What are the anomalies?
- Abnormalities of quantity: aplasia (absence of one kidney), additional third kidney
- Positional anomalies - dystopia: the kidney is located in the lumbar, iliac or pelvic region and has not risen to its place
- Anomalies of relationship: horseshoe kidney (fusion by the lower poles), S- and L-shaped fusions
- Anomalies in size: hypoplasia - a reduced but normally structured kidney
- Structural abnormalities: multicystic dysplasia, spongy kidney, cysts
- Anomalies of the pelvis and ureter: duplication, ureterocele, megaureter, narrowing of the ureteropelvic segment
- Vascular abnormalities: accessory artery compressing the ureter
Horseshoe kidney
With this anomaly, both kidneys are fused at the lower poles by an isthmus, forming a horseshoe shape. The kidney is located lower than usual, and the isthmus lies in front of the spine and large vessels.
The fusion itself is not a disease, and many people live with it their entire lives without knowing it. But the anatomy creates the preconditions for problems: the ureters bend over the isthmus, the outflow of urine becomes difficult, which is why stones are more likely to form and pyelonephritis develops.
- Dull pain in the lower back and lower abdomen, increasing with straightening of the torso
- Recurrent urinary tract infections
- Stone formation
- Hydronephrosis with significant obstruction of outflow
- Higher risk of injury due to unprotected isthmus position
Duplication of the kidney and ureter
One of the most common anomalies: the kidney is divided into two parts, each with its own pelvis. Duplication is incomplete when the ureters merge on the way to the bladder, and complete when each flows into the bladder separately.
Incomplete doubling is most often harmless. Complete one is much more often accompanied by problems, since the orifices of the ureters are located incorrectly.
- Vesicoureteral reflux into the lower segment ureter
- Ureterocele and upper segment ureteral obstruction
- Ectopic ureteral orifice is a confluence outside the bladder; in girls it is manifested by constant leakage of urine during normal urination
- Recurrent pyelonephritis
- Hydronephrosis of one of the segments
Dystopia and single kidney
- Dystopia - the kidney did not rise to the lumbar region during development and remained lower: in the iliac or pelvic region. The ureter is short, the vessels run atypically
- A pelvic kidney may be palpated as a mass in the abdomen and mistaken for a tumor.
- A dystopic kidney is more often susceptible to impaired urine outflow and injury.
- Aplasia is the congenital absence of one kidney; the second usually increases and takes over the entire function
- People with a single kidney in most cases live a full life, but need careful treatment of it
With a solitary kidney, the following are fundamentally important: control of blood pressure, avoidance of nephrotoxic painkillers without prescription, sufficient fluid intake, timely treatment of urinary tract infections and caution in contact sports.
Diagnostics
- Kidney ultrasound is the primary method of detection
- CT urography with contrast - exact anatomy, vessels, condition of the ureters
- MRI urography, especially in children and with contrast intolerance
- Excretory urography
- Dynamic nephroscintigraphy - separate assessment of function and urine outflow, a key study when deciding on surgery
- Victory cystourethrography for suspected reflux
- General analysis and urine culture
- Creatinine and GFR calculation
- Blood pressure control
Treatment
The anomaly itself cannot be treated and does not need correction. Only its consequences are treated.
- Observation with periodic ultrasound and tests - if asymptomatic
- Prevention and treatment of urinary tract infections
- Treatment of urolithiasis taking into account anatomy: access and crushing method are selected individually
- Pyeloplasty for obstruction of the ureteropelvic segment
- Ureterocystoneostomy for reflux and ureteral obstruction
- Dissection of ureterocele
- Heminephroureterectomy - removal of a non-functioning segment during kidney duplication
- Heminephrectomy for horseshoe kidney - removal of the affected half
- Stenting or nephrostomy for acute outflow obstruction
What is important for a patient with a kidney anomaly to know?
- Report your peculiarities to any doctor before operations and examinations - this affects tactics and interpretation of images
- Regularly undergo ultrasound and urine tests, even if you feel well
- Control blood pressure
- Do not take non-steroidal anti-inflammatory drugs for a long time unless prescribed
- Drink enough fluids
- If you have a solitary or horseshoe kidney, avoid contact sports and abdominal injuries
- Examine children if the anomaly is hereditary
- When planning a pregnancy, see a urologist in advance
Where to get examined in Tashkent
For a correct assessment, CT or MRI urography and separate assessment of renal function are needed, and in case of complications, reconstructive urology.
In Tashkent, such examination and surgical treatment of complications of kidney abnormalities are carried out at the UROLOGIC COMPLEX medical center and at the Tashkent Medical Park clinic.
If an anomaly is found by chance and nothing bothers you, there is no need to panic - but it’s worth going through a full examination once to understand whether you need regular monitoring. Clinic contacts are below.
