Pyeloectasia in adults

Enlargement of the renal calyx, known as pyeloectasia, can occur both normally and in various pathological conditions. Thus, pyeloectasia in adults appears with frequent consumption of large amounts of fluid, with increased diuresis, or as a result of urethral overflow. If we are talking about pathology, then here the cause can be both congenital and acquired. The problem is detected by ultrasound, and the need for treatment is determined by the doctor individually.

Epidemiology

Congenital defects of the urinary apparatus are quite common - about 36-39% of all developmental anomalies of various organs and systems. At the same time, the problem may become apparent only with age, provoking early disability due to the formation of chronic renal failure.

Pyeloectasia in adults is a steady progressive enlargement of the kidney pelvis with impaired urine flow, atrophy of the parenchyma and gradual worsening of organ dysfunction.

Most often pyeloectasia is detected in childhood, since congenital pathology accounts for more than 50% of all genitourinary malformations. The antenatal diagnosis frequency is about 1.5% during pregnancy, and after the birth of the baby - up to 3 cases per 1 thousand newborns.

Men are 2.5 times more likely to suffer from pyeloectasia. In addition, the left kidney is more often affected in men. The probability of independent disappearance of the problem in adults is much lower than in children.

Causes of the pyeloectasia in adults

Specialists distinguish two fundamental reasons for the development of pyeloectasia in adults:

• obstruction, or obstruction of the urine flow pathway;
• reflux, or urine backflow.

The pathology does not include cases in which the renal pelvis is temporarily enlarged after excessive fluid intake. In general, there are many conditions in which pyeloectasia is noted, for example:

• urinary stones, sand;
• blood clots;
• tumors;
• hyperplasia and adenoma of the prostate gland;
• urethral and urethral strictures.

In these pathologies, the development of vesicouretero-uretero-pelvic reflux is often noted, leading to the expansion of renal cavities. Any of the segments of the ureter can be compressed by external tumor neoplasms located in the ovaries, uterus, intestine. If we are talking about pelvic tumors of 3-4 stages, then the formation of pyeloectasia due to the spread of metastases is possible. Ureteral compression is also possible under the influence of inflammatory processes accompanying hip lipomatosis, Ormond's disease, and so on.

A special role in the development of pyeloectasia in adults is played by various defects in the development of the urinary system, which are not always manifested in childhood:

• horseshoe-shaped kidneys;
• pelvic dystopia;
• nephroptosis;
• ectopia, torsions, bends in the ureter.

Adult patients are also characterized by a disorder called neurogenic bladder. This is a condition caused by abnormal innervation and systematic urinary stasis in the bladder after urination. The long-lasting syndrome provokes the formation of ureterovaginal reflux, which is often complicated by recurrent infectious inflammatory processes and pyeloectasia.

The most likely predisposing risk factors for adult pyeloectasia:

• Endocrine pathologies leading to increased urine production;
• previous urologic surgical interventions;
• radiation therapy.

Intrauterine pyeloectasia can be caused by radioactive irradiation, taking certain teratogenic drugs, viral diseases in a woman during pregnancy. Some importance is also attached to genetic predisposition to urogenital or renal pathology.

Pathogenesis

The tendency to pyeloectasia is inherited in an autosomal dominant pattern. Internal obstruction is often the most likely cause of the disease in adults:

• narrowing of the uretero-pelvic segment;
• compression of the ureter by adhesions, tumors, vessels;
• Neurogenic disorders affecting the urinary apparatus.

Often pyeloectasia is considered as the first link in the development of hydronephrosis. Excessive enlargement of the pelvis is often found in women during pregnancy: such a condition is not considered pathological if the urinalysis values are within normal limits, and the disorder resolves on its own approximately 5-7 weeks after delivery.

In elderly men, pyeloectasia may be due to prostate adenoma, which provokes lower urinary tract obstruction.

Urinary stasis causes the development of compensatory-adaptive reactions, leading to gradual atrophy of kidney tissues. With the addition of infection, an inflammatory process begins, aggravating the existing morphological disorders, the severity of which depends, among other things, on the degree of compression of the ureter, as well as the stage of pathology, age of the patient, involvement of other organs in the pathology, compensatory capabilities of the body.

Symptoms of the pyeloectasia in adults

Clinical symptoms of pyeloectasia in adults are mostly absent. In some patients, there are complaints of lumbar pain with a tendency to increase in the morning hours or after ingestion of large amounts of fluid. The appearance of dysuria, general weakness, fever are characteristic of the inflammatory process - one of the possible complications of pyeloectasia.

In many adult patients, the first signs of the disorder are not directly provoked by pyeloectasia, but by the underlying cause of the pathology. For example, in disorders that involve obstruction of the lower urinary tract, there are frequent urges to urinate, spontaneous urine leakage, swelling, periodic severe colicky pain, sand or stones, weakening of the urine stream and so on.

Bilateral renal pyeloectasia in an adult is most often complicated by renal failure. The patient has:

• worsening of the general condition (poor appetite, sleep disturbances, general weakness and fatigue, etc.);
• elevated body temperature;
• lower back pain, sometimes abdominal pain;
• urinary flow problems.

