treatment make it possible to provide significant assistance with minimal postoperative complications. The indications for surgery may be the following deviations:

expansion of kidney cavities;

the presence of calculi in the kidneys;

significant narrowing of the ureter;

tumor formation in the pelvis.

Laparoscopic intervention

It is possible to diagnose a disease in a fetus at 14-20 weeks of its intrauterine development. The incidence of prenatal hydronephrosis is one in every hundred pregnancies. The study has shown that the incidence of this pathology is about two percent, prenatal diseases mainly affect boys. In this case, an operation is also possible. But this may end in premature birth, which the doctor must inform the mother about.

Often this condition can be transient, and pass without a trace after childbirth, or after some time.

Forecast

Hydronephrosis is a renal pathology in which the outflow of urine from the organ is disturbed, the calyces and pelvis expand, and the parenchyma atrophy. The calyx-pelvic system is a kind of funnel in which urine accumulates. If the body is healthy, fluid is freely excreted, there are no problems with its accumulation.

In newborns, hydronephrosis is usually congenital. If you do not get rid of this problem in a timely manner, the gradual progression of the disease can lead to significant impairment of kidney function and renal failure. You need to pay attention to any violations in the behavior and condition of the child, immediately seek medical help.

The causes of the appearance of pathology

The exact cause of hydronephrosis in newborns still cannot be named. Most experts are sure that the beginnings of the disease can be laid even in intrauterine development. Failure by a woman to comply with the main requirements during pregnancy (smoking, drinking alcohol, drugs) significantly increases the risk of developing pathology in a child.

The development of hydronephrosis in infants is associated with physiological abnormalities of the urinary system:

underdeveloped lumen of the ureter;
the wrong structure of the pryokhanny department;
narrowing of the bladder wall;
violation of the innervation of the kidneys with the central nervous system;
reflux (backflow of urine into the kidneys);
calculi in the ureter (it happens in rare cases in newborns).

The acquired form of hydronephrosis in newborns can develop against the background of other kidney diseases as a complication.

Symptoms of the disease

Pathology in newborns can be unilateral (one kidney is affected) and, less often, bilateral. With hydronephrosis of 1 kidney, the symptoms of the disease may not even appear, since the second kidney performs a compensatory function for the outflow of urine. Bilateral kidney damage can be life-threatening and cause uremia. Most often, hydronephrosis in newborns is diagnosed at the stage of development of kidney inflammation (for example).

The child has the following symptoms of renal hydronephrosis:

enlarged tummy;
heat;
lethargy and drowsiness;
because of the arising paroxysmal pains, the child screams, cries, is very restless;
refusal to eat;
itching - occurs due to the accumulation of toxins in the tissues due to a disturbed outflow of urine, the baby is constantly trying to scratch himself, scratching the skin;
streaks of blood are present in the urine.

When examined by a doctor, palpation may reveal a tumor in the area of \u200b\u200bthe affected kidney.

The degree of renal hydronephrosis in children

In newborns, 3 degrees of kidney damage with hydronephrosis are distinguished:

1 degree (pyelectasis) - the pelvis expands from pressure and accumulation of urine, there is a slight increase in the kidney, the parenchyma is not damaged, the functionality of the organ is not impaired.
2 degree (hydrocalicosis) - the liquid begins to squeeze the parenchyma and accumulate in the tubules, the calyx expands even more, the organ functions by only 40%.
Stage 3 (terminal) - the parenchyma atrophies irreversibly, the kidney increases significantly in size, and may gradually lose its function completely.

Possible complications

If hydronephrosis is not detected and treated in time in a newborn, complications will surely arise in the process of progression:

organ atrophy;
bacterial pyelonephritis;
renal failure.

To avoid this, it is necessary to conduct an examination during the period of intrauterine development for the timely detection of pathology.

Diagnostics

general urine analysis;
Ultrasound of the kidneys and bladder;
excretory urography.

A good specialist may suspect hydronephrosis by palpation and detect a characteristic swelling.

Reference! Timely intrauterine diagnosis of a pregnant woman makes it possible to detect hydronephrosis in the fetus even before birth at 16-20 weeks. For 100 pregnancies, 1 case of hydronephrosis is found in the fetus.

General rules and methods of treatment

Several factors influence the choice of treatment regimen for renal hydronephrosis in children:

the degree of pathology;
the duration of the inflammatory process;
the presence of concomitant pathologies.

There are times when, at the initial stage, the disease can go away by itself. A child needs up to 3 years of age to regularly carry out ultrasound of the kidneys (every 3-6 months) to monitor the dynamics of the organ. Sometimes it takes time for the organs to begin to perform their functions fully. During this period, conservative methods can be used that help stimulate the outflow of urine.

