Kidney Diseases

Uretero-nephral syndrome is formed with kidney and ureter's disease, but it can also be caused by the pathology of the lower levels of the genitourinary system, both due to a urinary disorder and an ascending infection. Undoubtedly, urologists should be engaged in diagnosis and treatment of kidney and ureteral disease, but most often, especially with abdominal, pain and peritoneal syndromes, as well as abdominal trauma, they enter surgical hospitals where there is not always a urological service.

Kidney diseases are manifold, surgeons and urologists often have to meet with the diagnosis of urolithiasis and pyelonephritis or a combination of them.

[1], [2], [3], [4], [5], [6], [7], [8]

Stones in the kidneys

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

Stones are localized more often on the right, in 40-50% of cases in the pelvis, in 30% of cases are detected during colic or with hydronephrosis in the ureters, in the cups and bladder within 12-15% of cases. According to their chemical composition, they are: oxalate, phosphate, urate, cystine, protein and mixed structures. In 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 paranefrosis.

The clinical picture of this kidney disease is heterogeneous. Stones in an inert state may not appear at all; when pyelonephritis joins pain and a feeling of heaviness in the lower back develop, often the pain radiates to the lower abdomen, leg; passage of sand or stone on the ureter is accompanied by the development of renal colic, and in the presence of concomitant pyelonephritis, clinical manifestations are brighter. Renal colic is accompanied by sharp cramping pains in the lumbar region, irradiating in the groin, genitals, thigh. Diagnosis of kidney disease usually does not cause difficulties, but sometimes it is necessary to differentiate with the pathology of the abdominal organs. For this, you can use the techniques: Barsova - with colic spraying the waist with chloroethyl causes pain reduction; Lorina-Epstein - when sipping for a testicle, there is a sharp increase in pain 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, symptoms of irritation of the peritoneum do not appear, and when the process is localized in the abdominal cavity this test is positive.

In the study of 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 ultrasound, review and excretory urography. In case of complications (hydronephrosis, pionephrosis, paranefrosis) the complex expands, but is performed only by a urologist.

Pyelonephritis

Pyelonephritis is a nonspecific kidney disease that is characterized by inflammation of the interstitium of the bowl-and-pelvic system. Pyelonephritis is a predominantly secondary pathological process (80%), which develops when the passage of urine is violated with the ascent of infection from the underlying parts. Distinguish sharp; and chronic pyelonephritis (unilateral and bilateral).

Clinic of kidney disease depends on the extent of tissue damage, the virulence of the microflora, the age of the patient and the reactivity of the organism. There are pains in the lumbar region with irradiation into the suprapubic and inguinal region, the thigh, often frequent and painful urination (pollakiuria). Pain syndrome is accompanied by a transient chill and fever. The diagnosis of this kidney disease is based on the clinical picture and urine and blood tests. With ultrasound, there may be an increase in the size and expansion of the bowl-and-pelvis system. Urography in the acute period is not carried out.

Chronic pyelonephritis is formed after three months of acute course. The clinical picture of kidney disease is heterogeneous and atypical, but there are usually periodic pains in the lumbar region, cystitis, weakness, malaise, pallor and facial swelling, tenderness of palpation, a positive symptom of Pasternatsky. To diagnose this kidney disease, leukocyturia should be identified (if a general urine sample is not detected, a Nechiporenko or Addis-Kakovsky study is needed), bacteriuria, the presence of protein, signs of pyelonephritis in ultrasound and urography (widening of the cavity system).

In this case, the form of chronic pyelonephritis is also revealed: wavy, latent, hematuric, calculous, tubular, anemic. These same studies can reveal the formation of a kidney disease, such as hydronephrosis. In the presence of chronic pyelonephritis, you must remember about a specific infection.

