hydronephrosis
Introduction
Introduction to hydronephrosis Less common, the renal pelvis has a transitional epithelium and cystic dilatation. Its occurrence also has congenital and acquired points. Different from the inflammatory obstruction mechanism of the diverticulum, there is no obvious cause of hydronephrosis. It is speculated that a functional obstruction may be formed due to the loss of the ring muscle at the entrance of the funnel. The most common symptoms are pain in the upper abdomen and side of the lower back. Occasionally, a lump can be touched, sometimes causing hematuria. The hydronephrosis should be associated with multiple kidneys caused by ureteral obstruction, pyelonephritis, medullary necrosis, and renal tuberculosis. Expansion phase identification. In the hydronephrosis secondary to the outlet obstruction, it is feasible to perform an incision in the pelvis funnel to improve drainage. If the expansion is due to internal stones, the kidneys are partially removed as appropriate. At present, the surgical treatment of the percutaneous route can achieve satisfactory results. basic knowledge The proportion of illness: 0.0003% Susceptible people: no special people Mode of infection: non-infectious Complications: pyelonephritis Kidney atrophy
Cause
Causes of hydronephrosis
Ureteral stenosis (30%):
When bladder tuberculosis develops into fibrosis, the contralateral ureteral orifice can be narrowed due to scar formation, hindering the urine drainage of the contralateral kidney, causing water to accumulate in the contralateral kidney and ureter.Lower ureteral stricture (20%):
The tuberculosis lesions near the contralateral ureteral orifice can be directly spread through the mucosal surface or infiltrated by the submucosa, so that a segment of the ureter above the ureteral orifice is also narrowed due to scar formation, causing water in the contralateral kidney and ureter.
Bladder contracture (25%):
Severe bladder tuberculosis will eventually cause bladder contracture. Bladder contracture causes the bladder to lose its ability to gradually expand its volume during filling and maintain normal bladder pressure, resulting in high intravesical pressure, especially when the bladder is inflammatory, often stimulating bladder contraction and making the pressure higher. The long-term high pressure in the bladder can impede the drainage of the renal pelvis and ureter or cause the bladder urine to flow back to the ureter and renal pelvis, causing water in the contralateral kidney and ureter.
Ureteral insufficiency (20%):
The normal ureter has a sphincter function in the oblique wall section of the bladder wall, which prevents urine from flowing back to the urethra and renal pelvis when the bladder contracts. Tuberculosis lesions around the ureteral orifice can cause the tube to stiffen due to fibrosis and lose the sphincter, leading to incomplete ureteral opening. Therefore, urine in the bladder can often flow back into the contralateral urethra and renal pelvis, causing water in the kidney and ureter.Prevention
Hydronephrosis prevention
Prevent primary diseases.
The disease is caused by stones, so clinical prevention should be based on the basis of stones.
1. According to the results of urinary component analysis and the shape of the stones on the flat sheet, the composition of the stone is judged, and the preventive measures are formulated.
2. For pediatric bladder stones, the main problem is to increase nutrition (dairy products). Here we place special emphasis on the importance of breastfeeding.
3. Drink plenty of water, drinking water is very effective in preventing urinary recurrence. Drinking more water can increase the amount of urine (the amount of urine should be kept at 2000-3000 m1 per day), which significantly reduces the saturation of urinary components (especially calcium oxalate). According to statistics, an increase of 50% of urine can reduce the incidence of urinary stones by 86%. 3h after a meal is the peak of excretion, but also to maintain enough urine. Drink water before going to sleep, so that the relative density (specific gravity) of nighttime urine is less than 1.015. Drinking more water can exert a certain pressure on the urinary tract in the proximal part of the stone, prompting the discharge of small stones; it can dilute the excrement and some substances related to the formation of stones (such as TH protein). However, it has been suggested that a large amount of drinking water also dilutes the concentration of inhibitors in the urine, which is detrimental to the prevention of stone formation. In fact, in the influence of urolith formation, the supersaturation of urine is in a very important position; in contrast, the effect of large amounts of drinking water on the reduction of inhibitor concentration is much smaller. Itoh et al believe that green tea can prevent the formation of calcium oxalate stones. Green tea contains 13% catechin, which has antioxidant effects, which can reduce the excretion of oxalic acid in the urine and the formation of calcium oxalate. Green tea treatment can increase the activity of superoxide dismutase (SOD).
4. Patients with stones should limit excess nutrients according to the needs of calories, and maintain a daily intake of 75-90 g of protein to maintain energy balance and reduce the risk of urinary stones. For patients with familial hyperuricemia or gout, the protein intake should be limited to 1 g/kg body weight. Control the intake of refined sugar. Do not eat spinach, animal internal organs and other foods.
5. Magnetized water has a certain anti-stone effect. Normal water becomes magnetized water after passing through a magnetic field with a strong magnetic field strength. It was discovered in 1973 that the dissolution of the stone in a container containing magnetized water. Through research, it is found that after the water is magnetized, the charge of various ions in the water changes, and the tendency to form crystals is significantly reduced, which can prevent the formation of urinary stones.
6. Treatment of diseases that cause stone formation such as primary hyperparathyroidism, urinary tract obstruction, urinary tract infection, etc.