Surgical intervention

If the dynamics are negative and the condition of the kidney worsens, you cannot do without surgical intervention. Usually, for hydronephrosis of newborns, they resort to laparoscopic plastic, which is the most gentle method today. The operation should not be performed on premature babies with low birth weight.

No incisions are required during the operation. A laparoscope (a tube with a camera at the end) is inserted through small incisions. A narrow section of the ureter is excised. A new connection of the pelvis with the ureter is formed. The child can be placed with an internal drainage stent, which will be removed after 2-3 months, or a catheter with a drainage tube. The doctor will determine the method of urine diversion based on the characteristics and results of laparoscopy.

Postoperative period

After the operation, the baby should be in the hospital for about a week. In some cases, his stay there may be longer (up to 3 weeks). During this period, constant monitoring of the condition is important.

After discharge, the newborn is put on dispensary registration. Once every 1-2 months, you need to undergo a control examination with a urologist. The doctor may prescribe uroseptic drugs as a maintenance course for 1 to 2 weeks.

For about 6 months, urine tests may show an increase in white blood cells, the presence of protein, and hematuria. This is considered a normal option after surgery. Analyzes need to be taken 2 times a month.

To determine the microcirculation of the periphery of the kidneys, a Doppler study is performed. When urination is restored, the kidney returns to its normal size, tissue regeneration occurs.

Find out the instructions for using renal staminate tea.

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Effects

Although 95% of surgeries are successful, young children have a higher risk of complications than adults. After laparoscopy, the child still needs surgical correction and constant monitoring by a urologist and neonatologist.

After the operation, you may experience:

bleeding;
inflammatory processes of an infectious nature;
if the operation is carried out during the prenatal period, pregnancy termination, premature birth is possible.

Thanks to minimally invasive surgical methods, the use of modern absorbable sutures, the internal introduction of drainage tubes and the use of antibacterial agents, the number of complications has recently decreased significantly.

Prevention measures

Prevention of hydronephrosis in newborns needs to be taken care of even during pregnancy. In infants, this is a congenital pathology, but its likelihood can be reduced if a pregnant woman adheres to certain recommendations.

do not take medications without a doctor's prescription;
do not drink alcohol;
do not smoke;
carry out all the necessary examinations at the appointed time;
eat well.

The sooner hydronephrosis is detected in a newborn, the more likely it is to restore the kidneys to a normal state and return their functionality. Parents need to be attentive to the manifestation of any violations of the child's body. Babies cannot describe their complaints themselves, so you must always monitor their condition, regularly carry out the necessary diagnostics in order to be able to fix any deviations from the norm.

In the next video, a specialist at the Moscow Doctor clinic will tell you more about the methods and features of the treatment of hydronephrosis in children:

Today, various kidney disorders in babies are not considered uncommon. In this article, you will get acquainted with the specifics of the disease, the factors of the disease and varieties, the symptoms of the disease in infants, as well as the main methods of diagnosis in the early stages of pregnancy, as well as the treatment of the disease.

This disease is a violation of the outflow of fluid from the renal pelvis and its cups:

As a result of this, the organ cavity expands, pressure increases. All this can provoke circulatory disorders. In other words, kidney function is impaired.
The disease can be acquired or congenital, and sometimes the doctor can diagnose the disease during the development of the fetus. Unfortunately, today quite often there are malformations of the genitourinary system in the embryonic period.
If this pathology is identified earlier, even before birth, the child will be fully able to recover. According to statistics, fetal kidney disease occurs in 5% of situations. Boys suffer from this pathology much more often.
Every year, up to 50 babies with hydronephrosis from 1 month to 17 years old receive help.

To understand what the disease is, you need to familiarize yourself with the structure of urinary excretion. The pelvis and cups are funnel-shaped with accumulated fluid. In a normal stay, no disturbances in the transmission of urine are formed, however, with the expansion of the cavities, this process is disturbed.

There are two types of disease:

disease with damage to one kidney;
a disease when both kidneys are poorly functioning.

In the first case, the patient usually does not feel the signs of symptoms. With a bilateral manifestation, the disease is as dangerous as possible, since a very serious, lethal condition can occur as a result of the accumulation of urea in the blood.

By origin, the disease is divided into:

congenital;
the acquired formation.

The congenital configuration comes across much more often than the acquired form. Therefore, the study of organs using ultrasound after birth has already been introduced into the mandatory diagnostic procedure by doctors.

