Kidney disease

Uretero-nephric syndrome is formed in case of kidney and ureter disease, but can also be caused by pathology of the lower levels of the genitourinary system, both due to urinary disorders and ascending infection. Undoubtedly, urologists should be engaged in diagnostics and treatment of kidney and ureter disease, but most often, especially in case of abdominal, pain and peritoneal syndromes, as well as abdominal trauma, they are admitted to surgical hospitals, where there is not always a urological service.

Kidney diseases are varied, surgeons and urologists most often have to deal with the diagnosis of urolithiasis and pyelonephritis or their combination.

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Kidney stones

Urolithiasis is a chronic kidney disease characterized by a disruption of metabolic processes in the body with the formation of stones in the ureteral system, ureters, bladder, prostate and urethra from salt and organic compounds of urine.

Stones are localized more often on the right, in 40-50% of cases in the renal pelvis, in 30% of cases they are detected during colic or hydronephrosis in the ureters, in the calyces and bladder within 12-15% of cases. According to their chemical composition, they are: oxalate, phosphate, urate, cystine, protein and mixed structure. By size: sand, small (up to 0.5 cm), medium (up to 1 cm), large and coral. In 90-95% of cases, urolithiasis is accompanied by the development of progressive pyelonephritis, hydronephrosis, pyelonephrosis, and sometimes paranephrosis.

The clinical picture of this kidney disease is heterogeneous. Stones in an inert state may not manifest themselves at all; with the addition of pyelonephritis, pain and a feeling of heaviness in the lower back develop, often the pain radiates to the lower abdomen, leg; the passage of sand or a stone through the ureter is accompanied by the development of renal colic, and in the presence of concomitant pyelonephritis, the clinical manifestations are brighter. Renal colic is accompanied by sharp cramping pains in the lumbar region, radiating to the groin, genitals, and thigh. Diagnosis of kidney disease usually does not cause difficulties, but sometimes it is necessary to differentiate from pathology of the abdominal organs. For this, you can use the following techniques: Barsov - with colic, spraying the lower back with ethyl chloride causes a decrease in pain; Lorin-Epstein - when pulling on the testicle, a sharp increase in pain is noted in the corresponding half of the abdomen and lumbar region; Olshanetsky - when palpating the abdomen of a standing patient in a bent position with colic, no symptoms of peritoneal irritation are detected, and when the process is localized in the abdominal cavity, this test is positive.

When examining urine, a distinctive feature of this kidney disease is the presence of microhematuria or the predominance of erythrocytes over leukocytes in urine tests according to Nechiporenko and Addis-Kakovsky. To confirm the diagnosis, it is enough to conduct an ultrasound, survey and excretory urography. In case of complications (hydronephrosis, pyonephrosis, paranephrosis), the complex is expanded, but is carried out only by a urologist.

Pyelonephritis

Pyelonephritis is a non-specific kidney disease characterized by inflammation of the interstitium of the renal pelvis. Pyelonephritis is a predominantly secondary pathological process (80%) that develops when the passage of urine is disrupted with the ascent of infection from the underlying sections. Acute and chronic pyelonephritis (unilateral and bilateral) are distinguished.

The clinical picture of kidney disease depends on the extent of tissue damage, the virulence of the microflora, the patient's age and the reactivity of the body. Pain appears in the lumbar region with irradiation to the suprapubic and inguinal region, thigh, frequent and painful urination (pollakiuria) is often noted. The pain syndrome is accompanied by transient chills and fever. The diagnosis of this kidney disease is based on the clinical picture and urine and blood tests. Ultrasound may reveal an increase in the size and expansion of the renal pelvis. Urography is not performed in the acute period.

Chronic pyelonephritis develops after three months of acute pyelonephritis. The clinical picture of kidney disease is heterogeneous and atypical, but mainly periodically occurring pain in the lumbar region, cystitis symptoms, weakness, malaise, pallor and pastosity of the face, pain during palpation, a positive Pasternatsky symptom are noted. To diagnose this kidney disease, the following must be identified: leukocyturia (if not detected in a general urine analysis, a study according to Nechiporenko or Addis-Kakovsky is necessary), bacteriuria, the presence of protein, signs of pyelonephritis in ultrasound and urography (expansion of the cystic system).

At the same time, the form of chronic pyelonephritis is also revealed: undulating, latent, hematuric, calculous, tubular, anemic. These same studies allow us to identify the formation of such a kidney disease as hydronephrosis. In the presence of chronic pyelonephritis, it is necessary to remember about a specific infection.

