hydronephrosis in children
Introduction
Introduction to Pediatric Hydronephrosis Pediatric hydronephrosis is caused by congenital ureteropelvic junction obstruction. More common in men, lesions are mostly on the left side, in the newborn about 2 / 3 lesions on the left side, and the incidence of bilateral lesions is 10% to 40%. Newborns and babies often come to the hospital with gastrointestinal discomfort and abdominal masses. The larger patients are more likely to have intermittent lumbar and abdominal pain, hematuria, urinary tract infection, etc. Occasionally, children with renal rupture and severe hydronephrosis There may be hypertension and uremia. basic knowledge The proportion of illness: 0.003% Susceptible people: children Mode of infection: non-infectious Complications: urinary tract infection
Cause
Causes of hydronephrosis in children
Ureteral obstruction (40%):
This is a common disease that causes hydronephrosis in the kidneys. The reason is that a small segment of the ureter is stenotic and causes obstruction, which causes the urine in the kidney to flow to the bladder and stagnant in the kidneys. Usually, as long as the stenosis of the ureter is removed and reattached to keep the ureter open, it can improve the hydronephrosis.
Urine countercurrent (40%):
Under normal circumstances, urine is passed from the kidney to the bladder through the ureter and then excreted; urine reflux is an abnormal phenomenon in which urine is poured from the bladder back into the ureter or even back into the kidney. At this point, the kidneys will have urine that is ready to flow to the bladder, as well as urine that flows back from the bladder. At this time, the kidneys will have too much water, causing hydronephrosis.
Prevention
Pediatric hydronephrosis prevention
Drug health care hydronephrosis is generally not cured by drugs, but in order to prevent secondary infection and protect kidney function, before the treatment of urinary tract obstruction is not made, you can:
1 antibacterial drugs: such as erythromycin, cephalosporin and the like.
2 Chinese medicine treatment: antibacterial traditional Chinese medicine that can be used for detoxification, such as Bupleurum, Phellodendron, Astragalus, Psyllium.
Dietary Health 1 increases energy intake, but in order to avoid increasing the burden of stagnant kidneys, it is not advisable to eat too much protein-rich foods. Energy intake relies mainly on carbohydrates and fatty foods.
2 such as unilateral hydronephrosis, do not have to limit the amount of drinking water, if bilateral hydronephrosis, there is renal dysfunction, to limit the daily intake of water.
2. Other notes:
Once the hydronephrosis is complicated, if the obstruction is not relieved in time, the infection is difficult to cure, and the infection accelerates the destruction of the kidney, forming a vicious circle and even forming a pus.
Complication
Pediatric hydronephrosis complications Complications, urinary tract infections
Because urine reflux in children is a congenital disease, most patients have no symptoms and no pain, but when symptoms appear, the kidneys may have been infected; the age of infection, from months to months As old as a teenager. However, the destruction of the kidneys is not destroyed by infection, and even if there is no infection, the kidneys may be slowly destroyed. The child's kidneys are not very mature kidneys. Each infection will destroy part of the kidney function, and these damaged kidney functions will not be restored; for example, the infection is destroyed by 10%, and the next damage is 20 %, after waiting to grow up, there may be only 50% of normal functions left.
Symptom
Pediatric hydronephrosis symptoms common symptoms complex urinary tract infection hematuria hypertension left and right waist and abdominal pain
Newborns and babies often come to the hospital with gastrointestinal discomfort and abdominal masses (more than half). Larger patients are more likely to have intermittent lumbar and abdominal pain, hematuria, urinary tract infections, occasionally kidney rupture, severe kidney Children with water can have high blood pressure and uremia.
Examine
Examination of children with hydronephrosis
1. Urine routine examination often occurs in the red blood cells and proteins after the enlargement of the renal pelvis.
2. Renal function tests include urea nitrogen, creatinine measurement, and clearance test. When bilateral renal hydronephrosis is severely impaired, serum creatinine and urea nitrogen increase.
3. Imaging examination: X-ray examination, B-ultrasound examination, renal puncture angiography, etc.
Diagnosis
Diagnosis and diagnosis of hydronephrosis in children
diagnosis
(1) medical history
The clinical manifestations are related to the location of the obstruction, the time, the speed of occurrence, the presence or absence of secondary infection and the nature of the primary lesion. For this reason, attention should be paid to the diagnosis: 1 early or latent chronic obstruction may be asymptomatic; 2 patient's Sensitivity is closely related to the discovery of its symptoms. Patients with abdominal mass, chronic low back acidulence, refractory refractory urinary tract infection, and unexplained hypothermia should consider the possibility of upper urinary tract obstruction and should be further examined. For children with intermittent abdominal mass and polyuria should pay more attention.
(two) signs
Further examination can be performed from the signs of pain, swelling, and abdominal mass in the kidney area to determine whether there is upper urinary tract obstruction.
