Without the excretory system, it is impossible to imagine the work of the human body. One of its components are the kidneys. This is a paired organ, the main task of which is to remove fluid and water-soluble elements. It is also directly involved in metabolism and regulation of acid-base balance. Both kidneys are present in the body of an absolutely he althy person. 2.5% of newborns have defects. And although rare, there is an abnormal absence of a kidney.
What is renal aplasia (agenesis)?
The causes, symptoms and treatments for such rare diseases will be discussed below. First you need to understand what these terms mean.
In various medical reference books, you can find a mixture of the two concepts of "aplasia" and "agenesis". Is there a difference between them?Agenesis is the complete absence of one or two kidneys at the same time. This pathology is congenital. In place of the missing organ, there are not even the rudiments of renal tissue. Aplasia is a phenomenon in which only a strand of connective tissue remains in the retroperitoneal cavity. In other words, it is an underdeveloped kidney, unable to perform its function.
In clinical practice, it does not matter which form of the disease is found in a child. In both cases, a full-fledged organ is absent. Unified statistics of diseases is also not presented. It is known that renal anomalies account for about 7-11% of all pathologies of the genitourinary system.
Historical background
Kidney agenesis has been known to mankind since ancient times. Even Aristotle mentioned this disease in his writings. He argued that if an animal cannot exist without a heart, then without a kidney or spleen - completely. During the Renaissance, the Belgian scientist Andreas Vesalius became interested in this problem. In 1928, the Soviet doctor Sokolov began to identify its prevalence among the population. Since then, scientists have identified several forms of aplasia (agenesis), each of which has its own clinical picture and prognosis.
Types of agenesia
There are several classifications of this pathology. The main distinguishes the disease by the number of organs.
- Right-sided agenesis of the kidney (ICD-10 code - Q60.0). This form of the disorder is most commonly diagnosed in women. Usually from birth, the right kidney is especially vulnerable. It is located belowleft and is considered less mobile. In most cases, all functions are taken over by the paired organ, and the person does not experience much discomfort.
- Left-sided kidney agenesis. This form of pathology is rare and is quite difficult to tolerate. The right kidney is less functional. She is not adapted to compensatory work.
Bilateral agenesis should be considered separately. This type of disease is characterized by the absence of two organs at the same time. With him, babies rarely survive. After birth, they immediately need a transplant operation. What is the code for bilateral kidney agenesis? ICD-10 includes this pathology under the code Q60.1.
Forms of aplasia
This renal anomaly is only one-sided. The pathological process can extend exclusively to the right or left organ. In this case, the kidney is usually represented by fibrous tissue in its infancy, but without the pelvis, ducts and glomeruli.
Causes of disorder
There is no consensus on the causes of renal agenesis in newborns. Physicians express different points of view. Some see the relationship of pathology with a genetic predisposition. Others deny this fact.
Long study of the disease and numerous studies have identified several factors that increase the likelihood of its occurrence. Aplasia or agenesis of the kidneys in the fetus is possible in the following cases:
- Chronic alcoholism, drinkingduring pregnancy.
- Diabetes mellitus in a future woman in labor.
- Past viral/infectious diseases in the first trimester.
- Woman's uncontrolled drug use for 9 months.
Kidneys begin to form in the fetus from the 5th week of its life in the womb. This process continues throughout pregnancy. However, the 1st and 2nd trimesters are considered the most dangerous. At this time, the probability of developing pathology, subject to the impact of adverse factors, is quite high.
General clinical picture
Aplasia or agenesis of the kidney may not manifest itself for a very long time. Some mothers do not go for ultrasound during pregnancy, and after the baby is born, they neglect the tests. As a result, a person is not even aware of existing he alth problems. He learns about the unpleasant diagnosis years later. As a rule, during a preventive examination at school or when applying for a job. In this case, a he althy kidney takes on up to 75% of the functions of a missing or poorly functioning organ. Therefore, the person does not feel any discomfort.
Sometimes a kidney anomaly begins to appear in a child in the first days of life. Among the main symptoms of pathology, doctors distinguish:
- various facial defects (puffiness, wide and flat nose);
- a large number of folds on the body;
- voluminous belly;
- low ear position;
- lower limb deformities;
- shifting the position of someinternal organs.
When kidney agenesis is diagnosed in a child, the disease is usually accompanied by anomalies in the development of the genital organs. For example, girls have a bicornuate uterus, vaginal atresia. In boys, the absence of the vas deferens is found. In the future, such problems may be complicated by impotence and even infertility.
Diagnostic Methods
Adult person is always diagnosed with "kidney agenesis" as a disability. However, you must first undergo a comprehensive examination. During it, the doctor collects the patient's history, studies his hereditary predisposition. Additional research methods may be required to confirm a preliminary diagnosis:
- Ultrasound.
- Urography with contrast agent;
- Renal angiography;
- CT.
It is possible to determine the absence or underdevelopment of the kidneys in the fetus through ultrasound. Already at the first screening study, which is scheduled for the 12-14th week, a specialist can confirm the pathology. After that, the woman is required to be assigned an additional examination for concomitant malformations.
Treatment measures
The only form of the disease that is actually life-threatening is bilateral renal agenesis. Quite often, a fetus with such a diagnosis dies in the womb or at the time of childbirth. Also, the likelihood of death inthe first few days of life is quite high due to kidney failure.
Thanks to the development of perinatal medicine, today it is possible to save a child with this pathology. To do this, it is necessary to perform an organ transplantation operation in the first hours after childbirth, and then regularly do hemodialysis. This method of treating the disease is quite real and is used in practice in large medical centers. However, initially, a quick differential diagnosis should be organized and other malformations of the urinary system should be excluded.
Unilateral renal agenesis has a favorable prognosis. If the patient's pathology is not complicated by unpleasant symptoms, it is enough for him to undergo a preventive examination once a year and take the necessary tests. It is also necessary to take care of a he althy kidney. Detailed recommendations should be given by the attending physician. As a rule, they include following a diet with the exception of spicy and s alty foods, and giving up bad habits.
Aplasia is not specifically treated. However, one cannot do without preventive recommendations to strengthen the immune system. It is necessary to eat right, to avoid infectious and viral diseases. It is also recommended to give up serious physical exertion.
In a severe form of the pathological process, hemodialysis and even organ transplantation may be required. In all other cases, therapy is prescribed individually, taking into account the nature of the disease and the overall clinical picture.
Prevention Methods
Aplasia and agenesis of the kidneyICD-10 codes are different. However, both of these pathologies cause concern for future parents. Can they be prevented?
If we exclude the genetic predisposition to the disease, then the preventive measures are quite simple. Even at the planning stage, the expectant mother should begin to monitor her he alth (eat right, give up addictions, engage in feasible sports). Such recommendations should be followed after the successful conception of the baby.
If the development of pathology could not be avoided, it is necessary to take measures to eliminate it. With bilateral agenesis, there is a symmetrical fetal delay in development, oligohydramnios. If an anomaly is detected before the 22nd week of pregnancy, it is recommended to terminate it for medical reasons. When a woman refuses her, conservative obstetric tactics are used. It is worth noting that with a unilateral absence of a kidney, a full life is possible. It is only necessary to occasionally undergo preventive examinations and examinations.
