Can a child's kidneys stop developing? One kidney from birth: causes of anomaly, how to live with such a pathology. Hydronephrosis of newborns: treatment

All over the world, babies are born every day with one kidney. Concerned parents do not always know how to behave in such a situation in order to make the life of a child with one kidney fulfilling. In cases where a pair of organs has not been formed, childhood will not be joyful and serene, like that of healthy peers, but such a disease should not be considered a disability. Modern medicine copes well with this pathology.

A child (fetus) has one kidney, should we sound the alarm?

A condition in which a child is diagnosed with congenital absence of one or several organs. There are several types of the disease:

Type of absence	Characteristics of the pathology	Impact on life
Two-way	Absence of a developed ureter	The fetus dies
Unilateral (right)	The left organ compensates for the work of the undeveloped right kidney	Does not cause any noticeable discomfort
One-sided (left)	The right kidney is unable to fully perform its work	More difficult to tolerate
Unilateral (with absence of ureter)	A healthy woman works “for two”	Does not affect lifestyle
Unilateral (without absence of ureter)	Absence of the orifice of the duct (visible on ultrasound of the kidneys)	Anomalies in the formation of the genital organs

Why did it happen?

During the period of intrauterine development of the fetus, anomalies in the formation of its organs are possible.

During the period of life when the fetus develops in the womb, the formation of all major organs occurs. It is during this period that there is a risk for everyone possible pathologies. In this case, expectant mothers are prescribed a screening procedure. Signs of the presence or absence of the second are visible; it is recommended to carry out the procedure once a month. Doctors and geneticists have not found an exact answer to what exactly provokes the disease in a newborn child, but the disease is not associated with a predisposition at the genetic level. The pathology of the absence of a kidney in a child may be due to the following:

• developed infections in the first trimester;
• the mother who gave birth to the baby is sick with diabetes;
• uncontrolled use of medications occurred.

The critical period for the life of the unborn baby is the 2nd and 3rd trimester of pregnancy. It is during this period that a failure in the formation of organs may occur.

How is the life of a child with this pathology different?

In the fetus in the womb

Boys are more likely to suffer from this pathology.

According to statistics, among people born with the pathology of the absence of a kidney, boys suffer from the disease more often than girls. During intrauterine development, the fetus may experience a stroke in the area of ​​the ureter, which causes improper formation of the organ. With a bilateral type of disease, children die before birth or in the first hours after birth, which cannot be said about unilateral agenesis. In a fetus with unilateral organ absence, the disease is not diagnosed or visualized in any way, but with bilateral organ absence, the following symptoms may be observed on ultrasound:

• wide nose;
• wide eyes;
• swelling on the face;
• ear deformation;
• forehead prominence.

In a newborn

Among premature babies, congenital absence of a kidney is more common than among healthy children. The working kidney compensates for the work of the sick one. If on ultrasound examination If no prerequisites for the disease were found and the children live without problems, then it will make itself felt days and months after the birth of the baby. If one kidney is not functioning sufficiently, children develop poorly urine reproductive system, which is accompanied by constant urination, general dehydration and frequent regurgitation. Patients living with this disease experience symptoms of increased blood pressure, swelling and intoxication of the body from harmful substances.

In an adult child

In girls, the absence of one kidney is often combined with pathology of the genital organs.

As you get older, the disease manifests itself differently: as a rule, harmful influence The reproductive system is affected. In a boy, the disease manifests itself in the absence of a testicle and vas deferens, and in girls there are disruptions in the development of organs such as the vagina, uterus, the fallopian tubes. The disease is completely incompatible with such a pathology as the absence of one kidney. renal failure. Therefore, it is important to monitor the health of children to prevent the development of infections and diseases that can lead to deficiency.

Diagnostic principles

It is very difficult to detect the disease before preliminary diagnosis. As children grow older, they do not develop any symptoms that would indicate the absence of a second kidney. When alarming symptoms appear, children are prescribed ultrasound diagnostics, which could visualize the diagnosis. There are cases when ultrasound doctors cannot always detect the problem, so they prescribe additional computer diagnostics and MRI so that specialists can see the full picture.

