of Children with nefrourologichesky pathology are approximately every sixth child who came to reception to the local pediatrician very much.of
Is normal the person has pair of kidneys which are located at a back wall of an abdominal cavity (zabryushinno) on both sides from a backbone at the level of lumbar vertebras. They are very small - the weight of everyone - only 0,5% of the gross weight of a body. But their correct functioning, the general health is very important for an organism.
of the Kidney are deleted from an organism by the final products of a metabolism which are formed as a result of a metabolism: the excess water, carbonic acid, salts, ammonia some not completely oxidized disintegration products (urea). Activity of kidneys promote preservation of constancy of osmotic pressure of cages, stability kislotno - the main balance of all organism. Besides, kidneys remove the harmful and toxic agents coming from intestines to a vorotny vein (the indole, phenol, rolled, arsenous, mercury connections, etc.) which are neutralized by a liver. Kidneys are the bodies not only deleting unnecessary and harmful substances from an organism, but also participating in formation of some substances (inkretorny function), such as D3 vitamin, biologically active agents participating in regulation of arterial pressure (a renin - angiotensin), the volume of the circulating blood (eritropoetin) etc.
Blood gets into kidneys through renal arteries, and flows from them on renal veins which fall into the lower hollow vein. The urine which is formed in kidneys due to processes of a filtration and reabsorption flows on two mochetochnik in a bladder where collects until an urination.
the Main structural and functional unit of kidneys is nefron (a ball, Shumlyansky`s capsule - Boumena, the descending tubule, Genle`s loop, the ascending tubule, a collective tubule) with its blood vessels. At the person on average one kidney contains about one million nefron, everyone long about 3 cm thanks to what the huge surface for a metabolism is created.in recent years parents and doctors are concerned about
- the number of children with congenital and hereditary diseases of the kidneys which are quite often complicated by stratification infectious - inflammatory processes in the bodies of uric system (BUS) and being the most frequent reason of development of such serious complication as the chronic renal failure (CRF) at children`s age increased.
the Secretory system begins to develop about 3 weeks of pregnancy. Kidneys begin to function approximately from ninth week of pre-natal life of the kid. Nefrona - structural units of kidneys develop about 20 - 22 weeks. They, as well as all bodies of urinogenital system, are very sensitive to any damaging (teratogenny) factors. Concerning development of congenital diseases of kidneys the first 2 - 3 months of pregnancy and what was a teratogenny influence earlier are considered the most dangerous, especially malformations, perhaps, incompatible with life will be rough. If the harmful factor acts on 3 - 4 week of pregnancy, at a fruit not development of kidneys (a kidney ageneziya) is possible if influence happened on 14 - 15 week of pre-natal development, it is possible to expect violation of a structure, form and quantity of elements chashechno - lokhanochny system of kidneys, but at the same time in general, the urinogenital system will be created.
Congenital diseases of uric system are called by such diseases which exist since the birth of the child and are result of violation of developments of a germ. Besides, this group of diseases includes also congenital violations of membrane transport of various substances in kidney tubules. Distinguish congenital a nephropathy (a disease of the kidney) and an uropatiya (damage of urinary tract).
On the origin congenital diseases of kidneys can have the acquired nature (the malformations resulting from influence of harmful factors directly on the developing embryo without damage of hereditary structures). Violations of development of a fruit are provoked by an unhealthy ecological situation: radiation, excessive gas contamination etc. Unfortunately, still not all future mothers realize pernicious consequences of smoking, alcoholism and drug addiction for health of the kid. The hormonal disorders and various infectious diseases of bodies of a small pelvis transferred the woman on different terms of pregnancy exert impact on emergence of anomalies in development of urinogenital bodies. Doctors note high risk of emergence of violations in development of a fruit in future mothers who had the catarrhal diseases on early terms of pregnancy which are followed by high temperature (38 ° With above). The pregnant woman needs to remember that to apply medicines without consultation of the doctor who is not convinced of safety of medicine for future kid, inadmissibly.
the Second big group of congenital diseases of kidneys has in the basis hereditary pathology (as a result of mutations of genes or chromosomes).
we Will consider anatomic anomalies of bodies of uric system of the acquired character.to
by Experts - nephrologists offered the following classification of congenital nefropatiya and uropatiya with anatomic anomalies of bodies of uric system (according to M. S. Ignatova and A. V. Papayan).