Congenital disease, as well as the received one, has a period III:

A disorder that is accompanied by poor urine flow;
Expansion or distension of the renal calyx;
Reduction of the parenchyma. The kidney and pelvis with calyx is large, the organ stops working. For what reason, these or other disorders in the fetus are formed during pregnancy, it has not been specifically established. But experts present the conditions that can cause the disease, from among them:

pollution of the surrounding environment;
x-ray action;
the parents of the baby are carriers of the disease.

The reasons

The unborn

This type of disease in an unborn baby is formed due to the emerging disorders of the genitourinary organization.

The violation appears with the following factors:

improper organ formation;
a rare disease in which the renal parenchyma is gradually replaced by cysts;
on the obviousness of an extra vessel in the organ;
improper placement of the tubular organ;
squeezing the ureter with a vessel, inflamed tissue or tumor;
pathology of fluid patency as a result of the presence of injury or stone;
the specific structure of the mucous membrane of the connective tissue tube.

In children

Features of congenital hydronephrosis are structural features of the baby's body. At the moment, it is impossible to note exactly why this violation appears, however, women, from the moment of the news of pregnancy, continue to harm the body with alcohol and cigarettes, use medications without the permission of the doctor, risk the health of the crumbs.

The key stages of hydronephrosis include 3 levels:

Level 1 hydronephrosis

Changing the pelvis with a whole parenchyma and preserving the basic functions of the kidney.

Level II hydronephrosis

An increase in the volume of the kidney, a defect in the parenchyma, a huge increase in the pelvis, a decrease in the functioning of the organ up to 40%.

With hydronephrosis of the third level

there is an increase in the kidneys, a decrease in the parenchyma, as well as a decrease in the activity of the organ by about 40% or the absence of the organ.

An intrauterine study at the time of pregnancy can show the presence of this disease in a child before birth.

For medical reasons, impaired renal function is a consequence of:

stenosis;
discharge of the ureter;
problems with the structure of the pelvic area;
the formation of stones;
disorders of the central nervous system;
narrowing of the bladder neck;
decreasing fluid.

The consequence of the disease leads to the inability of the child to go to the toilet normally.

Symptoms

The course of the disease is usually asymptomatic. Painful sensations in most cases begin with the onset of microlith in the organ, as well as with the appearance of inflammatory processes.

Symptoms for the inflammatory process in the kidneys in children are as follows:

temperature increase;
pain when urinating;
lumbar pain;
the appearance of bloody discharge in the urine.

The insidiousness of the course of hydronephrosis in children may not be noticed. But the first signs are the following symptoms:

an enlarged belly;
when infectious diseases attack the body;
increased temperature;
weakness and itching occurs;

The disease interferes with the normal withdrawal of fluid, and toxic substances remain in the baby's body. Poisonous substances irritate the skin of the child, which causes itching. The doctor, examining such a child, is able to detect a neoplasm by probing.

There are times when the first sign of the onset of the disease is the formation of bloody clots during urination.

Diagnosis

Diagnostics include:

delivery of urine and blood tests;
Organ ultrasound.
The main way to diagnose hydronephrosis in a child is an x-ray method. Thanks to this method, it is possible to establish the ratio of the volume of a certain kidney in relation to the parameters of a healthy organ.
To clarify the diagnosis, computed tomography of the kidneys, radioisotope study and screening are performed.

If a child's disease has been forming for quite a long time, the disease can cause a severe complication -. Therefore, it is necessary to monitor the child's condition, follow all the doctor's instructions. Today, medicine makes it possible to detect the disease even at the stage of intrauterine formation of a child - from the 20th week of pregnancy.

In order not to miss the further course of the disease, children are constantly undergoing ultrasound examination. A child under the age of three should be examined at least once every six months, older patients need to be examined once within 12 months.

The diagnostics also includes:

Ultrasound examination method. The expert examines the bladder and kidneys and determines the functioning of the organ in a filled state and after fluid has been removed from the body. Diagnostics helps to detect disorders of the parenchyma, pelvis and ureter. If the results are in doubt, drugs that promote a diuretic effect are used in the search. In this case, the patient is given a lot of water to drink.
Excretory urography... A substance is injected into the vein of the infant, while observing how this substance is excreted. Thus, a conclusion is made about the work of the kidneys.
Research with radionuclides produced in the case of assessing the location, formation, scale of the organ in order to recognize the main cause of the organ disorder. In this way, the activity of the renal parenchyma is determined.
X-ray method studies of the kidneys and urinary tract during the act of urination using radiopaque substances. This study is performed if there is reason to suspect the presence of a urine throw.