During examination general condition in the womb it is also important to observe the character amniotic fluid and how the baby grows. If the kidney is not visible and the diagnosis is confirmed, the doctor needs to collect all the information about the course of the mother’s pregnancy, hereditary diseases in the family and previous infections that could prevent the birth healthy baby. This will make it possible to formulate the correct treatment.

As a person grows, all his internal organs. In nature, paired human organs are not always symmetrical, which is a variant of the norm. However, if one kidney is one and a half or two times larger than the other, this indicates the presence of problems that require treatment.

One kidney larger than the other may be the result of:

• hydronephrotic transformations;
• inflammatory diseases;
• urolithiasis;
• malignant and benign neoplasms;
• vicarious or compensatory hyperplasia, which develops in the absence of a second kidney.

Hydronephrotic transformation

Hydronephrosis, or hydronephrotic transformation, develops due to enlargement of the kidney chambers under the pressure of urine. The main causes of hydronephrosis are abnormalities of the urinary system, kidney stones, trauma and tumor formations of benign and malignant organs. Hydronephrosis occurs in the lungs (pyelectasia), moderate severity and severe forms.

In a newborn, hydronephrotic changes can be a consequence of congenital anomalies in the structure of the ureters, as well as the result of incomplete development of their valves. Often, urinary retention results from a narrowing of the lumen of the ureter or urethra.

In adult patients, kidney enlargement is a consequence bacterial infection, kidney stone pathology, injuries of the urinary system, benign and malignant neoplasms. Often, urine can be retained due to inflammation of the genital organs, which are located next to the kidneys.

Inflammatory diseases

Most often, infectious and inflammatory processes lead to a slight enlargement of the kidney: pyelonephritis, glomerulonephritis, nephritis. As a result of an infectious lesion, swelling of the kidney tissue occurs. With a strong inflammatory process, urine is retained, which leads to a significant increase in the affected organ in comparison with the healthy one.

With pyelonephritis, swelling of the kidney parenchyma is observed. With glomerulonephritis, the papillae of the kidneys are affected, which are eventually replaced by connective tissue.

Urolithiasis

Kidney stone pathology can be diagnosed in children of different ages and adults, while representatives of the stronger half of humanity are more susceptible to this pathology.

Among the causes of calculus formation, the most common are poor water quality, poor nutrition, sedentary lifestyle life, hot climatic conditions and genetic predisposition. Less commonly, inflammation in the kidneys and abnormalities in the structure of the urinary organs lead to urolithiasis.

Neoplasms

Significant asymmetry can be provoked by benign and malignant neoplasms, which includes polyps, hemangiomas, cysts. In the process of growth, tumor neoplasms cause urine retention, which, in turn, leads to an increase in the size of the organ.

Hypoplasia

Hypoplasia is a pathological condition in which one kidney is smaller than the other. This pathology is a consequence of a lag in the development of one organ from another, a congenital pathology that forms during the intrauterine development of the fetus. If a child has one kidney smaller than the other, complications (dysplasia, mental retardation) are most likely to occur.

In the absence of congenital complications, the smaller kidney is susceptible to inflammatory processes.

Hidden pathology may be indicated by:

• regular causeless increase in body temperature;
• disorders of the digestive system (diarrhea, vomiting);
• disruption of the vitamin D metabolism process, which results in the development of rickets;
• color change skin with a predominance of pallor and cyanosis.

Signs

First of all, the presence of pathology is indicated renal colic - pain syndrome V lumbar region. At the same time, newborns become capricious and restless. Parents need to be extremely careful, as it is difficult to identify problems in children. At the first latent stage, which all diseases go through, the problem can only be recognized during palpation or instrumental examination.

Upon joining inflammatory process The patient's body temperature rises, while appetite worsens and the functioning of the digestive organs is disrupted, nausea and vomiting occur. Gastrointestinal disorders accompany almost every kidney disease.

The next sign is impaired diuresis. During the emptying process Bladder The patient may experience pain and burning in the perineum, as well as pain in the pelvic area. Also, depending on the reason for the change in the size of the organ, the volume of urine excreted may increase or decrease.