- anatomic anomalies of kidneys:
- quantitative (an ageneziya - absence of body, an aplaziya - an underdevelopment of body and its functions, additional kidneys);
- position (an allotopia - the wrong position of body in space, nefroptoz - omission of kidneys, rotation - turn of body in space);
- of anomaly of a form (horseshoe, S - L - figurative kidneys);
- of anomaly of mochetochnik:
- of anomaly of quantity (ageneziya, doubling);
- of anomaly of situation (an ektopiya - anomaly of development at which the mouth of a mochetochnik is located not in a bladder, and, in an urethra / in a vagina / on a crotch skin surface, a retrokavalny mochetochnik
- an arrangement of a site of a mochetochnik behind the lower hollow vein);
- of anomaly of a structure and a form (a gidroureter - a liquid congestion in an expanded mochetochnik owing to existence of the obstacles complicating urine outflow, a diverticulum
- congenital bladder walls in the form of a bag, a dilyatation
- abnormal expansion of a gleam of body);
- of anomaly of quantity (ageneziya, doubling);
- of anomaly of situation (an ekstrofiya - lack of the lower part of a forward belly wall and a body of a bladder, and defect of a belly wall it is replaced with a back wall of a bladder (area of a mochepuzyrny triangle) with the openings of mochetochnik gaping on it);
- of anomaly of a structure and a form (a diverticulum, a megacisyew - the bladder which is excessively increased in volume; the urakhusa (an umbilical sine) of
- of a pre-natal uric channel in a navel is usually combined with a hypertrophy of its walls, persistiruyushchiya urakhus
- of anomaly of quantity (ageneziya, doubling);
- of anomaly of situation (the urethra valve, a gipospadiya - lack of final part of a male urethra with localization of its external opening in the unusual place, an epispadiya
- a full or partial nezarashcheniye of a forward wall of an urethra);
- of anomaly of arteries;
- of anomaly of veins;
- arteriovenozny fistulas;
- of anomaly of lymphatic vessels;
- of anomaly of development of a penis;
- of anomaly of development of testicles;
anomalies of development of kidneys early.Ekhografiya`s (ultrasonography)
allows to diagnose congenital malformations of kidneys from the middle of the II trimester of pregnancy. Pre-natal diagnostics is possible, since 20th week of pregnancy and earlier. Experts of ultrasonography also pay attention to a condition of amniotic waters since it is not enough - and abundance of water can be diagnostic symptoms of any disease, including and kidneys. I pay your attention that at detection of any pathology at a fruit, future mother cannot remain in private with this problem, to worry and save in myself sense of guilt, it is necessary to obratsya to the family psychologist. It is necessary to add that in some cases, the diagnoses made vnutriutrobno are not confirmed.
At the birth of children with congenital diseases of kidneys for statement of the diagnosis use also excretory urography and a nefrostsintiografiya - the research methods allowing to define anatomotopografichesky features of kidneys at introduction of contrast substance and an angiography of kidneys - the method allowing to reveal existence and the characteristic of a blood-groove of a kidney.by
Also investigate kidney functions (biochemical blood tests, urine, the analysis of urine across Zimnitsky etc.)
At anomalies of number of kidneys, except for an ageneziya (not development of body) which outcome adverse, carry out symptomatic treatment, selection of a diet and active therapy of possible inflammatory diseases as at anomalies of kidneys conditions for obstructive violations, refluxes (the return throwing of urine from a bladder in a kidney), infection of uric ways are often created. Such form of anomaly quite often is complicated by renal arterial hypertension in connection with which appoint lifelong hypotensive therapy. At heavy violation of functions of body transplantation of a kidney is possible.
of Anomaly of position of kidneys (position) meet more often. Such children are put on the dispensary account, by it appoint courses of massage and carrying bandages (according to indications) and carry out prevention of such complications as gidronefroz and an urolithic illness (MKB), and at emergence of a resistant pain syndrome apply expeditious treatment.
of Anomaly of a form (union) meets in 15 - 20% of all honourable anomalies. Allocate symmetric (horseshoe) and asymmetrical (S - and L - figurative unions). Treatment conservative and supervision. Surgeries carry out at the expressed gidronefroz (obstruction lokhanochno - an urethral segment), the expressed pain syndrome, at development of MKB, tumors.chashechno - lokhanochny system function of kidneys is not broken by
At anomalies. These anomalies do not demand special treatment, except for cases when they is complicated by any pathological process, usually nefrolitiazy (MKB).
of Anomaly of development of mochetochnik - a basic element of anomaly of the kidney. Treatment only quick.
of Anomaly of development of a bladder meet at boys more often. Ageneziya (not development) of a bladder a disease extremely rare, often combining with other defects of uric system. Children with such pathology are impractical.
the Most important direction of modern children`s urology - correction of congenital anomalies of urinogenital system, first of all, congenital defects of development of an urethra and bladder. And if couple of decades ago these defects demanded long-term multi-stage treatment, then today even more often urologists seek to operate such children for one stage. From such anomalies of urinogenital system, first of all, It should be noted such congenital diseases as a gipospadiya (an underdevelopment of final department of an urethra and an epispadiya (partial or full splitting of a forward wall of an urethra) as being of great importance for full development of the child. Treatment of this pathology demands carrying out various plastic surgeries. At these operations of fabric for replacement undertake at the least patient.
