Pathologies of the urinary system are quite common and occupy a significant place among all somatic diseases. Many diseases are practically asymptomatic. If an increase in the kidneys is detected during ultrasound, the causes of such a pathological phenomenon should be clarified.
The kidneys are involved in the processes of homeostasis and perform an important role: they control the composition of the blood, remove decay products of many chemical compounds, toxic substances and excess water from the body. The main indicator of the state of this body is the size. He althy kidneys function continuously. If a certain pathological process develops, this immediately affects the functionality of this paired organ, and, as a result, an increase in the size of the kidneys occurs.
Norma
During life, the size of the kidneys changes: this urinary organ is formed up to about 50-55 years, and then the mechanisms of irreversible atrophic processes are triggered.
An adult has a he althy kidneyhas the following parameters:
- length for women - 8-10 cm, for men -10-12 cm;
- width - 4-5 cm and 5-6 cm.
There are a number of aspects that must be taken into account for the correct estimation of parameters:
- Individual characteristics of the body, in which it is permissible to change the size of the kidneys up to 15-20%.
- For the elderly, the disappearance of the fat layer of this organ is characteristic, the width of which in he althy people is approximately 12 mm.
- One kidney may be slightly larger than the other.
In the asymptomatic course of the pathology, an increase in the kidney helps to identify palpation and ultrasound.
Kidney size in children
In newborn babies, the weight of the kidney is approximately 10–12 g. During the first year of life, the weight of the paired organ reaches 35 g, and the size increases by 1.5–2 times. The main difference in the structure of the kidneys in newborns and children under 1 year old is the immaturity of the cortical layer, where the filtering part is located - Bowman's capsule, as well as descending and ascending loops. The thickness of the cortical layer is no more than 2 mm, while the medulla is 8 mm. As the child grows and matures, the cortical layer increases 4-5 times.
Below are normal kidney sizes for children of different ages:
- 1 month: length 4.2mm, width 2.2mm;
- 6 months: length 5.5mm, width 3.1mm;
- 1 year: length 7.0mm, width 3.7mm;
- 6 years: length - 7.9 mm, width - 4.3 mm;
- 10 years: length 9.8mm, width 5.2mm;
- 15 years: length– 10.7 mm, width – 5.3 mm.
Symptoms of kidney enlargement
If at the initial stage of the disease the increased size of the organ does not cause concern, then in the advanced form, the pathology is accompanied by many symptoms. It is at this stage that the diagnosis of disorders in the genitourinary system is most often carried out.
Kidney enlargement symptoms:
- pain in the lumbar region, aching nature of pain;
- frequent, painful urination, blood in the urine;
- increased body temperature, which is characteristic of kidney infiltration;
- swelling due to impaired urination.
Causes of pathology
The main cause of kidney enlargement are serious diseases of the urinary system. The exception is a congenital pathology or a situation where the patient has only one kidney that does double work.
Pyelonephritis is a common cause of acute symptoms of an enlarged kidney. In the inflammatory process, which has an infectious nature of origin, there are aching pains, fever, painful urination, nausea. The disease occurs as a result of infection of the urinary tract with various pathogenic bacteria. Untreated inflammation becomes chronic and is characterized by periodic exacerbations.
In addition, a pathology such as hydronephrosis leads to an increase in the kidney in adults. This is a progressive disease in whichurine accumulates in the renal pelvis. Over time, its abnormal amount leads to a change in the size of the cups, and in the future - to a direct increase in the kidney.
Hydronephrosis is a severe form of complications provoked by a number of serious acquired or congenital pathologies. This disease is fraught with the development of irreversible pathological processes in the kidney tissues.
Symptoms and causes of hydronephrosis
This chronic disease can lead to oncological degeneration of the kidney. Women are more susceptible to the disease, in men this disease is much less common. In 95% of cases, it affects only one kidney. The main cause of the primary type of hydronephrosis are congenital anomalies of the urinary canals. The secondary type of the disease occurs as a result of acquired pathologies. The reasons for the development of secondary hydronephrosis can be:
- urolithiasis;
- diseases of the genitourinary system;
- narrowing of the urethra caused by trauma;
- malignant tumors of the genitourinary system, abdominal cavity, small pelvis, spinal cord.