Lower back pain increases after a night's rest, or after drinking a lot of fluids.

If the disease, which provokes problems with urine output, is not treated in time, atrophy of renal tissue may develop, compression of the kidney itself may occur. The function of the organ is disturbed, chronic renal failure is formed. If pyelonephritis joins, then the processes of loss of the affected kidney are accelerated. In such a situation, it is said about the complicated course of pyeloectasia.

Complications and consequences

Since pyeloectasia in adults is usually hidden and does not make itself known for many years, and the kidneys during this time function with increased load, the problem can progress to the development of pyelocalcystasia and hydronephrosis. Renal function gradually deteriorates, the structure of the organ changes.

Normally, the urinary fluid formed in the kidneys is transported unobstructed to the calyxes, then to the lobules, to the ureters and then to the bladder, from where it is excreted through the act of urination. If this process is disrupted, there is an increased risk of hydronephrosis, a disorder of urine flow, which is accompanied by enlargement of the calyx and pelvic system with further atrophy.

Hydronephrosis goes through these stages in its development:

1. Directly pyeloectasia.
2. Enlargement of not only the pelvis but also the calyxes, resulting in damage and atrophy of the renal tissue.
3. Complete atrophy of the kidney, its dysfunction.

Stagnation of urinary fluid, which occurs in pyeloectasia, promotes the growth and multiplication of resistant pathogens, which entails frequent recurrences of infectious and inflammatory diseases of the urinary system.

Another frequent complication in adults is the formation of drug-resistant nephrogenic hypertension. Medical experts point out that high blood pressure against the background of hydronephrotic changes in the kidneys is the first sign of impending chronic renal failure.

Diagnostics of the pyeloectasia in adults

Diagnosis and treatment of adult patients with pyeloectasia is performed by urologists or nephrologists. If tumors of the reproductive system in women are suspected, consultation with oncologists and gynecologists is required.

It is important to remember that a one-time detection of pyeloectasia in an adult patient can not be considered a pathology. This phenomenon can be exclusively physiological. In such a situation, dynamic ultrasound observations are prescribed.

In general, diagnosis is aimed at excluding or establishing functional pathologies or organic disorders in the body. Ultrasound diagnosis in all cases is mandatory and can be supplemented by other studies:

• Laboratory tests. If pyeloectasia is compensated, then the urinary fluid analysis will be normal. Changes in the form of leukocyturia, proteinuria, bacteriuria indicate the presence of an inflammatory reaction. Precipitation of salts is detected in dysmetabolic nephropathy, urolithiasis. Blood tests for creatinine and urea levels are prescribed for bilateral lesions, which may indicate an increased likelihood of renal failure. If the urine analysis demonstrates the presence of bacteriuria, additionally carry out the identification of the causative agent and its sensitivity to antibiotics.
• Instrumental diagnostics. If the informativeness of ultrasound examination is insufficient, excretory urography, cystography, nephroscintigraphy, angiography, computed tomography or magnetic resonance imaging with contrast agent injection may be prescribed. If a malignant process in the bladder or prostate is suspected, cystoscopy and TRB are prescribed.

In general, one or another method of additional diagnostics in adult pyeloectasia is selected based on the available indications.

Differential diagnosis

Differential diagnosis is performed between physiologic and pathologic types of pyeloectasia. First of all, it is important to timely and correctly identify the trigger mechanism - the initial cause of the formation of pyeloectasia, because in most cases this disorder in adults is secondary, acquired character.

Treatment of the pyeloectasia in adults

If moderate pyeloectasia in adults is diagnosed, which does not progress and does not bother, then active therapeutic measures are not necessary. In order to prevent the aggravation of enlargement, herbal diuretics and uroseptic agents are indicated. It is important to control the volume of fluid intake at one time: it is better to drink often, but a little, and to reduce the renal load to visit the toilet and at night.

The accompanying detected inflammatory process in the form of cystitis, pyelitis or pyelonephritis is an indication for treatment with such drugs:

• antibacterial agents (broad-spectrum antibiotics);
• uroseptic;
• immunomodulatory agents;
• multivitamin preparations;
• in urolithiasis - litholytics, preventing the formation and precipitation of crystals.

Adult patients with pyeloectasia must be adjusted drinking regime and diet. Limit the use of table salt, exclude animal fats, saturated broths, strong tea and coffee, alcohol, sausages, spices and seasonings, chocolate.

There may be a need for surgical treatment - for example, if pyeloectasia of the left, right kidney in adults continues to progress, despite compliance with diet and drug support. The scope of intervention depends on the nature of the underlying pathology. The operation is performed using laparoscopy, as well as open or endourologic access. The main goal of surgical treatment is to restore urodynamic function, disturbed due to pyeloectasia.

