calyceal diverticulum
Introduction
Introduction to the renal pelvis The renal diverticulum is the cystic cavity of the renal parenchyma that covers the transitional epithelial cells. The narrow passage is connected to the renal pelvis or renal pelvis. The diverticulum has no secretory function, but the urine can flow back into the sputum. The disease was first described by Rayer in 1841. It can be multiple, located in any part of the kidney, but the renal pelvis is more susceptible. basic knowledge The proportion of illness: 0.0002% Susceptible people: no special people Mode of infection: non-infectious Complications: kidney stones
Cause
Cause of renal diverticulum
Causes:
The etiology of the renal diverticulum is still unclear. The incidence of children and adults is similar, suggesting that it is the cause of embryology. In the early stage of embryonic stage, some segments of the ureter are formed in the third and fourth segments, and then degraded in order, if they persist. Being a separate branch may form a renal diverticulum.
The mechanism:
According to its mechanism of birth, there are congenital or acquired differences. Most of the diseases found in childhood are congenital diseases. In 1976, Kottasz and Hamvas proposed congenital Vasocentric theory. Some authors advocated that they acquired the acquired disease. In some patients, the renal diverticulum may appear after an acute upper urinary tract infection, suggesting that the diverticulum may be formed by a small localized cortical abscess that breaks into the collecting system, or that the intrauterine pressure increases during childhood, and the urine reflux Amar reported that in children with vesicoureteral reflux, the incidence of renal pelvic and renal diverticulum was significantly increased. Of the 32 children with pyelonephritis, 23 had reflux, suggesting that the formation of the diverticulum may be kidney. As a result of sputum reflux, other causes include stone obstruction, infection of the renal pelvis, kidney damage, sphincter achalasia around the renal pelvis, paralysis or dysfunction.
Types of:
There are two types of renal diverticulum, the most common type I diverticulum, often located in the cup of the renal pelvis, connected with the renal sputum, mostly in the pole of the kidney, the most common in the kidney, usually small, 1mm to several Centimeters vary from occasional to large diverticulum. This type of diverticulum is asymptomatic for long-term follow-up. The type II diverticulum is connected to the renal pelvis or the adjacent large renal pelvis. It is located in the central part of the kidney and has a large shape and often has clinical symptoms.
Prevention
Kidney diverticulosis prevention
Eat light and easy to digest food, fresh vegetables and appropriate amount of fruit, drink water properly. Pay attention to the balanced diet.
Avoid overeating and eating unclean food. Avoid seafood, beef, lamb, spicy spicy food, wine and all kinds of hair such as: spiced anise, coffee, parsley and so on. Do not eat all tonics, tonics and easy-to-fire foods such as: chili, rational, chocolate and so on.
Complication
Renal diverticulum complications Complications kidney stones
The incidence of calculi in the sputum was 9.5% to 39%, which may be calcium calculus. Mangin et al found 90 cases of calculus in 90 patients with 90 diverticulum.
Symptom
Renal diverticulum symptoms common symptoms urgency, urinary frequency, urinary pain, hematuria, pyuria, pleural effusion
Most simple renal diverticulum has no clinical symptoms. It is only found by accidental venous pyelography. When the diverticulum is secondary to infection or stones, there may be low back pain, gross hematuria, pyuria, fever and frequent urination, urgency, dysuria, etc. There are few symptoms of urinary tract infection in patients with stones. The severity of symptoms is not related to the size of the diverticulum. Some small renal diverticulum can also cause obvious low back pain, which may be related to the increase of pressure in the junction of the renal pelvis or poor drainage. The renal diverticulum channel is very narrow, and the stone can rarely be discharged into the renal pelvis through the cervical sac. If there is a stone, renal colic will appear. When the diverticulum is combined with stones, the surface of the renal parenchyma often forms scar or atrophy. Scar formation often leads to diverticulum channel. closure.
At this time, the stone is located in the lumen of the renal parenchyma, completely separated from the collecting system, the closure of the diverticulum channel can cause acute infection and renal abscess. The renal abscess often leads to symptomatic pleural effusion, and the infection can also cause yellow granulomatous renal pelvis. Nephritis, Ulreich et al reported that 1 patient had spontaneous rupture of the renal pelvis during venous pyelography, and the rupture of the diverticulum was not reported in the literature. Theoretically, the larger diverticulum can be traumatic rupture, Wulfsohu et al. It is reported that 1 patient has normal hypertension after renal nephrectomy, and the relationship between hypertension and renal pelvis is still unclear.
Examine
Examination of the renal pelvis
1. Urine routine: patients with co-infection may have microscopic hematuria, white blood cells, gross hematuria in severe cases, need to be urinary bacteria culture plus drug sensitivity test.
2. Blood routine: The total number and classification of white blood cells can be increased when the infection is severe.
Secretory urography is often used in the diagnosis, and the delayed imaging can be found in the diverticulum. In addition, retrograde angiography, CT and MRI sometimes help.
Diagnosis
Diagnosis of renal diverticulum
Simple renal diverticulum due to lack of symptoms and signs, its diagnosis depends on imaging examination.
The renal pelvis should be differentiated from hydronephrosis, renal cysts that break into the renal pelvis, kidney tumors and renal tuberculosis. The hydronephrosis is often caused by stenosis of the renal pelvis funnel or calculus obstruction. Loss of normal cup mouth, and is in the normal position of the renal pelvis, while the diverticulum is in the renal cortex; the funnel of the hydronephrosis is often longer, and the diverticulum is closer to the collecting system, and the adjacent renal pelvis remains in a normal shape. When the renal cyst breaks into the collecting system, signs similar to those of the renal pelvis are often present, but the channel between the cyst and the collecting system is wide and the wall is thin and smooth. The renal tumor is mainly characterized by deformation of the renal pelvis and irregular edges. There are often filling defects, the edge of the renal tuberculosis cavity is not neat, often combined with renal worm-like changes, tuberculosis cavity is often multiple, combined with the clinical manifestations of renal tuberculosis and urine acid-fast bacteria examination, can be identified, kidney B-ultrasound and CT examinations will help identify diverticulum, cysts, tumors and tuberculosis.
