Such a pathology as kidney reflux, the symptoms of which are not clearly expressed in the initial stages, is rare. In most cases, the disease affects children and the elderly. Consider the causes of the disease, types, degrees of development, signs, as well as how to diagnose and treat.
What is vesicoureteral reflux of the kidney?
Normally, the pressure in the bladder when it is full should cause the canal to close. Thus, urine exits through the urethra. Reflux, which in Greek means "reverse movement", is a violation of the process of outflow of urine, during which it returns back to the bladder. Such a pathology is possible with a non-working, underdeveloped or weak valve.
Each time the bladder fills, part of the urine returns to it, and over time, a change in the capacity of the organ is observed. At the same time, urine reflux can occur both while going to the toilet in a small way, and as it fills up. Bladder. Reflux of urine into the kidneys in the early stages of the disease does not manifest itself. It can only be detected with a pelvic exam.
Types of pathology
Urologists divide such a pathology as vesicoureteral reflux of the kidney into an active form and a passive one. In the active form of the disease, the return of urine into the ureter occurs only in the process of urination. At this time, the muscles of the bladder come into tone, and simultaneously with the release of urine outward, there is an outflow of urine into the ureters, and then into the kidneys. During this, a person may feel pain in the lower back and discomfort when going to the toilet. This pathology is most often caused by valve insufficiency.
In the passive form of reflux, urine is thrown back as the organ fills with urine. In this case, valve insufficiency is more pronounced, and urine returns constantly. The volume in this case depends on the degree of violation, the condition of the valve and the ability of the urea to contract.
Also, doctors classify pathology by:
- etiological factor - it can be congenital or acquired;
- by nature - one-sided or two-sided;
- according to the course of the disease - constant or intermittent.
It is noted that even a slight disruption in the functioning of the valve or the anatomical structure of the bladder can lead to reflux and significantly affect the normal functioning of the organs.
Degrees of disease
There is a generally accepted classification,according to which urologists determine the degree of pathology. It is on this that the future choice of treatment for kidney reflux depends.
Urine reflux levels according to classification:
- First degree. Due to insufficiency of the valve, a small backflow of urine occurs. At the same time, the structure and volume of the bladder does not change. At this stage, there are no pronounced symptoms, and complications, both infectious and non-infectious, are minimal.
- Second degree. Urine outflow is observed in the entire ureter, but without dilatation, that is, urine does not reach the kidney area. At this stage, the pathology can progress, although obvious signs are also not observed. It can be detected during a routine or preventive examination of the pelvic organs.
- Third degree. Urine reaches the kidney area and reduces their functionality by 20%. The ureter at the same time increases in size and there is a modification of its structure and tissues. Signs are of moderate severity and the risk of infection is increased.
- Fourth degree. The ureter significantly increases in volume. Kidney function is reduced by 50%. A person feels significant discomfort, body temperature rises and swelling appears. If the process is two-way, it can pose a threat to the life of the patient.
- Fifth degree. Symptoms are pronounced. The ureter not only increases in size, but also bends. There is itching on the skin, diuresis, nausea and vomiting. Medical care is indispensable here.
Causes of occurrence
Depending on how and when kidney reflux develops, it can be primary or secondary. In the first case, it is caused by congenital anomalies, that is, the incorrect formation of organs occurs even during the intrauterine development of the baby. Backflow of urine may be due to a duplication of the ureter, gaping or dystory of the mouth, as well as a short submucosal tunnel in a certain part of the ureter.
The secondary form does not occur on its own, but against the background of other pathologies of the urinary system.
Among the reasons for the development of secondary reflux are:
- stenosis of the ureteral neck;
- urethral canal structure;
- prostate adenoma;
- inflammation of the bladder (cystitis);
- damage to the shape or structure of the ureter during surgery.
Symptomatics
Kidney reflux symptoms are latent for a long time. In the initial stages, the patient may experience minor and periodic aching pain in the lumbar region. They often appear after urination. Children who are not yet able to describe the nature of the pain may complain of pain in the lower abdomen, as well as in the groin.
The manifestation of the disease depends directly on the degree of pathology. If at the first stage urine returns in small quantities, then this process will not be symptomatic in any way. Starting from the third degree, there is an expansion and modification of the structure of the ureter. Often the patient has all the symptomspyelonephritis, namely: the temperature rises, he alth worsens, urine becomes dark and cloudy and pains appear in the lower abdomen.
In most cases, reflux can be detected already at the stage of complications. It can manifest itself in the form of frequent cystitis, chronic pyelonephritis and enuresis.