Intrauterine diagnosis

Usually, a pregnant woman undergoes 3 examinations - once during the trimester:

Already in the period from the 16th week, the kidneys gradually begin to function in the embryo, for this reason, the II study is carried out.
If, during screening, only the formation of fluid is noticeable, but neither the cups nor the pelvis have increased in volume, this violation does not apply to hydronephrosis.
There are situations when an advanced stage of this disease is observed in a baby in the womb. During the ultrasound scan, it is noticeable that the kidney tissue is very thin. This leads to a syndrome of impairment of all kidney functions, leading to a disorder of water, electrolyte, nitrogen and other types of metabolism. Unfortunately, babies cannot explain how they feel. An older child is able to complain about the occurrence of pain in the side.

The child is also injected with contrast, but into the urethra.

The bladder fills, and if there is urination, the doctor takes x-rays. The picture shows that due to the violation, the substance returns to the ureter.

Treatment

At the first stage of the disease, it is better to use conservative methods of cure. This therapy is focused on stimulating the outflow of urine. In most cases, this is sufficient for effective treatment. The second stage of the disease implies the presence of two dynamics, positive and negative, in the following cases:

the condition of the kidneys is aggravated, therefore, surgical intervention is necessary;
positive dynamics implies continuation of the prescribed cure and systematic supervision.

Embryo treatment

The position of the doctor who has identified hydronephrosis in the fetus is based on the fact that a woman in position is constantly examined, and in many situations she is even hospitalized, as well as:

Surgical intervention, consists in eliminating the narrowing in the zone of transition of the renal pelvis into the ureter, is carried out by various methods.
The Anderson-Hines method is considered the most productive. This method is used during surgery, when the narrowed place of the ureter is excised, which leads to a normal union with the pelvis.
A tube or the thinnest prosthesis with an internal fluid outlet is determined in the site of the new union. In the very latter case, an operational invasion may be ordered.

When a pregnant woman appears to a qualified doctor in a timely manner, he will conduct competent therapy, which will only lead to a positive result in treatment. The postoperative period in all children is not the same. Your child may have a drainage tube installed and will be followed up in the hospital for a couple of weeks. Also, when the prosthesis is introduced, the baby will be discharged within 9 days. After a couple of months, the prosthesis will be removed using special equipment. If the defect is diagnosed on time and the operation is performed, the probability of a positive outcome is 96 - 98%.

You can also learn about the expansion of the renal pelvis from this video.

Sometimes at birth such a diagnosis is made as "hydronephrosis of the kidney" in a newborn. a disease characterized by blockage of the ureter with a tumor, calculi, blood clots, or there is a violation of urine flow due to improper development of the organs that excrete it. In newborns, this pathology usually affects one of the kidneys, mainly the left one. With a bilateral lesion, an urgent operation is required, otherwise the baby may die.

Such a disease is treated mainly surgically, and conservative methods are used in order to slightly alleviate the patient's condition and in order to prepare for surgery. Medicines are used in the postoperative period to reduce the likelihood of complications.

How does the disease manifest itself?

Renal hydronephrosis in newborns is dangerous because its symptoms appear only in the third stage. Therefore, the first symptoms should be noticed by parents. They should be alerted that the baby became lethargic, capricious, began to eat poorly, and sleep was disturbed. With abdominal pain, the child twists his legs and pulls them up.

Attention should be paid to the condition and quality of urine. If suddenly bleeding appears on the diapers, do not delay the visit to the doctor.

The main symptom of the disease is an enlarged kidney, which is easily palpable during bimanual palpation, and can also be detected on ultrasound. A strong enlargement of the organ is manifested by a large abdomen. Often, hydronephrosis of the kidneys in newborns is accompanied by an infectious complication with an increase in temperature. In this case, urine contains a large number of leukocytes.

Causes of occurrence

Hydronephrosis is congenital and acquired. most often there is a congenital form, which is characterized by abnormal development of the kidneys and their vascular system during intrauterine development. A baby is born with an abnormal ureter that may be narrowed or misplaced, an extra arterial vessel. He, in turn, compresses this organ very strongly, as a result of which the outflow of urine is disturbed.

In a newborn, a violation of the outflow of urine can be detected both from one kidney, and from both at the same time. In this case, the diagnosis is made - unilateral or bilateral hydronephrosis.

It is still not fully understood what causes the abnormal intrauterine kidney formation, leading to the onset of this disease. One thing is obvious - the abuse of alcoholic beverages by a woman in a position can provoke possible abnormalities in the fetus. In addition, smoking and taking certain medications negatively affect the health of the unborn baby.

The acquired form of kidney hydronephrosis occurs due to complications that are caused by other kidney diseases.