For availability pathological processes in organs indicate changes in general clinical indicators. With an infectious-inflammatory lesion in the urine, the level of leukocytes increases. With urolithiasis, the number of red blood cells, protein and salts increases.

Attention! With renal hyperplasia, the severity of symptoms is usually lower. Characteristic feature small kidney is the absence of pain.

Diagnostics

In order to determine pathological changes in paired organs and the cause of their occurrence, you need to seek help from a specialist - a nephrologist. During the examination, the doctor will conduct a survey, examine the patient and refer him for clinical and instrumental examinations.

During the study, the doctor determines the signs and duration of the disease, the presence accompanying pathologies and clarifies the presence of a history of diseases of the urinary system. Next, palpation is carried out, during which the doctor determines the location of the kidneys, as well as their size.

After receiving the data, the patient submits biological material For laboratory research. General blood and urine tests indicate problems, which are indicated by changes in white blood cells, protein, red blood cells and their sedimentation rate. According to the results general analyzes the patient is sent for bacteriological examination of urine in order to identify the pathogen infectious process. Biochemical analysis urine is necessary to determine the level of creatinine, urea and nitrogenous compounds, changes in the level of which indicate kidney disease.

To confirm the preliminary diagnosis, which was made on the basis of the data obtained during the research, one or more instrumental examination methods are prescribed. Most commonly used ultrasound diagnostics. Using this method, you can determine the size and condition of the kidney tissues, as well as their vessels. If necessary, X-ray diagnostics can be used. This method is applicable when there is insufficient data obtained during ultrasound.

Treatment

Depending on the reasons that led to the enlargement or reduction of the kidneys, as well as concomitant pathologies, the doctor prescribes treatment individually for each patient.

The main areas of treatment are:

• diet;
• taking medications;
• surgical intervention.

Dietary nutrition helps reduce the load on diseased organs, which allows them to better perform their functions. For urolithiasis special diet helps change the acidity of urine, which can dissolve stones.

Exist general recommendations in nutrition. So, the patient needs to exclude fried, smoked, salty, fatty, and canned foods from the diet. It is also necessary to avoid carbonated sweet drinks and alcohol. The restrictions include coffee and cocoa-containing products. Don't eat meat and fish fatty varieties. It is recommended to enrich your diet with vegetables, fruits, cereals and fermented milk products With low level fat content

Drug therapy

The patient is prescribed antispasmodics and painkillers that will help relieve pain and alleviate the patient’s condition, and in case of kidney stone pathology, also speed up the passage of stones. In the presence of an infectious-inflammatory process, a course is prescribed antibacterial therapy. The choice of drug is based on the data of bacteriological analysis of urine, before obtaining which antibiotics are used wide range actions.

To normalize the passage of urine, as well as the passage of stones, diuretics are used plant origin. It is worth remembering that not all renal pathologies require diuretics. For some diseases, taking diuretics can only worsen the patient's condition. Therefore, medications are prescribed strictly by a doctor.

Further treatment with medications is carried out symptomatically. For example, with increased intrarenal pressure, which has led to hypertension, drugs that normalize arterial parameters- ACE inhibitors.

Surgery

Surgery is necessary if the enlargement or reduction of the kidney is due to anomalous structure organs of the urinary system. The operation is also indicated for large sizes tumors and in case medications it was not possible to restore the functioning of the organ.

Operations are carried out to remove obstacles to the outflow of urine. Most in an effective way is an endoscopic operation that can cope with many problems. When the ureter is narrowed or stones are difficult to pass, operations to install a stent or catheter are used. If the enlargement of the kidney has resulted from a narrowing of the lumen of the ureter, surgeons recommend surgery to excise it. For renal stone pathology, contact, remote and laser crushing methods are used.

Kidney enlargement is a consequence inflammatory pathologies, urolithiasis, hydronephrosis. A decrease in kidney size is called hypoplasia. Used for treatment medicines, diet and, if indicated, surgery.

Good day, my dear readers! I think each of us, young mothers, has heard unknown diagnoses about our newborn from a pediatrician. Often, they are errors, and sometimes they are just a forecast. However, it also happens that the diagnosis made by the children’s doctor is absolutely justified and confirmed by test results, and then, unknowing parents turn to the Internet for help.

