Types of diseases
Etiologic aspects
A. Primary (congenital) hydronephrosis:
First No obstructive lesions of the ureter (renal lesions of motor nerves, congenital avaskularnost,
primary congenital pelvic increase).
Second With obstructive lesions of the urethra (stricture and stenosis of the anomalies of the courts, bending the ureter, ectopia,
duplication, improper insertion, diverticulum).
B. Secondary (acquired) hydronephrosis:
First Obstruction in the ureter based (stone, neoplasms, strictures, cysts).
Second Obstruction of the ureter outside (tumors, cancer of the uterus, surgical injury during operations, folding ureter
because of ptosis, or adhesions, pregnancy, lesions and diseases of the spine).
Third Obstruction due to bladder lesions (tumors of the meatus, bladder diverticula, bladder stones, congenital
anomalies, bladder neck contracture, bladder neck hypertrophy).
4th Obstruction of the urethra (urethral stricture or diverticulum, the camera in the urethra, meatus stenosis, atresia,
congenital valve on the back of the urethra, increasing faith montanum, tumors and cysts of the urethra, fistulas, uretrokela).
5th Obstruction due to prostate disease (hypertrophy, tumors, cysts, stones).
6th Diseases of the penis and foreskin.
7th Kidney disease (abnormalities, Aberrant blood vessels, cysts, tumors, ptosis, stones, infections,
renal artery aneurysm).
Pathology
To be caused hydronephrosis must be excreted urine and that it retains in the kidney. Constantly expanding ekskretovanje enabled pelvis and partial reabsorption of urine.
To create hydronephrosis is an important condition for increasing the internal pressure, because hydronephrosis occurs after the partial obstruction of the renal arteries, which causes a reduction of pressure in the pelvis. Pressure increased on renal pelvic vessels causing ischemia causing damage to the feeding performance of renal parenchyma, atrophy and dilatation of the pelvis. If the damage occurred ireparabilno supply blood to the kidneys atrophic process will be stopped even after the removal of obstacles.
Etiologic-anatomic aspect
Expanded renal pelvis, ureter and part of the bowl proximal to the obstacles.
Male hydronephrosis do not make changes on the surface of kidney, except pelvis increases. In advanced cases of renal parenchyma becomes thinner. In large hindronefrozama of renal parenchyma left behind only a thinner cortex in which there are few normal glomeruli, while most of the tubular system was destroyed. Inside held the remains of walls and glass Bertinijevih pillars in the form of fibrous partitions.
Diagnosis
Anamnesis
Some cases of hydronephrosis can develop without interference. The second creates pain, which does not depend on their size hydronephrosis, there are huge, and without pain.
In cases of intermittent hydronephrosis has a period of pain due to complete obstruction that was partly the point. With strain relief of obstruction attacks cease. There are frequent calls to urinate.Large amounts of urine after the release of hydronephrosis.
The clinical picture
Kidney pain in the attacks, without apparent cause, with increasing frequency. More often the right side, more often in men.
In urine, no pathological findings in the absence of infection stones. It has a shape with microhematuria, and with profuse bleeding, the cause of bleeding is ecchymosis and pelvic varices mucosa.
It can often be felt enlarged kidney. He is a little sensitive in the attack. Once the patient notices that his mind enlarged kidney, and that lose when the interference takes a specific position.
In cases of large hydronephrosis can occur ileus, gastrointestinal disturbances.
Sometimes pain occurs after cessation of polyuria.
Cistoskopski findings
No expulsion of urine, although there Peristaltic waves. As soon as the catheter passes into the ureter obstacle appears in the urine drops fast, without normal intermisija. The influx of large amounts of urine, the maximum capacity of the pelvis is 15 cm3, shows hydronephrosis. The urine contains less salt and other compounds other than urine from a healthy kidney.
Radiological findings
Closed hydronephrosis can not be seen with intravenous pyelography (kidney excluded).
In early hydronephrosis may be seen flattening and enlargement of some or all small cup. When the pelvic bowl to reduce spread and expand at the expense of the papillae. Pelvic or kruškat gets square shape, and angle of insertion of the ureter becomes sharp. The ureter adheres to the inner edge of the pelvis.
No defect in the charge, except for cases of hemorrhage or tumor.
Closed hydronephrosis are rare. They are usually painless.
Partial hydronephrosis (hidrokaliks) is an extension of one or more of the patella. Occurs due to inflammation, tuberculosis, and neoplasms of kidney stones.
The functional state
Hydronephrosis of one kidney does not lead to a change of function. Hydronephrosis of both kidneys and even can be a long time without loss of function.
The sequence of signs, symptoms, according to the parameters of significance for the diagnosis
Anamnesis
Dull pain in kostovertebralnom corner. Intermittent attacks of severe pain or right renal colic. The pain can radiate along the ureter. The pain may accompany symptoms such reflexes collapse, Nausea, vomiting, abdominal meteorism. Sometimes after the attacks of pain may be seen to reduce cancer pain.
Clinic
Enlarged kidney. Increased after the reduction in renal colic and polyuria.
Cystoscopy
Cessation of secretion of one kidney, a delay in the excretion of color hromocistoskopiji.
Pyelogram
The characteristic image enlarged renal pelvis. Off the kidney in a closed hydronephrosis.
Functional characteristics of
Hydronephrotic atrophy over time creates Renal functional changes characteristic of no hydronephrosis. Consequence of ongoing obstruction is a progressive reduction of global functions.
When the obstacle is removed, can occur polyuric crisis, the secretion of several liters of urine for several days. In these crises, in addition to losing large amounts of water and salt. The disorder is transitory, with greater dysfunction than glomerular tubular
For evaluating the functional state needs to be done: hromocistoskopiju, intravenous pijelografiju concentration test, PSP test, urea and creatinine clearance, urine possible separate (from each kidney) to examine the clearance, including clearance osmolarni.
It is possible that at an earlier stage, when the global function is preserved, it may prove functional damage to the tubules, decreased excretion of NH4 and acid, the acid salt loading with NH4CI.
Forecast
Bilateral hydronephrosis congenital origin usually causes death in early childhood.
Incomplete obstruction can cause only a minor extension of the pelvis and lower kidney damage.
Unilateral hydronephrosis, if not accompanied by complications rarely cause death - because of the splash or bleeding. Most commonly occurring secondary infections, stones and rarely tumors or tuberculosis.
The infection causes pyelonephritis, and if there will be ureetr closed pyonephrosis.
Operative mortality is low, 1-5% of cases nephrectomy. Conservative surgery often can not preserve renal tissue, and there are plenty of postoperative complications (in cases with no obstructive lesions).
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