The renal pelvis is dilated in the newborn. Kidney pyelonectasia in the child

In modern pediatrics, quite often there are various pathologies of the excretory system. And sometimes during a preventive check, doctors note that the kidney is dilated in the newborn. Naturally, such a diagnosis makes parents panic and seek more information about this pathology. So how dangerous is it? Is it possible to notice the symptoms of pyelonectasia alone? What treatment is needed for the baby? What are the complications of the disease? Answers to these questions will be useful to many parents.

The renal pelvis: what is it? A short excursion into the anatomy

It is not a secret for anyone that the kidneys are an important excretory organ. And in order to understand what pyeloectasia is, you need to briefly familiarize yourself with the anatomical features of the human body.

Kidneys are paired organs located behind the parietal leaf of the peritoneum in the lumbar region. Each kidney is covered with a dense fibrous capsule directly below the parenchyma, consisting of a cortical and cerebral substance - this is the internal part of the organ, in the thickness of which is the system of accumulation and excretion of urine.

The smallest elements of the system are the kidney cups, which merge together, form larger cups. In turn, from the complex of cups the so-called renal pelvis is formed. What it is? This is the structure in which urine is collected and fed into the ureter. The right and left ureters carry it directly into the bladder.

When it can be said that the renal pelvis is enlarged? Norm and pathology

Naturally, in order to determine whether the child has a pathology, it is necessary to compare the parameters with the acceptable values. So what sizes should the pelvis have in the norm? Here a lot depends on the child's age:

• For fetus before 32 weeks of pregnancy the norm is 4-5 mm;
• In the fetus of 32-36 weeks, these indices should be equal to 7-8 mm;
• The size of the newborn baby's pelvis should not exceed 7 mm.

So what is pyeloectasia? This is a pathology that is characterized by an enlargement of the renal pelvis. It should be noted immediately that this is not an independent disease - it appears as a result of already existing abnormalities of the urinary system. By the way, this pathology can manifest itself both before and after the birth of the baby.

Classification of pathology

You can classify the disease in several ways. For example, pyeloectasia in a child can be right-sided, left-sided and bilateral. In addition, the causes and the moment of enlargement of the pelvis are taken into account, dividing the ailment into:

• Congenital organic expansion (is the result of abnormal intrauterine development of the urinary system);
• Congenital dynamic expansion - is associated with impaired urine outflow, as a rule, is diagnosed in newborns;
• Acquired kidney pyeloectasia in a child - develops after birth as a result of trauma to the organs of urination or inflammatory process in the excretory system;
• The acquired dynamic expansion - is recorded with urolithiasis or the presence of tumors.

The main causes of the development of pathology

If during the examination it was found that the kidney pelvis is dilated in the newborn, it is important to determine the cause. As a rule, the change in size is associated with a violation of the outflow of urine - the liquid accumulates in the calyxal-pulmonary system of the kidney, causing its expansion. In turn, the violation of outflow of fluid can be associated with different pathologies.

The reasons include narrowing of the ureter or its inflection. Sometimes, for one reason or another, the valve apparatus of the tuberculosis-ureteral junction is not formed correctly, as a result of which urine begins to accumulate in the kidney. Pyeloectasia in a child can be associated with muscle weakness - this is observed among premature infants.

Sometimes the ureters are squeezed by vessels or other nearby organs, especially if there are various abnormalities of fetal development. The risk factors include the presence of tumors (including benign), as well as urolithiasis, because organic or mineral formations can clog the ureteral lumen, disrupting the normal outflow of fluid.

It is proved that there is a certain genetic predisposition. The risk factors include severe pregnancy (presence of preeclampsia, eclampsia), as well as acute inflammatory lesions of the mother's kidneys during the fetation of the fetus.

What symptoms are accompanied by the disease?

Pyeloectasia in a child, as a rule, proceeds without any symptoms. Sometimes it is possible to note some nonspecific signs - the baby often cries, from time to time loses its appetite, becomes restless.

Older children sometimes complain of discomfort in the lower abdomen and in the lower back. Painful syndrome and difficulty urinating are also possible, but they are usually associated with complications of pyeloectasia, including the formation of kidney stones or the development of inflammatory diseases.

What is dangerous pyeloectasia? Possible consequences

In most cases, kidney pyelonectasia in the child is benign. Nevertheless, there is a possibility of complications, therefore it is worth to familiarize with their list:

• Because of the increased pressure in the bladder, a rapid increase in ureters (megoureter) is possible with subsequent stenosis.
• In boys, the valves of the posterior part of the urethra are sometimes affected.
• Complications include vesicoureteral reflux, in which reverse urine flow to the renal structures is observed.
• Bloating of ureters (urethrocele), the result of which is a violation of normal urination.
• If the pelvis is enlarged, this creates conditions for the development of kidney stone disease in the child.
• Hydronephrosis is a pathology in which there is a sharp widening of the pelvis, while the ureter retains its normal dimensions.
• The ureter may enter the urethra or vagina (ectopia).
• Violation of the normal outflow of urine can lead to the development of pyelonephritis and sclerosis of the kidney tissue.

Methods of pathology diagnosis

How do you know that the kidney is dilated in a newborn? This can be done with ultrasound examination of the kidneys and abdominal cavity. By the way, according to statistics, the right kidney is more often affected than the left kidney. There is one more regularity: because of physiological features, boys are more likely to have pyeloectasia. On the other hand, they usually diagnose an easy degree of pathology, which quickly passes by itself.

Additionally, X-ray examinations are carried out, including cysto- and urography. Normally, the size of the pelvis after urination should not change - this is another sign of the pathology that can be detected during the tests.

This violation can be noticed even before the birth of the child. Starting from the 17th week of pregnancy during an ultrasound examination, an experienced doctor may notice changes in the size of the renal pelvis.

Are there effective methods of treatment?

Intrauterine treatment of the fetus is not carried out. Quite often as the growth and intrauterine development develops, the problem disappears by itself even before delivery. If the renal pelvis is dilated in a newborn, the doctor can make an effective treatment plan after the research.

Naturally, it is impossible to reduce the size of pelvis with medication. Therefore, drug therapy is reduced to taking medications that facilitate the outflow of urine. Treatment depends on the presence of complications. When inflammation is prescribed, anti-inflammatory drugs, with urolithiasis - means that can dissolve small mineral formations and accelerate their excretion.

Every three months you need to undergo ultrasound diagnosis. So the doctor has the ability to monitor the dynamics of the disease. According to statistics, in most cases, pyeloectasia passes by itself, the size of the pelvis comes back to normal as the child grows.

In the most severe cases, surgical intervention is required. The operation is indicated in those cases, if the pathology continues to progress, in connection with which the functioning of the kidneys is disturbed. Indication is also the presence of complications, including vesicoureteral reflux, ectopia, urolithiasis. As a rule, endoscopic surgical methods are used, which allow to avoid cavitary surgery and a long period of rehabilitation.

Prevention of complications

Unfortunately, there are no specific preventive measures. Naturally, a pregnant mother is advised to carefully monitor the health status, immediately undergo treatment for certain inflammatory diseases and not forget about planned ultrasound studies of the fetus. If pathology is diagnosed during intrauterine development, the doctor will carefully monitor the condition of the newborn, which will help to avoid the development of complications.

These same rules must be followed and after the birth of the baby - every 3-6 months it is necessary to do ultrasound of the genitourinary system.