This happened to a friend of mine; at the first examination after the ultrasound results, the doctor reported that the child had pyeelectasis (this diagnosis is made if the renal pelvis is dilated in a newborn). What can I say: with any illness in the baby, young parents begin to panic. Fortunately, pyeelectasis is not a cause for alarm at all, but only a reason to be a little more attentive to your baby.

The renal pelvis is a kind of funnel designed to “collect and remove” urine from the body. Roughly speaking, the pelvis serves as a conductor - urine enters it from the renal cups, after which it is released naturally (by urination).

The ureters play a significant role here, because if the pelvis is enlarged, then they narrow, thereby creating an obstacle to the natural passage of urine. In this case, we can talk about pyeloectasia.

2. Causes of pyeelectasis in a newborn

Initially, I would like to note that this disease can occur in the fetus while still in the womb. If a woman does not miss doctor’s consultations and attends all scheduled ultrasound examinations, then even during pregnancy, any deviations in the development of the baby can be identified.

Pathology can be detected by ultrasound after 17 weeks of pregnancy. It is believed that the normal size of the pelvis in newborns should not exceed 10 mm.

It should be noted here that the causative agent of the disease can be the following factors:

• hereditary predisposition;
• unformed lumen of the ureters (with subsequent narrowing);
• abnormalities (for example, “detachment” from the ureter of the pelvis).

All the above reasons apply to congenital pathology. However, it is worth saying that literally 40% of children are born with this disease.

Besides physiological characteristics formation of the pelvis, the causes of acquired pyelectasis should be highlighted:

• consequences of kidney diseases;
• infections.

3. Symptoms of pyelectasis

Often, the expansion of the renal pelvis does not affect the general health newborn

In fact, there are several stages of the disease:

1. Stage I. The disease is asymptomatic and does not cause any inconvenience to the child, so the parent may not notice signs of deterioration in the baby’s condition. Kidney functions are not impaired and continue to “work” in a “normal” mode.
2. Stage II. At this stage, the kidney and subsequently the pelvis enlarge. The baby may cry when urinating because this procedure Now it makes him uncomfortable. The “performance” of the kidneys is reduced by 40%.
3. Stage III. The kidney continues to enlarge, due to which its functions are reduced by more than 40%.

In any case, there is no need to panic, because this pathology treatable.

4. Diagnosis of the disease

If we're talking about about congenital pyeloectasia, it is most likely that the pathology will be established during pregnancy. In this case, the doctor will decide on further treatment of the newborn baby, or will advise expectant mother about the right image life for intrauterine elimination of the disease.

In some cases, slight pyelectasis is normal and goes away some time after the baby is born. Most often this disease occurs in boys.

Again, after birth, the baby will be examined by a doctor. To establish (or refute) a diagnosis you will need:

• collect a urine test;
• do an ultrasound (to determine the size of the pelvis).

Once the diagnosis is confirmed, the doctor will prescribe appropriate treatment for the child. For example, during the second ultrasound during pregnancy, we were diagnosed with pyeloectasia, but the first ultrasound of the baby’s abdominal cavity showed that the pelvis had disappeared. So there is no need to worry prematurely.

5. How to treat an enlarged renal pelvis in an infant

Parents need to be prepared for the fact that treatment of the pelvis is a lengthy process. This does not mean at all that the procedures will take a huge amount of time and take away energy. Not at all! For example, a friend of mine’s baby was prescribed medication and ordered to undergo a course of physiotherapeutic procedures.

By the way, this is the treatment prescribed to most children with a disease such as pyeloectasia.

Many parents are interested in why this pathology is dangerous. I hasten to please you! In the initial stages (stages I and II of the disease), the dilated renal pelvis does not require surgical intervention, and after completing a course of treatment it completely “disappears” without a trace.

On last stage diseases, in addition to collecting urine and undergoing an ultrasound examination, the doctor may prescribe other procedures:

• radioisotope research;
• intravenous urography;
• cystography.

After all the tests have been completed, the newborn will most likely undergo surgery, but there is no need to be afraid of it, since it is carried out using a bloodless method and using tiny instruments.