(3) Laboratory inspection
1 routine urine examination: early patients with mild hydronephrosis urine can be normal, when the development of the renal pelvis enlargement can appear hematuria and proteinuria. A large amount of proteinuria and casts are not common in upper urinary tract obstructive diseases. 2 Renal function test: Renal function test in patients with unilateral upper urinary tract obstruction hydronephrosis is generally not due to contralateral compensation. The phenol red test and sputum excretion test indicate that there is damage indicating bilateral kidney damage. When severe bilateral hydronephrosis occurs, the urine flow is slow through the renal tubules, and a large amount of urea is reabsorbed, but creatinine is generally not absorbed, which results in a ratio of urea to creatinine exceeding the normal 10:1. When renal parenchymal damage seriously affects renal function, both serum creatinine and endogenous creatinine clearance will increase. 3 anemia: appears in the renal dysfunction of both kidneys.
(4) X-ray examination 1 urinary tract plain film: showing an enlarged kidney shadow, such as calcification in the urinary tract, suggesting that the kidney ureter has stones and obstruction. 2 intravenous pyelography: in addition to severe damage to the kidney function can generally provide more detailed information, from which you can understand the location and causes of obstruction; the degree of renal pelvis, renal pelvis and ureteral dilatation; from the thickness of renal hydronephrosis and its development Density roughly estimates the function of the kidney. For high-dose intravenous pyelography and simultaneous video recording and film can dynamically observe the renal and ureteral peristaltic function to distinguish whether it is mechanical or dynamic obstruction. The creep function on both sides can be compared. 3 retrograde pyelography: poor renal function, poor venography of the urography can be retrograde angiography to understand the location of obstruction, etiology and obstruction, but must be alert to the retrograde intubation of the bacteria into the water caused by the kidney The pus kidney, or the stimulation of the intubation and contrast agent, causes the mucosal edema of the obstruction site to increase the degree of obstruction from incomplete to complete. 4 percutaneous nephrolithotomy: for venography is not ideal, retrograde angiography failed or not suitable for retrograde angiography, the antegrade angiography of the kidney can be located under the guidance of B-ultrasound under the guidance of B-ultrasound to understand the location and extent of obstruction. For the obstruction of the proximal ureter and renal pelvis, and the urinary collection of urine can be cytological examination and culture, or catheter can be indwelled for urine drainage. 5 angiography: patients with suspected obstruction and vascular malformation can be used as renal blood vessels, abdominal aorta, inferior vena cava or renal vein angiography as needed to understand the relationship between obstruction and blood vessels. From the angiography, you can also learn about the blood supply of the kidney and the thickness of the renal cortex. 6 Bladder urethrography: This angiography in patients with bilateral renal ureteral hydrops can be used to understand whether there is vesicoureteral reflux and neuropathy bladder and other diseases.
(5) Ultrasound examination. Can understand the degree of kidney, ureteral hydrops, the degree of renal parenchymal atrophy, can also initially detect the location and cause of obstruction, and can guide the puncture angiography.
(6) Radionuclide examination 1 Radionuclide kidney map: In the obstructive kidney map, the vascular phase and the secretory phase have a certain degree of suppression, which is related to the severity of obstruction and the obstruction time, mainly manifested as a slow decline in the excretory phase. The kidney map helps to estimate the difference in the degree of renal function and obstruction, but it cannot be quantified. 2131I scan gamma photography revealed poor nuclide intake: the slow transport of radionuclides through the renal cortex has a glint accumulation in the renal pelvis.
(7) CT can understand the location of obstruction, help to detect the cause of obstruction, and clearly show the degree of expansion of the kidney and ureter and the thickness of the renal cortex. It can also compare the structure and function of both sides at the same time.
(8) Percutaneous nephrolithotomy and ureteroscopy can be used for intraluminal observation of the obstruction site, and can be used for biopsy and expansion, incision, intubation, etc., and can also be used for renal ostomy.
(9) cystoscopy can directly observe the bilateral ureteral opening and the intubation side to collect urine for renal function test, quantitative analysis of urea, colorimetric test of phenolsulfonate or rouge, and can predict the renal pelvis capacity from urine output. Retrograde angiography was performed by cannulation.
(10) Measurement of intrarenal pressure by percutaneous renal puncture cannula (>F18) and insertion of a F12-14 catheter into the bladder from the urethra, keeping open to drain the fluid in the bladder, using saline or contrast agent at 10m1/ The flow rate of min was injected into the renal pelvis until the fluid filled the upper urinary tract and the rate of infusion of the renal pelvis and bladder (10 ml/min) was equal. The pressure of the renal pelvis was connected to the pressure tube to record the pressure of the renal pelvis (absolute pressure of the renal pelvis). At the same time, the bladder pressure was measured by the catheter. The absolute pressure of the renal pelvis was subtracted from the abdominal pressure (bladder pressure). The normal pressure was 1.18~1.47kpa (12~15cm) H2O, and >1.47kpa (15cmH2O) showed mild obstruction. :> 2.16kpa (22cmH2O) showed moderate obstruction, >3.92kpa (40cmH2O) was severe obstruction.
If the contrast agent is injected at the same time, the film or video can be taken at the same time to understand the location and cause of the obstruction.