I Want to stop on one of the most frequent complications of congenital anomalies of uric ways (in lokhanochno - a mochetochnikovy segment) - on a gidronefroza as its frequency 3 makes a case on 1000 newborns. Gidronefroz - the accruing expansion of kidney cups and lokhanka with an atrophy of a kidney parenchyma (a kidney cover) caused by chronic violation of outflow of urine from a kidney. To development of a gidronefroz gives any process (both in uric system, and out of it - stones, tumors, etc.) causing an obstacle in a way of outflow of urine. The atrophy (the reduction of weight and volume of kidneys which is followed by the easing / termination of their function) of a kidney parenchyma and muscle fibers of a wall of uric ways is caused by the increasing vnutrilokhanochny pressure and function of a kidney decreases. However in our country the system of diagnostics screening - method - ultrasonography (sensitivity of a method 65 - 98%), including and vnutriutrobno is well adjusted. Dynamic supervision over children at whom till the birth the diagnosis gidronefroz since at 10% of these kids in the first days of life this diagnosis is not confirmed was made is necessary. If the disease develops at more advanced age, then one of its symptoms - existence of opukholevidny education in a stomach of the kid revealed usually by parents when bathing the child. Early revealed gidronefroz defines success of expeditious treatment and safety of function of a kidney. The set of researches is over the last 5 years conducted, and extensive positive experience on carrying out operations on plasticity of mochetochnik at children is saved up, optimum methods of postoperative drainage of urinary tract etc. are found that leads to good results of treatment.
congenital anomaly, Not less important on the importance, - anomaly of a bladder. At the same time special the attention is deserved by a bladder ekstrofiya. In this case lack of a forward wall of a bladder, as well as the corresponding part of a wall of a stomach takes place. Treatment of such anomaly also consists in carrying out plastic corrective surgeries which congenital eliminate defect.
Congenital malformations of an urinary system meet in 6% of pathoanatomical researches of children aged till 1 year.Mediko`s
- the genetic consultation, prenatal diagnostics, preventive methods directed to improvement of health of the most future mother allow to warn in 50 - 70% of cases the birth of children with serious congenital and hereditary illnesses, and at some forms - to carry out successful preventive treatment, and then in your house the long-awaited healthy child will appear!
Attentive parents can suspect wrong. There are several symptoms to which it is necessary to pay attention early to reveal a disease of kidneys or uric ways and to prevent development of serious complications:
- you Watch quantity of urinations and volume of the emitted urine. The newborn child during the first 1 - 3 days of life urinates 3 - 5 times a day - it is a physiologic transition state of an urinary system. From 4 days to 6 months the frequency of urinations reaches 20 - 25 times a day, after 6 months and till 1 year - 10 - 14 times. By 5 years the quantity of urinations is reduced twice. The frequent urination and desires to it (without the urination) is an occasion to see urgently a doctor. If the child is not enough and seldom urinates or does not urinate absolutely (urine volume in the first 3 days of life - about 50 - 100 ml, till 6 months - on average 180 - 190 ml, 6 months - to 2 - x years - 230 - 300 ml, 3 - 4 years - about 400 - 500, with 5 to 7 - 500 - 700 ml, are more senior 7 - 800 - 1000 ml), it has a nikturiya (prevalence of amount of the urine emitted at night over day volume; is normal day sostavlyat 2/3 all amounts of urine per day), a poliuriya (increase in volume of daily amount of urine more than twice), day or bed wetting (it concerns to children 3 - 4 years are more senior) - address experts!
- Pay attention to color of urine and its transparency. So far the small child - it is easy. Normal color of urine light-yellow, in the morning urine the most saturated. Muddy urine, blood impurity in urine etc. can be symptoms of serious diseases.
- Survey of genitalia has important value. At newborn boys it is necessary to pay attention to the urethra location. If suddenly the kid had a reddening and a swelling of a scrotum from one or both parties, during swaddling or at a prikasaniye to a scrotum the child cries, becomes uneasy, do not hesitate and do not self-medicate, and urgently address the pediatrician or the children`s urologist. At girls it is necessary to pay attention to external vulvar lips. There should not be their hypostasis, reddening etc., there have to be no allocations (physiological allocations from a genital tract - light, mucous are noted at girls in the period of a neonatality, at chest age, they are caused by existence in an organism of the girl of placentary and maternal hormones, further allocations will appear only at pubertatny age). With adult children the situation is more difficult, but the child who grows in a situation of trust and care, will surely complain if something is not so.
- Pay attention to an unexpected increase in weight at your kid or on the expressed and long remaining “traces“ from an elastic band of shorts or socks - it can be hypostases.
- Pay attention to complaints of the child. Waist pains, in a side, over a pubis, at the act of an urination, and at small children also belly-ache, especially intensive and repeating, have to cause serious concern in parents.
- If the child becomes sluggish, pale, refuses food, it lifts temperature to high rates (38 - 40 ° C), and at the same time, visible displays of cold are not observed, and febrifugal preparations give only short-term effect - make the general test of urine of your kid.