Stages of the disease
The initial phase of hydronephrosis is characterized by a slight increase in the size of the pelvis, proceeds without severe symptoms. Possible malaise, decreased performance.
At the second stage, the organ ceases to function properly due to a significant increase in the pelvis, the walls of which become thinner, the kidney itself also increases. There are constant pain in the lumbar region, attacks of hypertension, nausea.
At the third stage of the disease, the increase in the kidney occurs twice, there is a pronounced violation of its functionality. Urine becomes cloudy, with impurities of blood. The disease at this stage is severe. With a complete loss of function, the diseased kidney is removed.
Cyst
Kidney cysts often become a factor in the increase in this organ in size. The main cause of a kidney cyst is the accelerated growth of epithelial structures in its tubules. Most often, this similar phenomenon occurs due to injuries, hereditary predisposition, infectious and parasitic pathologies. Sometimes a kidney cyst is congenital and is formed as a result of a loss of connection between the urinary structures and the germinal tubules.
In most cases, the spectrum of symptoms associated with a kidney cyst includes:
- an increase in body size;
- recurrent urinary tract infections;
- the presence of urine in the blood due to increased pressure in the kidney and violation of the integrity of blood vessels;
- pain in the lower back or side, resulting from an increase in the size of an organ, which compresses nearby organs;
- accumulation of fluid in the kidney;
- presence of protein in urine;
- increased blood pressure.
If a concomitant infectious disease occurs against the background of the development of a kidney cyst,signs of pyelonephritis appear.
Enlargement of this organ in children
As a rule, an enlarged kidney in a child occurs without specific symptoms. However, fever, back pain, and urinary problems may occur.
Pyeloectasia in children is the initial stage of kidney enlargement. This pathology is prone to rapid progression.
At later stages, the disease affects the entire pelvicalyceal complex. Difficulty urinating is more pronounced. With more advanced forms, depletion of the renal tissues occurs, the kidneys stop working fully or become incapacitated. The baby's body temperature rises to high numbers.
There may be several reasons for an enlarged kidney in a child:
- Maternal alcohol abuse during pregnancy;
- genetic predisposition;
- vesicoureteral reflux;
- defects in kidney development;
- prematurity;
- disturbance of innervation;
- impaired urine flow;
- tumor process;
- excessive fluid in the body;
- urinary tract infection or obstruction.
Diagnosis
The traditional plan for diagnosing a patient with renal pathologies includes:
- collection of anamnesis and complaints;
- clinical medical examination;
- percussion and palpation of the kidneys;
- determining the presence of Pasternatsky's symptom;
- laboratory diagnostics: general urine and blood tests, biochemicalblood test, Zimnitsky test, Nechiporenko urine test.
The list of methods for instrumental diagnosis of the causes of kidney enlargement includes:
- Ultrasound of the kidneys;
- CT, MRI;
- excretory urography.
Principles of treatment
The treatment regimen for kidney enlargement for each patient is compiled individually. First of all, the causes of this pathological phenomenon, the age of the patient, concomitant diseases are taken into account. Infectious and inflammatory processes are an indication for antibacterial and supportive treatment.
If endocrine diseases have become the cause of an enlarged kidney, such a pathology is corrected by the appointment of hormonal medications. Congenital malformations, as well as diseases accompanied by disturbances in the flow of urine or the occurrence of a pathological formation in the structure of the kidney, are treated surgically.
Modern medicine has minimally invasive and effective surgical intervention techniques that help eliminate existing problems and practically do not cause negative complications.
With hydronephrosis of the kidney, conservative therapy is ineffective. It can be aimed at eliminating the pain syndrome, suppressing and preventing infection, lowering pressure, correcting kidney failure in the preoperative period. The emergency method for acute hydronephrosis is percutaneous nephrostomy, which allows you to remove accumulated urine in the kidney and reduce pressure in the organ.
Viewssurgical therapy of hydronephrosis are different and are determined by the cause of the pathology. They are divided into organ-preserving, reconstructive and organ-removing. Treatment of kidney enlargement in adults and children should be comprehensive and timely.
In the case of urolithiasis, lithotripsy or surgical removal of stones from the obstruction site is performed. Removal of an enlarged kidney (nephrectomy) is resorted to in the absence of its functionality and the risk of complications. Surgery is also performed for intrarenal cysts.
We looked at the causes and treatment of kidney enlargement in adults and children.