IN postoperative period The baby requires special care, which the doctor himself will advise the parents about.

For some time after treatment, the child should be observed by a nephrologist. Required:

• systematically take a urine test (once a month);
• conduct ultrasonography(to observe the size of the kidneys and pelvis).

Parents should not worry if their newborn has pyeelectasis, because after complete cure this disease does not lead to complications, which means it does not entail any consequences.

Therefore, dear readers, you can not panic, but calmly treat your children! And I wish you get well soon! Take care of yourself and your loved ones!

Interest in the problems of peri- and neonatal nephrology is due to the growing number of cases of kidney and urinary tract diseases, often associated with troubles in the ante- and neonatal periods and insufficient vigilance of neonatologists and pediatricians. Factors that pathologically affect the kidney are: congenital and hereditary diseases, extragenital pathology, gestosis and threat of miscarriage, intrauterine infections, hypoxia of the fetus and newborn, hypothermia, metabolic disorders, dehydration, inadequate energy supply, polypharmacy.

After birth, the child must a short time adapt to new living conditions, which is accompanied by significant strain on the functions of all organs and systems, including the urinary system. Immaturity of the renal structures and significant stress on the kidneys, especially in children with pathological conditions perinatal period, often lead to nephropathy. IN last years there has been an increase in the incidence of newborns (developmental anomalies, hereditary disorders metabolism, innate nephrotic syndrome). Along with the bright manifestation in infants, it is also possible undercurrent renal pathology, which may later appear chronic process or lead to the formation of chronic renal failure.

The main function of the kidneys is to maintain homeostasis, which is ensured by saving compounds necessary for the body and excreting their excess, as well as releasing metabolites and foreign substances. The kidneys are involved in osmo-, volumo-, ion regulation, maintaining the acid-base state, excretory and incretory processes in the body. The basis of their activity is: filtration of plasma in the glomeruli, active and passive transport of ions and organic compounds in renal tubules, providing tubular reabsorption, secretion and concentration of urine.

According to most researchers, the main number of nephrons in newborns is finally formed and corresponds to that in adults already at the time of birth (about 1 million), but their structure is characterized by anatomical and morphological immaturity.

The size of the glomeruli of the kidneys of newborns and their total functional surface are much smaller than those of adults. The capillaries of the glomeruli are covered with columnar and cubic epithelium, which is less favorable for filtration. The kidneys of newborns are distinguished by shorter loops of Henle and proximal tubules, which are less convoluted and have insufficient activity enzyme systems in the absence of acidic mucopolysaccharides in the intercellular space.

It has been proven that by the time of birth, the renal glomeruli are more mature compared to the tubules, the individual parts of which are unevenly developed.

In infants, the glomerular filtration rate (GFR), secretion, and ability to concentrate urine are reduced, and the ability to excrete excess water and osmotic diuresis are limited. Reabsorption of electrolytes, amino acids, glucose is imperfect, not effective enough neurohumoral regulation renal functions.

The main reasons for low glomerular filtration are limited permeability of the glomerular membranes, insufficient filtering surface, low arterial pressure and increased resistance to blood flow. GFR based on endogenous creatinine clearance in the first week of life ranges from 20-25 to 68 ml/min. The amount of glomerular filtration is directly dependent on the child’s body weight and maturity. Renal excretion of water is limited by low glomerular filtration. This is partially compensated by high water losses (25-30 ml/kg/day) through the skin and lungs. The kidneys of newborns are able to remove fluid from the body if it enters gradually; a one-time load can cause an increase in the volume of extracellular fluid without increasing diuresis.

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On the issue of “normality and pathology” of organs urinary system newborns

Today, kidney pathologies in newborns are not uncommon. In infants in the first month of life, doctors often diagnose an enlargement of the renal pelvis, which in medicine is called pyeloectasia. This disease can be congenital or acquired. As a rule, the risk of renal pyelectasis in newborn boys is 3-5 times higher than in girls.

According to experts, the development of pyeelectasis is facilitated by both hereditary predisposition and harmful effects on a woman’s body during pregnancy.