Possible Complications
Regardless of the reasons that led to the reflux of urine into the ureter and kidneys, reflux is fraught with the development of all sorts of complications. The high risk lies in the fact that in the initial stages the pathology does not manifest itself.
Complications that occur most often with reflux:
- pyelonephritis;
- hydronephrosis;
- chronic kidney failure;
- renal hypertension.
Despite the fact that such pathologies, both in terms of symptoms and the course of diseases, are different, they can be provoked by one common factor - improper outflow of urine. Also, a stagnant urethra in the ureter is an excellent environment for the development and reproduction of infections.
Diagnosis
If reflux occurs when urine is thrown into the kidneys, it means that the pathology has already passed into the third stage and has begun to manifest itself with certain symptoms. The first and second degree of the disease can be noticed only by chance at a preventive examination in the presence of other complaints or pathologies in the patient.
In order to accurately diagnose and determine the degree of development of the disease, a number of diagnostic procedures are carried out:
- going topatient history - the doctor should find out if there have been cases of pathologies associated with the urinary system in the patient in the past;
- visual examination and measurement of pressure, which excludes or confirms renal hypertension;
- laboratory tests - urinalysis (elevated ESR and white blood cells indicate inflammation in the body), blood chemistry helps evaluate kidney function;
- excretory urography - an x-ray with contrast shows which channel the urethra passes from accumulation to exit (are there any anomalies and bends in the structure of the organ);
- Ultrasound - done on a full bladder and immediately after urination, this allows you to assess how much the urea is filled and how it is then emptied, as well as to identify the structure of tissues and possible anomalies in the development of the organs of the urinary system;
- voicing cystography - diagnoses whether there is a backflow of urine into the ureter and what degree it is, is carried out using a contrast agent, which subsequently appears on the pictures.
Treatment
A specialist will tell you about the symptoms and treatment of kidney reflux. Therapy primarily depends on what caused the pathology, on the age of the patient and the severity of the disease. In the initial stages, conservative treatment is carried out. This period is characterized by inflammation of the lower ureter and does not affect the kidney area, so you can limit yourself to drug therapy.
When contacting a urologist for help in the first three stages of developmentthe percentage of complete recovery of the patient is up to 70%.
Conservative therapy is as follows:
- Diet. It is important in case of pathology to reduce s alt intake to a minimum, give up smoked meats, fatty foods, switch to vegetables, fruits and grains. Taboo on alcohol, soda and strong coffee.
- Drugs. These can be antibiotics, anti-inflammatory drugs, antispasmodics, depending on the degree of spread of the inflammatory process and infection. If the pressure is high, drugs are prescribed to reduce it.
- Physiotherapy. Therapeutic baths, magnetotherapy, electrophoresis reduce the inflammatory process, remove spasms and restore the physiological current of the urethra.
Surgery for Kidney Reflux in Adults
As a rule, conservative therapy is carried out for six months. If there is no improvement during this time, moreover, complications arise in the form of recurrent pyelonephritis and a decrease in kidney function, surgery is indicated.
At the initial stages of the development of pathology, with the 1st and 2nd degree of reflux, endoscopic correction is performed. With the help of injections, volume-forming implants are introduced into the region of the orifice of the ureter. They perform a strengthening function. The implants are based on collagen, teflon or silicone. These materials are hypoallergenic, durable, and have good compatibility with human organs.
For kidney reflux, surgery is also performed ifpathology progressed to a high degree of severity. Laparoscopic laureterocystoneostomy is indicated for carrying out at the 3rd or 5th degree of pathology. At this stage of the development of the disease, the walls of the ureter have already changed significantly, therefore, the removal of pathological areas is promptly carried out, as well as the creation of an artificial connection of the ureter with the ureter. This operation can be performed with resection of part of the ureter or with a kidney transplant.
Forecast and prevention
With kidney reflux, it is important to diagnose in a timely manner. Only in this case, the pathology can be stopped or cured by conservative therapy. If complications or illness are accompanied by pathological changes in the kidneys, then surgery cannot be avoided.
There are no special preventive measures other than preventive diagnostics. It is worth protecting the back and pelvic organs from injuries, hypothermia, treating any inflammatory processes of the urinary system in a timely manner and reducing s alt intake.
Conclusion
Kidney reflux, depending on the type (congenital or acquired), as well as the degree, is a curable disease. Often, the pathology can be eliminated by conservative methods, but if the disease is neglected, surgical intervention is indicated. It is important to be diagnosed in a timely manner, since the disease develops for a long time and does not manifest itself in any way. In the initial stage, it can be found by chance during a pelvic examination.
