unilateral renal absence
Introduction
Brief introduction of unilateral kidney deficiency Unilateral kidney deficiency, that is, unilateral kidney is not developed, also known as unilateral kidney (unilateralkidney), the frequency of occurrence is higher than the absence of double kidney. However, because there are no specific symptoms or signs that can indicate unilateral kidney deficiency, the incidence is not accurate. It is usually unintentional to find a patient with a solitary kidney during an angiographic examination. Prenatal ultrasound can distinguish polycystic kidney or renal hypoplasia, thereby improving the detection rate of this disease. basic knowledge Sickness ratio: 0.0002%-0.0004% Susceptible people: no specific people Mode of infection: non-infectious Complications: anal atresia
Cause
Unilateral kidney deficiency
Causes
There is no significant difference between URA embryo development and BRA. The main problem is still on the ureteral bud. On the embryonic side, the renal tissue and ureteral bud growth are disordered, and the contralateral kidney is often compensatory hypertrophy. The kidney has no renal parenchyma, renal pelvis and renal pedicle remnant, and the ureter is cord-like fibrous tissue without lumen.
Prevention
Unilateral renal deficiency prevention
There is currently no clear evidence that single kidney patients have a higher susceptibility to other diseases. However, some people think that single kidney patients have a higher incidence of pyelonephritis, kidney stones, ureteral stones, tuberculosis, glomerulonephritis and other diseases. The current focus on prevention of infection and its sequelae has greatly reduced the morbidity and mortality of single kidney patients. 5% of patients die from kidney damage, and such patients may survive if they have two kidneys. It is therefore recommended that URA patients should be more cautious in their activities. Rugui et al reported that URA patients are prone to hypertension, hyperuricemia, and decreased renal function, but no proteinuria occurs. Arguero evaluated the incidence of hypertension and proteinuria in 157 middle-aged URA patients at 47% and 19%, respectively, but the incidence of renal insufficiency was only 13%. Despite this, the lives of such patients have not been significantly affected.
Complication
Unilateral kidney deficiency Complications anal atresia
The disease often associated with other genitourinary abnormalities, such as vagus blood vessels, ectopic kidney, renal dysplasia, ureteropelvic junction obstruction, hypospadias, cryptorchidism, double uterus, double ureter, contralateral adrenal gland, seminal vesicle, testis, fallopian tube , lack of ovaries, anal atresia and spinal deformity.
Symptom
Unilateral kidney deficiency symptoms common symptoms proteinuria isolated kidney hypertension
The isolated kidney that compensates for hypertrophy can completely bear the normal physiological needs, life is not affected, and there is no discomfort. It is often not found for life. Even if the contralateral kidney is infected, trauma, stones, water, tuberculosis, go deep. It was discovered after the urinary examination.
Examine
Unilateral kidney deficiency examination
1. Cystoscopy: visible asymmetry of the bladder triangle, one side of the ureteral fistula atrophy flat, ureteral port absent, although some have a tube, but the intubation is blocked; the other side of the ureteral orifice is in the normal position, but also ectopic In the midline, posterior urethra or seminal vesicle.
2. Abdominal plain film + KUB: venous urography (IVU) One side of the kidney shadow is absent, not developed, the contralateral kidney shadow is enlarged, and other deformities of the isolated kidney can be found.
3. B ultrasound, CT, kidney map, renal angiography, etc. can assist in diagnosis.
Diagnosis
Diagnosis of unilateral renal deficiency
diagnosis
Usually URA patients do not have specific clinical manifestations, most of which are reported from autopsy results, because the kidneys on both sides are relatively independent, the contralateral normal kidneys do not have a higher susceptibility, and the effects of Argues on URA patients A large number of investigations and studies have shown that the incidence of proteinuria in middle-aged patients with orphan kidney is 20%, hypertension is 47%, and renal function is 13%. If the vas deferens or epididymis is missing in the physical examination, Vaginal absence, separation or atrophy with single or double uterus should be vigilant.
Differential diagnosis
1. Renal hypoplasia: imaging examination showed that one side of the kidney shadow was significantly reduced, the renal pelvis and renal pelvis became smaller, but the shape was normal, the contralateral kidney was compensatory, both bilateral ureters were present, and the ureteral opening position was normal under cystoscopy. Patients may have high blood pressure.
2. Renal atrophy: imaging examination can be seen unilateral renal shadow or bilateral renal shadow reduction, renal pelvis and renal pelvis distortion, deformation, displacement; often primary causes such as pyelonephritis, renal contusion, renal arteriosclerosis, etc.; Bilateral lesions may have progressive renal insufficiency and often have high blood pressure.
3. Fusion of kidney: Although there may be ectopic, intravenous urography and CT, MRI examination showed two kidney fusion images, and each has a ureter, cystoscopy ureteral opening position is normal.
4. Self-cutting kidney: The kidney loses function due to tuberculosis, and the cheese-like tissue is often accompanied by calcification. The imaging examination is easy to distinguish.