Pyeelectasis occurs as a result of impaired urine flow in the child’s body. This disease is dangerous because it can lead to such serious disease such as hydronephrosis of the kidney in a newborn, in which there is an increase in the level of fluid in the baby’s kidney when the normal outflow of urine is disrupted. This is a rather serious pathology, since in the absence of proper therapy, the affected kidney can lose its functions and cause a condition life-threatening child. We invite you to talk about congenital diseases kidneys in newborns, as well as their treatment.

Types and causes of kidney hydronephrosis in a newborn

According to doctors, the most common reasons hydronephrosis in newborns is congenital anomalies structure of the kidneys and their vessels. Hydronephrosis can be unilateral (affects only one kidney) or bilateral (affects both kidneys). As a rule, hydronephrosis in children is unilateral. In the case when an enlarged kidney in a newborn is associated with an expansion of the ureter, they speak of a disease such as ureterohydronephrosis.

There are such degrees of hydronephrosis:

1. Pyeelectasia – (stretching renal pelvis due to high pressure urine). On at this stage kidney function is not impaired, but it is already slightly increased in size.
2. Hydrocalycosis (greater dilation of the renal pelvis and renal calyces). The fluid contained in the tubules compresses the kidney parenchyma, which leads to significant disruption of its function.
3. Increased atrophy renal tissue, which takes irreversible nature. In this case, the function of the kidney is gradually lost, which leads to its death. A kidney that has lost its function poses a serious threat to the child’s health.

Diagnosis of hydronephrosis

The severity of hydronephrosis manifestations will depend on the degree of the disease. Hydronephrosis in newborns, as a rule, does not manifest itself in any way until the third degree of the disease. The only thing that can attract parental attention in this case is increased anxiety baby, as well as the appearance of blood in his urine (in rare cases).

Today, prenatal ultrasound diagnostics makes it possible to detect this disease even during the fetal development of the baby - starting from the 15th week of pregnancy, when it is already possible to determine the collecting system of the child’s kidney. The main sign of the presence of the disease will be an enlarged kidney in a newborn. In this case, specialists should monitor the course of pregnancy, and after the birth of the baby, re-examine the child. If the symptoms of the disease persist in the newborn, he is prescribed additional examination which includes:

• Ultrasound of the kidneys and bladder before and after urination;
• voiding cystourethrography;
• intravenous urography;
• nephroskintigraphy - radioisotope research kidneys and urinary system.

As a supplement, methods such as color Doppler mapping (CDC), radioisotope renography, computed tomography or magnetic resonance imaging can be used.

In addition, to study kidney function, a specialist may prescribe functional tests urine (test according to Nechiporenko, test according to Zimnitsky).

Based on the results of these studies pediatric urologist makes a diagnosis and determines a strategy further treatment. It should be noted that with hydronephrosis in newborns accurate diagnosis The doctor can diagnose only a month after the birth of the child.

Treatment of hydronephrosis in newborns

Hydronephrosis is treated only surgically, whereas conservative therapy It is only advisable to eliminate the inflammatory process or alleviate the symptoms of the disease before surgery.

The operation to treat this pathology in newborns consists of removing obstacles that interfere with the normal outflow of urine. According to experts, each specific case requires individual approach, That's why surgical method therapy for hydronephrosis should be chosen directly by the doctor who will operate on the child.

To date, treatment of this disease most often performed endoscopically. The endoscope is inserted into abdominal cavity through two small punctures, and all manipulations are carried out thin surgical instrument. In this case, the operation itself is controlled using a monitor. This method treatment of hydronephrosis makes it possible to significantly reduce the trauma of the operation, as well as practically eliminate the threat of the development of postoperative complications.

Finally, I would like to note that renal pyeloectasia in newborns does not require medical intervention. In these situations it is recommended dynamic observation using ultrasound two to four times a year. As for hydronephrosis of the first and second degrees, sometimes during the first year of a child’s life it goes away on its own without surgical intervention. But the disease of the third degree, as well as the increase in its manifestations, requires emergency surgery, since running forms hydronephrosis of the kidneys in newborns can lead to such severe pathologies as chronic pyelonephritis, degeneration and death of kidney tissue. Therefore, parents should be extremely attentive to their children, and if various changes occur in their condition and behavior, immediately contact their pediatrician!