Kinds

Hydronephrosis of the kidneys in newborns, a photo of which clearly demonstrates the essence of the problem, is most often one-sided. Mostly boys are exposed to this pathology. This disease is divided into three types.

Pyelectasis is the first stage of pathology, characterized by an increase in the pelvis due to increased pressure. At this stage, it has not yet been affected, the main functions of the organ are preserved, but it itself is already slightly enlarged. With timely treatment started, serious consequences can be avoided.

The second stage of hydronephrosis is hydrocalicosis. In this case, the pelvis of the organ increase even more along with the kidney cups. Excess urine accumulating in the renal tubules begins to compress the parenchyma, due to which its functioning is almost completely disrupted.

The third stage of hydronephrosis is accompanied by active atrophy of the renal tissues. In this case, the kidney stops working completely. At this stage, only surgical treatment is carried out.

Diagnostics

Hydronephrosis of the kidneys in newborns is diagnosed using ultrasound, computed tomography, laboratory studies, and vocal cystography.

An experienced doctor is able to diagnose such a pathology during the first examination. With the help of palpation, he determines whether the kidney is enlarged or not, after which he sends the child for examination. With the help of modern equipment, it is possible not only to confirm the very fact of the disease, but also to establish the degree of organ damage, as well as to find out the possible causes that led to the occurrence of hydronephrosis.

Excretory pyelography is performed to assess the excretory and with the help of vocal cystography, reflux can be detected, which in some cases provokes hydronephrosis.

If renal hydronephrosis is diagnosed in newborns, reviews of mothers recommend ultrasound diagnostics every three months to track changes in dynamics. In this case, complications can be prevented.

Treatment

If the kidney is slightly enlarged, then conservative treatment is carried out to normalize the outflow of urine. With timely commenced competent treatment, a positive result can be achieved by restoring the functioning of the kidney.

When diagnosing the second stage of a disease such as hydronephrosis of the kidneys in newborns, treatment is also carried out mainly by a drug method with the obligatory tracking of dynamics. If it is positive, then conservative treatment is continued according to the established scheme. Negative dynamics presupposes a mandatory surgical intervention.

In the third stage, surgical intervention is performed in 100% of cases.

Indications for surgery

Thanks to modern methods of treatment, effective assistance is provided with minimal operational complications. If renal hydronephrosis is diagnosed in a newborn, surgery may be prescribed in the following cases:

expansion of organ cavities;
strong;
the presence of calculi in the kidneys;
the occurrence of a tumor in the pelvis.

Surgical intervention

The most gentle method of surgical intervention is laparoscopic plastic. The meaning of its implementation lies in the fact that through the small incisions made, a laparoscope is introduced, which is a tube with a screen at the end. With the help of such a device, a narrow section of the ureter is replaced by a new wide junction of this organ and the renal pelvis created by surgeons. This contributes to the normal restoration of urine flow.

Such surgical intervention is performed at any stage of the disease. After that, the baby spends one week in the hospital.

The child must be registered with a urologist. For preventive purposes, the baby should take uroseptics for two weeks. In addition, during the first year after the operation, it is recommended to regularly take a urine test.

Treatment with folk remedies

In the presence of a disease such as hydronephrosis of the kidneys in newborns, treatment with folk remedies involves the elimination of the obvious symptoms of this pathology.

50 g of adonis herb, oat grain, field horsetail, bearberry, nettle leaves and 150 g of birch leaves;
100 g each of birch buds, sedum grass, field horsetail, adonis, oat grain, bedstraw and hop cones;
250 g of bearberry and birch buds, 50 g of hoofed, horsetail and knotweed each, 75 g of beans and corn stigmas;
150 g each of juniper fruits, birch leaves and dandelion roots.

To prepare a tincture, 100 g of any collection is poured with a liter of boiling water, boiled for 10 minutes, then poured into a thermos along with the green mass and left overnight. Strain and drink a 100 g tincture before meals. The course of treatment lasts 4 months, with a break of 2 weeks, after which it is continued.

For children, it is necessary to prepare a tincture in the following daily dose of herbal collection:

up to 1 year - 0.5 tsp;
up to 3 years old - 1 tsp;
3-6 years - 1 dec. l .;
6-10 years old - 1 tbsp. l .;
over 10 years old - 2 tbsp. l.

It should be remembered that some herbs may have contraindications.

Output

Thus, if you have been diagnosed with renal hydronephrosis in newborns, you should not despair. The main thing is that if the degree of the disease is mild, then it is necessary to monitor the dynamics of the development of this pathology and treat the child with a medication. Surgical intervention is carried out in the most severe cases, but thanks to modern techniques, a high probability of recovery is guaranteed.