7. The drug can be orally administered according to the abnormal metabolism in the body, such as thiazide drugs, allopurinol, orthophosphate. Patients with recurrent calcium oxalate stones should avoid excessive intake of vitamin C.
8. Regular review of urinary patients must be reviewed regularly after the stones are discharged. This is mainly because: 1 For most patients with stones, after the stones are discharged, the factors that cause the formation of stones are not solved, and the stones may recur. 2 In addition to clear stones during surgery, no matter what method is used, there may be some stone fragments of different sizes in the body. These stone fragments may become the core of future stone recurrence.
Complication
Hydronephrosis complications Complications, pyelonephritis, renal atrophy
1. Kidney atrophy. This type of lesion is the most typical hazard of hydronephrosis, mainly because of urinary obstruction, enlarged renal pelvis, increased intrarenal pressure, and pressure on renal tissue vessels, resulting in progressive ischemic atrophy, destruction of kidney, and impaired renal function.
2, urinary tract infection. Urine urinary stagnation in the kidney, ureter, is conducive to bacterial growth and reproduction, and pyelonephritis, ureteritis, cystitis or periarteritis.
3. Stone formation. Blocking the urethra with stones can cause hydronephrosis, and the formation of hydronephrosis will in turn induce kidney stones, a vicious circle, infected bacteria, pus, and necrotic tissue cells become the core of stone formation. In particular, the infected urine salt crystals precipitate and deposit into stone.
Symptom
Symptoms of hydronephrosis common symptoms persistent fever and fever accompanied by frequent urination, urine... abdominal pain
Occurred at the junction of the pelvis and ureter, the stenosis usually ranges from 1 to 2 mm, and can also be as long as 1 to 3 cm, resulting in incomplete obstruction and secondary distortion. Under the electron microscope, there are excessive collagen fibers around the muscle cells in the obstructive segment and in the middle of the cells. The muscle cells are damaged for a long time, and the inelastic narrow segment mainly composed of collagen fibers blocks the urine.
The main performance is:
1. Symptoms of the primary disease, such as pain in the stones, hematuria in the tumor, urinary tract stenosis and dysuria.
2. The back side of the water is sore.
3. Concurrent infections include chills, fever, and pyuria.
4. The cystic mass of the affected side of the waist.
5. Chronic renal insufficiency, uremia, bilateral obstruction.
Examine
Examination of hydronephrosis
Renal expansion should be checked: auxiliary examinations are:
1, urine routine can have microscopic hematuria, proteinuria, hydronephrosis with infection can be seen pus cells.
2, B-ultrasound.
3, intravenous pyelography can be seen in the renal pelvis and renal pelvis expansion of water, or contrast agent suddenly stopped at the junction with the renal pelvis and ureter, the lower ureter is not developed or normal.
Further check the project:
1, retrograde renal pelvis ureterography.
2, diuretic kidney map.
3. Pressure test in the renal pelvis.
4. CT and MAR are of great significance for the diagnosis of etiology.
Diagnosis
Diagnosis and diagnosis of hydronephrosis
Identification of hydronephrosis:
1. When a simple renal cyst is enlarged, it can often touch a cystic mass. However, it occurs at any age; urography shows compression, deformation or displacement of the renal pelvis; the cyst puncture does not contain urine components; ultrasound examination reveals a round, transparent, dark area in the kidney.
Second, the cyst around the kidney can have a cystic mass with unclear borders. There is often a history of trauma; the activity of the mass is poor, the sense of fluctuation is not obvious; the urography shows that the kidney is shrinking and shifting, and the renal pelvis and renal pelvis are not dilated; the ultrasound has a neat dark area around the kidney.
Third, a large cystic mass can be found in the waist of the adrenal cyst. X-ray plain films showed annular calcification; urography showed that the kidneys moved down and rotated poorly, and the renal pelvis and renal pelvis did not dilate; retroperitoneal angiography, ultrasonography, radionuclide adrenal scanning and CT showed images of adrenal masses.
Fourth, the right cyst of the liver cyst or under the xiphoid can touch the cystic mass. However, the location of the cyst is superficial, easy to reach, tenderness is obvious; no urinary system symptoms are included; ultrasonography and radionuclide liver scan show signs of cyst.
Fifth, the left upper abdomen of the pancreatic cyst can touch the cystic mass with unclear margin. But often accompanied by abdominal trauma or history of acute pancreatitis, more common in adults, no urinary system performance; urine sugar test positive; gastrointestinal bowel meal X-ray examination has signs of compression.
Sixth, the mesenteric cyst can touch the cystic mass with clear edges. However, the mass is shallower and moves to the left and right, with symptoms of intestinal obstruction; X-ray examination of gastrointestinal bowel meal has signs of compression.
Seven, polycystic kidney on one side or both sides of the upper abdomen can touch the cystic mass. However, the surface of the mass showed multiple cystic nodules with no undulation; urography showed that the renal pelvis and renal pelvis were stretched or deformed without dilatation; ultrasound examination and radionuclide renal scan showed bilateral kidney enlargement, and the renal area had Multiple round cyst images.
Eight, the iron-shaped kidney with water can reach irregular cystic mass. However, urography showed that the renal axis was inverted and the shape of the renal pelvis was lower and approached to the midline, and the renal pelvis protruded to the medial side.