In the transition of inflammation from the kidney tissue (with carbuncle, purulent pionephrosis or perinephritis) paranephric fiber develops parainfluorosis (rarely the migration of microflora occurs by hematogenous pathway). The purulent process in the paranephric fiber develops very quickly, but, given the presence of transverse connective tissue bridges, the bowl has a limited nature of the process (often the upper one), although, in some types of microflora, it can be generalized. A distinctive feature of this kidney disease is a sharp and progressive weighting of the patient's condition due to the development of the intoxication syndrome against the already existing kidney disease. Pains are sharp, peculiar to any purulent inflammation, but can also occur in the form of renal colic. The pains are localized in the lumbar region and in the hypochondrium, especially with deep inspiration and cough due to the involvement of sub-diaphragmatic tissue in the process, sometimes effusion into the pleural cavity is formed.

Diagnosis of kidney disease

Diagnosis of kidney disease is based on the presence of a typical picture (the existing disease, the formation of the syndrome of intoxication, a typical pain syndrome). On examination, the pastosity of the skin in the lumbar region is noted, the muscles are strained and painful during palpation, the reflex curvature of the spine in the direction of defeat, flexion in the femoral and knee joint of the limb (psoas symptom) to limit mobility due to pain. The symptoms of Pasternatsky (pain with percussion in the lumbar region) and Israel are sharply expressed (soreness with pressure in the lumbar triangle). Confirm the diagnosis of ultrasound and survey 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)

Ureter (ureter), which is a cylindrical, slightly flattened musculo-epithelial tube with a diameter of 6-15 mm, connects the renal pelvis with the bladder. There are three levels of anatomical narrowing: the initial, iliac and in the transition to the pelvic part, where the most often occurs the infringement of stones, the formation of strictures.

From the pathology of the ureters, urolithiasis is most often noted, which is manifested by the development of renal colic. When the stone is removed, the process stops. When infringement develops hydronephrosis due to violation of the passage of urine, and subsequently its stricture. Inflammatory diseases of the ureters (ureteritis, pyeloureteritus) are often descending, with the admission of microflora from the kidney tissue or lymphatic vessels, but there may be ascending pyeloretheitis or pyelonephritis with simultaneous damage to the renal pelvis.

Damage to the ureter (open, closed, partial and complete) are divided into four groups according to their origin: traumatic (open and closed); operative (especially with operations on pelvic organs); in endovezical studies (catheterization and retrograde urography); when the stone is removed by extractors. In the early days may not be seen, but in the future, depending on the level and type of damage, accompanied by the development of peritonitis, periureteritis,: parainfritis; urinary swabs, urinary fistulas ureteric stricture (diagnosis is complicated, requires the involvement of an experienced urologist).

Malformations and ureteral tumors are rare, their diagnosis is complex and must be performed by a urologist, they can be suspected when forming the uretero-nephral syndrome, and also in the presence of concomitant kidney disease.

Uretero-nephral syndrome is accompanied by a characteristic clinical picture. Pains with somatic pathology and traumas are constant, with spasms or functional-somatic (more often urolythiasis) pathologies of cramping in the form of colic irradiating from the lumbar region to the lower abdomen: from the upper ureter to the celiac or iliac region; from the middle section into the inguinal; from the lower part to the genitals and thigh. Possible dysuria, oliguria, anuria. Urine is characterized by leukocyturia (especially in inflammatory diseases, it is desirable to carry out bacteriological research), the presence of hematuria (especially with urolithiasis, tumors, traumas), the presence of protein (especially high in pathology), salts, cylinders. The detection of these symptoms is an indication for further specifying topical diagnosis of kidney disease. The simplest and most inexpensive method is ultrasound (it makes it possible to identify the position, pathology of the parenchyma, pelvis, stones, developmental defects) by ultrasound is not diagnosed. Survey urography reveals the situation, the presence of stones in the pelvis, but urate, ksanite and cystine stones are not detected, and they make up more than 10% of urolithiasis. Excretory urography is available with the help of urecontrasts: it reveals hydronephrosis, the presence of stones, strictures, malformations, certain types of tumors. Cystoscopy and chromoscystoscopy, retrograde urography are informative for diagnosis of kidney disease, simple and accessible, but they can only be performed by a urologist or a surgeon who has passed specialization in urology. If a tumor is suspected, a magnetic resonance imaging is indicated. Other methods, and there are many, recently or left; or applied strictly according to the indications.

[9], [10], [11], [12], [13], [14]