The most common surgical methods involved are:

• Lochano-ureteroplasty, excision of distended pelvic tissue, ureteral stitching, bouching, balloon dilation, laser or current endotomy.
• Stone removal by remote or contact lithotripsy, open surgery, endoscopy with nephrolitholapaxy.
• Palliative intervention and procedures to stabilize urinary outflow in acute inflammatory process (nephrostomy, epicystostomy, urethral catheterization, placement of a stent catheter through the ureter into the pelvis, etc.).
• Removal of neoplasms that interfere with normal urodynamics.
• Removal of the kidney in cases of complete dysfunction and parenchymal damage (in particularly severe cases of pyeloectasia).

Diet in adult renal pyeloectasia

Pyeloectasia in adults is combined with the need to follow a gentle diet, involving nutritional adjustments to restore water-salt balance and facilitate kidney function.

Meat and fish dishes should be boiled rather than fried. You can also bake or steam them.

It is better to divide meals into 4-6 times a day, in small portions.

It is very desirable that all food should be prepared without adding table salt. In adults with pyeloectasia should not consume more than 2.5 g of salt per day, and in case of high blood pressure, it should be completely abandoned.

The daily volume of liquid consumed should be no more than 1 liter.

Dietary nutrition involves not only limiting the use of spicy spices, condiments and alcoholic beverages, but also a strong "cut" share of protein foods, because protein complicates renal function. Relatively allowed protein products remain eggs, lean white meat and fish - in small quantities.

Completely exclude from the diet of a patient with pyeloectasia:

• broths of meat, fish or mushrooms;
• fatty meat or fish, offal;
• sausages, sausages, smoked meats;
• salted and smoked fish, caviar, canned food;
• salty cheese, legumes (peas, beans, etc.);
• chocolate, cocoa;
• onions, garlic, radishes, sorrel, spinach, sour and pickled vegetables, mushrooms;
• horseradish, mustard, peppers, sauces and marinades;
• strong coffee, sodium mineral waters.

The list of allowed foods is quite extensive and includes:

• Unleavened bread and loaves, breadcrumbs, pancakes and fritters without salt;
• vegetarian soups with cereals, vegetables, greens;
• boiled or baked meat - lean veal or poultry, boiled tongue;
• lean fish, baked, stuffed, bay;
• milk 1.5-2.5%, sour cream10-15%, kefir or ryazhenka, cottage cheese and dishes from it;
• Eggs (up to 2 per day) in the form of boiled soft-boiled, omelettes;
• rice, corn, pearl groats, buckwheat and oatmeal, pasta;
• potatoes and any other vegetables, unsalted vinaigrette, fruit salads;
• berries, fruit;
• honey, jam, sour cream, fruit candy;
• weak tea or weak coffee, vegetable or fruit juice of own preparation, rosehip decoction.

It is important to control the consumption of ready meals and semi-finished industrial products. As a rule, such products contain a lot of hidden salt, the use of which is highly undesirable in patients with pyeloectasia.

Prevention

There is no specific prevention of pyeloectasia in adults. The recommendations of specialists are of a general nature only:

• it is necessary to treat any infectious and inflammatory diseases in the body in a timely manner;
• avoid hypothermia;
• eat right and eat well;
• drink adequate amounts of fluids throughout the day;
• avoid back and abdominal injuries;
• Go to the toilet in a timely manner - in advance or at the first sign of an impending urge to urinate;
• Visit your family doctor regularly, and if indicated or if you have a hereditary predisposition, get a kidney ultrasound.

Special preventive measures to prevent pyeloectasia are necessary for women who are planning a pregnancy or are expecting a baby. Pregnant women should monitor their own well-being and notify doctors if any suspicious symptoms appear. Laboratory tests and ultrasound, which are necessarily carried out throughout the gestation period, contribute to the timely detection of diseases. The earlier the problem is detected, the easier it will be to deal with it and the lower the risk of complications. To prevent pyeloectasia during pregnancy, it is necessary:

• treat infectious processes in the body (preferably at the stage of planning a child);
• treat bacteriuria and obstructed urine flow as early as possible, especially in women with multiple uteri, multiple pregnancies, large fetuses;
• adhere to a healthy lifestyle, listen to the doctor's recommendations, and regularly undergo all necessary diagnostic measures;
• observe the rules of personal hygiene;
• avoid hypothermia, fatigue, avoid stressful situations, maintain immunity at the proper level.

Forecast

Prognosis in adult pyeloectasia can be favorable - if the conditions of regular monitoring, prevention of progression and timely treatment of the underlying causative disease are observed. A patient with diagnosed enlargement of the renal pelvis should regularly visit a nephrologist or urologist, perform an ultrasound examination, take a general urine test.

Family doctors should consult with patients on the need for a reasonable approach to diet and drinking regimen, healthy lifestyle, avoiding situations that can adversely affect the state of immunity. In some cases, depending on the indications, it is possible to prescribe uroseptic, herbal preparations with anti-inflammatory and diuretic activity, immunostimulants, which is especially important in periods of natural instability of immunity - for example, in winter and spring.

Pyeloectasia in pregnant women usually resolves on its own in 1-1.5 months after delivery. If the pelvis has not returned to normal, the patient is systematically monitored, with mandatory correction of diet and fluid intake.

Pyeloectasia in adult men suffering from prostate pathologies, in many cases passes after successful treatment of the underlying disease.