Hydronephrosis in children is a very common kidney disease that can be congenital and acquired. The congenital form is caused by disorders in the intrauterine development. Acquired occurs after the inflammatory processes in the organs of the urinary system.
Disease classification
Hydronephrosis is a disease in which the outflow of urine into the bladder departs more slowly than is necessary for the normal functioning of the organs. Because of this, urine accumulates in the renal pelvis, creating pressure and expanding the cavity of the kidney, thereby disrupting its work.
Hydronephrosis is divided into two types - unilateral (when one kidney is affected) and bilateral (when both kidneys are affected), depending on localization. More common in boys.
As a rule, one kidney is affected (most often the left). A bilateral lesion is very dangerous, since in this case the disease progresses much faster, threatening to go to the chronic stage, leading to kidney dysfunction.
Degrees of Hydronephrosis
There are three degrees of hydronephrosis in children.
- 1st degree. Expansion of the pelvis occurs, but the kidney continues to function normally. Ultrasound examination shows a slight increase in the organ, but there are no other external manifestations.
- 2nd degree. An expansion of 15-20% occurs, the walls of the kidney become thinner, the functioning of the organ deteriorates significantly, and the structure of the kidney is destroyed.
- 3rd degree. The kidney increases almost 2 times, the functionality is not more than 15-20% or completely absent. The organ atrophies. This is the last and most dangerous stage of hydronephrosis. The development of renal failure can be fatal.
Causes of the disease
The main reasons for the development of hydronephrosis in children include:
- improper formation of the urinary system during fetal development;
- improper location or underdevelopment of the ureter;
- displacement of the kidneys;
- the presence of an extra vessel that compresses the ureter, thereby disrupting the urination process;
- narrowing of the neck of the bladder ;
- improper urine outflow;
- mutations;
- heredity;
- improper discharge of the ureter from the kidney;
- reflux - when there is an outflow of urine from the bladder to the ureter.
The causes of acquired hydronephrosis include:
- urogenital system injuries (for example, during surgery);
- colds that have contributed to the development of the inflammatory process;
- sometimes hydronephrosis is caused by the presence of urolithiasis;
- infections of the genitourinary system.
Congenital hydronephrosis in children is directly related to the mother’s lifestyle. The reasons that can provoke an incorrect laying of the child’s organs include:
- alcohol;
- smoking;
- mother taking medications that are prohibited during pregnancy;
- unbalanced nutrition of mom;
- polluted environment;
- work in hazardous industries.
Symptoms
With hydronephrosis in children, symptoms may not appear for a long time. The first stage is almost asymptomatic, but with the second it progresses very quickly, which is fraught with serious consequences. The main symptoms indicating the disease can be distinguished:
- sharp paroxysmal pain in the lumbar region and abdomen (in most cases from the affected kidney);
- swelling and itching of the skin;
- blood in the urine (in the third stage);
- difficulty urinating;
- fever;
- an increase in the size of the abdomen due to accumulation of fluid;
- lethargy, moodiness, loss of appetite;
- with palpation, an increase in the kidney can be detected (visually looks like a swelling);
- the baby cries when urinating.
Symptoms begin to manifest from the second stage. Until this moment, a healthy kidney takes over all the functions. This is the danger of hydronephrosis, as the disease progresses very quickly. In young children who cannot yet point out their pain, the identification of symptoms depends on the mother and her care.
Important! At the first sign, you should immediately consult a doctor.
Diagnosis of hydronephrosis
It is possible to detect the development of hydronephrosis using ultrasound already at 15 weeks of fetal development. If the doctor reveals an increase in the size of the kidney, then the question of further monitoring of the child or urgent surgery is decided, because modern technologies allow children to perform intrauterine operations. If a decision is made to monitor the dynamics, then it is necessary to conduct an ultrasound procedure every third month.
In any case, the question of further actions based on the results of ultrasound examination is decided individually.
The diagnosis made during pregnancy after the birth of the baby is confirmed in about 30-35%.
When diagnosing the health of a newborn child, in addition to ultrasound of the kidneys, the following procedures are used:
- identification of seals and swelling in the lumbar region;
- renal urography (administration of a contrast agent, with the help of which the degree of expansion of the renal pelvis is revealed;
- determination of the volume of residual urine;
- nephroscintigraphy (a diagnosis that allows you to assess the level of kidney function and the degree of damage).
Confirm congenital hydronephrosis thanks to the above diagnostic methods is possible in the first month of a child’s life.
According to the results of studies, the doctor prescribes an individual, most effective treatment for a particular child.
Treatment of hydronerphosis in children
Treatment of hydronephrosis is very important to start at an early stage. In this case, doctors note a successful result without any consequences. The kidneys begin to function fully.
With kidney hydronephrosis in a child, treatment can be conservative (with the use of medications) and prompt.
Many babies, especially premature babies, are under the control of doctors for some time. Systematic examinations and control tests help stop the disease in a natural way.
The conservative method is used only at the first stage of the disease, in which there is no destruction of the organ. Actions are aimed at eliminating stagnation of urine. With hydronephrosis, which is accompanied by an infection, antibiotics are prescribed. It is imperative that you follow a diet, drink plenty of fluids, and have your doctor constantly monitor. After proper treatment, the organ is fully restored. If this did not happen or a worsening of the condition began, an operational method of treatment is required.
With hydronephrosis, an operation for a child can be performed in several ways:
- Laparoscopy. Thanks to this method, the risk of complications is minimized and the rehabilitation period is significantly reduced. But such an operation is not done to premature babies or toddlers with a lack of body weight.
- Pyeloplasty The damaged tissues of the ureter and pelvis are removed and a new connection is established between them. This method allows you to cure hydronephrosis in 90% of cases.
- Ureter resection.
- Nephrostomy An operation in which a catheter is inserted into the kidney to drain the urine.
- Nephrectomy If the disease has passed into the third stage and the organ is completely destroyed, removal of the kidney is required . This is done only as a last resort and unilateral hydronephrosis. If at least 10% of healthy tissues are preserved, this method is abandoned and another, more gentle, but effective one is used.
- If two kidneys are affected, transplantation is necessary.
Children after surgery do not suffer from hydronephrosis and quickly recover.
Prevention of hydronephrosis
To minimize the risk of hydronephrosis, the expectant mother needs to give up all bad habits and eat right, do not take drugs that are prohibited during pregnancy.
Prevention of acquired disease are:
- proper nutrition;
- minimizing the amount of salt in food;
- heavy drinking;
- compliance with the temperature regime - avoid overcooling;
- avoid lower back injuries.
Possible complications
The healing process depends on the stage at which treatment began. The longer treatment does not begin, the higher the risk of serious complications. It is necessary to take into account the swiftness of the development of the disease, especially after the beginning of the second stage, at which the death of healthy tissues begins.
One of the serious complications is the attachment of an infection, as a result of which pyelonephritis can develop. Symptoms will include fever, urinary retention, pain, and intermittent urination.
The most terrible consequence of hydronephrosis is renal failure, which can occur in the third stage due to the lack of treatment. The body is constantly exposed to toxins and harmful substances, which normally should be excreted in the urine. The child will constantly need hemodialysis to cleanse the blood. The only treatment for kidney failure is a kidney transplant.
Finally
With timely treatment of hydronephrosis in children under three years of age, recovery occurs in the vast majority of cases. For any symptoms, you should immediately consult a doctor, and during pregnancy, do not neglect planned screenings.