renal fusion
Introduction
Introduction to kidney fusion About 1 case of some form of kidney fusion occurs in every 1000 individuals, the most common is horseshoe kidney. The fused kidney block contains almost two excretory systems and two ureters. The kidney tissue can be evenly divided between the two flank, or completely on one side. Even in the latter case, the double ureteral opening is open to the intrinsic position of the bladder. The fusion of the two posterior kidneys occurs early in the embryo, when the kidneys are still in the pelvic cavity and the position is low. Therefore, they rarely rise to the high position where the normal kidney should reach, and can even stay in the pelvic cavity. At this point, the kidney can get a supply of multiple blood vessels (such as aorta, iliac vessels, etc.) in this area. Of the patients with both ectopic and fused kidneys, 78% had urinary malformations and 65% would show other genitourinary defects. basic knowledge The proportion of illness: the incidence rate of infants and young children is about 0.001%-0.002% Susceptible people: no special people Mode of infection: non-infectious Complications: hydronephrosis
Cause
Cause of renal fusion
Cause:
The fusion of the two posterior kidneys occurs early in the embryo, when the kidneys are still in the pelvic cavity, and the position is very low. Therefore, they rarely rise to the high position where the normal kidney should reach, and even stay in the pelvic cavity. At this time, the kidney The supply of multiple blood vessels in this area (eg, aorta, iliac vessels, etc.) is available. Of the patients with both ectopic and fused kidneys, 78% have urinary malformations and 65% will show other urogenital System defects.
pathology
Since the kidneys are fused early, normal rotation does not occur, so each pelvis is located on the anterior surface of the kidney. Therefore, the ureter must cross the isthmus of the horseshoe kidney or cross the anterior surface of the fused kidney. At this time, one or several ectopic blood vessels will cause some degree of compression on the ureter and cause obstruction. Hydronephrosis and the resulting renal fusion infection are more common. Bladder ureteral reflux is also often associated with renal fusion.
In the horseshoe kidney, the isthmus often connects the lower kidney poles of each side, and each kidney block is lower than the normal position. The long axis of these kidney blocks is vertical, while the normal kidney axis is arranged along the lumbar muscle edge, with a slanted "eight" character relative to the spine. In rare cases, the two kidneys fuse into one, which contains two renal pelvis and two ureters. Such a kidney block can be located in the midline and the ureter is in a fixed position (combined fusion ectopic kidney).
Prevention
Kidney fusion prevention
The prevention of this disease is not special and is congenital.
To prevent kidney fusion, we must first do the following two points to prevent:
1, nutrition should be balanced, reasonable diet. Symptoms of kidney fusion and yin deficiency are generally considered to have biological factors, that is, genetically fragile, inherently nervous and neurotic, and such people are most likely to have a sense of fear.
2, diet kidney. There are many foods that can tonify the kidneys. In addition to black black sesame seeds, black fungus, black rice, black beans and other black food can raise the kidney, walnuts, leeks, shrimp, sheep waist, etc. can also play a role in kidney and kidney.
3, sleep and nourish the kidney. Adequate sleep plays an important role in the biochemistry of blood and the maintenance of kidney essence. Clinically, many patients with renal failure have experienced excessive day and night, excessive fatigue, and lack of sleep. Therefore, do not stay up late, develop good habits, work early and get up early, is conducive to the maintenance of kidney essence.
Complication
Renal fusion complications Complications hydronephrosis
Due to the high incidence of ectopic renal blood vessels and one or two arches in the ureter surrounding or crossing the kidney block, the fused kidney is prone to ureteral obstruction. Therefore, hydronephrosis, stones and infections are more common. The huge fusion of the concave surface of the humerus can also cause dystocia.
(1) Infection, mainly manifested as diplococcus pneumonia, peritonitis, subcutaneous infection, urinary tract infection. The infection is more insidious.
(2) thrombosis and embolic comorbidities, which is one of the serious fatal complications of this disease. Followed by pulmonary or venous thrombosis, thrombophlebitis of the surrounding vein.
(3) Promote cardiovascular disease, which can accelerate arteriosclerosis due to long-term hyperlipidemia, especially elevated plasma concentrations of low-density lipoprotein. In recent years, it has been found that it can aggravate glomerular progressive sclerosis.
Symptom
Renal fusion symptoms common symptoms ureteral obstruction peptic ulcer nausea bloating
(1) Symptoms: Most patients with fusion kidneys are asymptomatic, but some can develop ureteral obstruction. Gastrointestinal symptoms (kidney and intestinal reflex) similar to peptic ulcer, cholelithiasis or appendicitis may also occur. If there is ureteral obstruction When hydronephrosis or stones form, they are prone to infection.
(2) Signs: Physical examination is usually negative, unless the kidney block can be touched in an abnormal position. For horseshoe kidneys, it is possible to touch the mass in the lower lumbar vertebrae (isthmus). In cross-ectopic cases, it may be in the flank or The lower abdomen touches a mass.
Examine
Kidney fusion examination
1. Laboratory inspection:
Urine analysis was normal except for infection, and renal function was normal unless each fused kidney was diseased at the same time.
2. X-ray inspection:
Horseshoe kidneys, if the kidney axis is visible in the plain film, they are parallel to the spine, and sometimes the isthmus can be recognized. The flat piece can also show a case of a large soft tissue block in the flank and no kidney shadow on the other side. Function, through the urinary tract angiography can be clearly diagnosed, the increase in renal tissue density makes the location and shape of the kidney more clear, urography can also see the renal pelvis and ureter.
1 The horseshoe kidney is located on the anterior surface of the kidney block, while the renal pelvis of the normal kidney is located on the inner side of the kidney. For the horseshoe kidney, the most diagnostic clue is that the renal pelvis is oriented toward the midline and is more than the ureter. Close to the center line.
2 Cross-ectopic fusion kidney showed 2 renal pelvis and 2 ureters, one of which must cross the midline to urinate in the bladder's natural position.
3 A pie-shaped or massive kidney is located in the pelvis (pelvic fusion kidney), but its ureter and renal pelvis can be developed and can compress the top of the bladder.
3. CT scan:
The outline of the kidney can be clearly depicted, but it is not essential. For pelvic fusion kidneys or in the flank, the plain film inserted into the ureteral catheter will provide the first clue for diagnosis. Retrograde angiography will show the location of the renal pelvis and Changes in infection or obstruction, renal scintigraphy can show the kidney block and its contours, like ultrasound images.
Diagnosis
Diagnostic differentiation of renal fusion
Separated kidneys that fail to perform normal placement can be confused with horseshoe kidneys, which are arranged along the lumbar muscle, while the horseshoe kidney is parallel to the spine, with the lower pole in front of the psoas muscle and the renal pelvis in the horseshoe kidney isthmus. Oriented to the midline and close to the spine. If there is a significant obstruction in the ureter that prevents the kidney, part of the renal pelvis or ureter from developing, it may cause missed diagnosis, venography or retrograde angiography in the urinary tract angiography. Urography can also show excretory passages in the kidney block.
Generally, no treatment is needed. Unless infection or obstruction occurs, the isthmus of the horseshoe kidney can be improved to improve drainage. When one of the horseshoe kidneys is poorly drained, it can be removed.
