Hydronephrosis

Hydronephrosis is an increase in the size of the pelvis and calyxes of the kidney, which occurs due to the occurrence of an obstacle to the release of urine at the junction of the ureter with the pelvis. The urinary tract consists of the renal cups, renal pelvis, ureter, urethra, bladder. The pelvis and calyx represent the collecting system of the kidney.

The very obstruction of the outflow of urine leads to a significant expansion of the pelvis up to irreversible impairment of kidney function. The degree of enlargement of the pelvis and renal calyces depends on the pressure of urine and varies widely. With a slight obstruction to urine output, a moderate increase in the pelvis is caused and is not accompanied by impaired renal function. This only increases the risk of pyelonephritis.

Most children have congenital hydronephrosis . The causes of hydronephrosis can be divided into external and internal. With an internal cause, it occurs with congenital narrowing of the ureter, in view of the underdevelopment of the lumen and is more common than others. With an external cause, the ureter is compressed.

Hydronephrosis can be detected using fetal ultrasound. This condition can present with bloody urine, urinary tract infection, abdominal pain, or an enlarged abdomen. There are times when there are no external signs.

In order to finally establish the existence of hydronephrosis, the following steps must be taken

The first step is to do an ultrasound of the fetus. From the 15th week of the prenatal period, the renal pelvis and cups are clearly defined. If the pelvis remains enlarged after the birth of the child, a more in-depth urological examination is decided by the decision of the pediatric urologist.

The child is tested as follows:

• Ultrasound of the kidneys, bladder before and after urination. By ultrasound, signs of damage to the parenchyma are determined, reveal a weak, moderate and severe degree of hydronephrosis.
• Radiopaque examination of the outflow of urine from the bladder.
• Intravenous urography - an X-ray is taken after a radiopaque contrast agent is injected.
• Nephroscintigraphy - a study of the kidneys with a radioisotope.

In newborns, signs are detected after 3-4 weeks. At the same time, the first 3 weeks after birth, the body's water exchange changes, while the size of the pelvis and cups changes.

The manifestations of hydronephrosis often disappear on their own. During the first 3 years, it is shown that an ultrasound scan is performed 2-4 times a year, after three years, once is enough.

Hydronephrosis can have a positive or negative trend. With an increase in the pelvis during the observation period, it is necessary to carry out an operative intervention.