When inflammation passes from the renal tissue (in carbuncle, purulent pyonephrosis or perinephritis) to the paranephric tissue, paranephritis develops (microflora is rarely introduced hematogenously). The purulent process in the paranephric tissue develops very quickly, but given the presence of transverse connective tissue bridges, it is often of a limited nature (usually upper), although, with some types of microflora, it can be generalized. A distinctive feature of this kidney disease is a sharp and progressive worsening of the patient's condition due to the development of intoxication syndrome against the background of an existing kidney disease. The pain is sharp, characteristic of any purulent inflammation, but can also occur in the form of renal colic. The pain is localized in the lumbar region and in the hypochondrium, especially with deep inhalation and coughing due to the involvement of the subdiaphragmatic tissue in the process; sometimes effusion is formed in the pleural cavity.

Diagnosis of kidney disease

Diagnosis of kidney disease is based on the presence of a typical picture (existing disease, formation of intoxication syndrome, typical pain syndrome). During examination, pastosity of the skin in the lumbar region is noted, the muscles are tense and painful upon palpation, reflex curvature of the spine towards the lesion, flexion in the hip and knee joint of the limb (psoas symptom) to limit mobility due to pain. Pasternatsky's symptoms (pain upon percussion in the lumbar region) and Israel's symptoms (pain upon pressure in the lumbar triangle) are sharply expressed. The diagnosis is confirmed by ultrasound and plain radiography of the abdominal cavity (the kidney is lowered, the dome of the diaphragm is high, the diaphragmatic sinus does not unfold, the shadow is blurred, the lumbar muscles do not contour)

The ureters, which are cylindrical, slightly flattened muscular-epithelial tubes with a diameter of 6-15 mm, connect the renal pelvis with the urinary bladder. They have three levels of anatomical narrowing: initial, iliac, and at the transition to the pelvic part, where stones are most often incarcerated and strictures are formed.

Of the ureter pathologies, urolithiasis is most often noted, which manifests itself in the development of renal colic. When the stone passes, the process is stopped. When strangulation occurs, hydronephrosis develops due to a violation of the passage of urine, and subsequently its stricture. Inflammatory diseases of the ureters (ureteritis, pyeloureteritis) are often descending, with the entry of microflora from the renal tissue or lymphatic vessels, but there may also be ascending pyeloureteritis or pyelonephritis with simultaneous damage to the renal pelvis.

Ureteral injuries (open, closed, partial and complete) are divided into 4 groups by origin: traumatic (open and closed); surgical (especially during operations on the pelvic organs); during endovesical studies (catheterization and retrograde urography); during stone removal with extractors. They may not be noticed in the first days, but subsequently, depending on the level and type of injury, they are accompanied by the development of peritonitis, periureteritis, paranephritis; urinary leaks, urinary fistulas, ureteral strictures (diagnosis is difficult, requires the involvement of an experienced urologist).

Developmental defects and tumors of the ureter are quite rare, their diagnosis is complex and should be performed by a urologist, they can be suspected in the formation of ureteronephric syndrome, as well as in the presence of concomitant kidney disease.

Uretero-nephric syndrome is accompanied by a characteristic clinical picture. Pain in somatic pathology and trauma is constant, in spasms or functional-somatic (usually urolithiasis) pathology it is cramping in the form of colic, radiating from the lumbar region to the lower abdomen: from the upper sections of the ureter to the celiac or iliac region; from the middle section - to the inguinal; from the lower section - to the genitals and thigh. Dysuria, oliguria, anuria are possible. Urine examination reveals the following: leukocyturia (especially in inflammatory diseases, in this case it is advisable to conduct a bacteriological study), the presence of hematuria (especially in urolithiasis, tumors, trauma), the presence of protein (especially high content in pathology), salts, cylinders. The detection of these symptoms is an indication for further clarifying topical diagnostics of kidney disease. The simplest and least burdensome method is ultrasound examination (allows to identify the position, pathology of the parenchyma, pelvis, presence of stones, malformations) ultrasound is not used to diagnose. Survey urography reveals the position, presence of stones in the pelvis, but urate, xanite and cystine stones are not detected, and they make up more than 10% of urolithiasis. Excretory urography with urocontrasts is available: it reveals hydronephrosis, presence of stones, strictures, malformations, some types of tumors. Cystoscopy and chromocystoscopy, retrograde urography are informative for diagnosing kidney disease, simple and accessible, but they can only be performed by a urologist or surgeon who has specialized in urology. If a tumor is suspected, magnetic resonance imaging is indicated. Other methods, and there are many of them, have recently either been abandoned; or are used strictly according to indications.

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