What is incomplete kidney duplication? Complete and incomplete duplication of the kidney: causes, signs, treatment Incomplete duplication of the kidney, structure, anatomy in women

March 17, 2017 Doctor

Double kidney is the most common type of urinary tract anomaly. Such an anomaly is not a pathology; as a rule, its presence does not cause a person any particular inconvenience, but the doubling of an organ is dangerous with the risk of developing other more serious diseases.

According to external characteristics, the pathology represents two internal organs fused together. In this case, the duplication of the vascular and parenchymal parts does not always occur; most often, its lower part is functional. Duplication can be unilateral or bilateral, complete or incomplete - all this is a conditional division, which is associated with the presence of its own vessels, as well as the ureter in the daughter kidney.

With complete doubling of the internal organ, each of the daughter kidneys is equipped with its own pyelocaliceal system, as well as a ureter, which opens the way to the bladder. When incomplete, the ureters merge into one, which opens a “passage” to the bladder. It often happens that the daughter ureter does not merge with the main one, but it opens in the intestine or vagina. If the latter anomaly occurs, then the person will be found to have urine leakage.

Most often, the anomaly develops in the prenatal period, when the embryo is actively developing inside the mother. Medical statistics indicate that girls are more susceptible to this anomaly, and out of every 150 newborns, one of them is diagnosed with pathology. In most cases, duplication of only one kidney is observed (82%), but bilateral duplication also occurs (12%).

The main reasons may be:

• Genetics;
• Taking potent hormonal drugs by a pregnant woman (especially in the 1st trimester);
• Exposure of a pregnant woman to ionizing radiation;
• Lack of vital vitamin or mineral components in a woman’s body during pregnancy;
• Avitaminosis;
• Poisoning of the body with potent drugs;
• Abuse of alcoholic beverages;
• Smoking during pregnancy.

Incomplete kidney duplication does not pose a particular threat to humans. It even happens that a person lives his whole life with a congenital anomaly and is completely unaware of its presence, and it is discovered only during a medical examination of a completely different disease.

Complete doubling of the kidney is dangerous due to its possible complications, among which we can highlight:

• Pyelonephritis is an inflammatory process of the urinary tract with damage to the pelvis, cups and renal parenchyma;
• Hydronephrosis is a violation of the process of urine outflow, in which urine is retained and accumulates in the renal pelvis;
• Urolithiasis is the process of formation of sand and stones in the organs of the urinary system;
• Tuberculosis;
• Kidney neoplasm;

Types of kidney duplication

As mentioned above, the anomaly can be complete or incomplete.

1. Complete - instead of one internal organ, two are formed, each of which has an underdeveloped pelvis. Each of the pelvis is equipped with its own ureter, which flows into the bladder at a different level.
2. Incomplete doubling of an internal organ - in medical practice, this anomaly is more common than the one described above. The anomaly can appear on both the left and right kidneys, while an enlargement of the internal organ is clearly observed, its upper and lower parts are clearly visible, each of which is equipped with its own artery. During the development of the anomaly, the pyelocaliceal system continues to remain unified.

In addition, the anomaly can appear on either the left or right kidney.

• On the left kidney - it does not pose a serious danger to humans, the anomaly does not have negative symptoms and is often discovered during a random medical examination;
• On the right kidney, the anomaly also does not pose a serious threat to humans; during the process of formation, the internal organ takes on an increased size.

Symptoms

It is important to note that the characteristic signs of the anomaly appear only with complete doubling of the internal organ and appear in the form of:

• Dilatations of the upper urinary tract;
• The occurrence of infections in the urinary canal;
• The appearance of the process of reverse outflow of urine from the ureter;
• Manifestations of pain in the lumbar region from the side where the anomaly occurs;
• Increased body temperature;
• General weakness;
• The appearance of a cloudy shade in the urine;
• Increased blood pressure;
• Painful process of urination;
• Urinary incontinence.

These signs can appear both together and separately. The activity of symptoms directly depends on the form of the disease and the general condition of the human body.

Diagnostics

In order to clinically determine the duplication of the kidneys on both sides, the patient should undergo the following examinations:

• Cystoscopy;
• Ascending urography;
• Radiography;
• Magnetic resonance urography.

Treatment

An anomaly of both kidneys does not pose a serious danger to humans, but it can be accompanied by unpleasant complications, which is why it is necessary to recognize the disease in a timely manner and, if necessary, begin the required treatment.

If the anomaly does not bother a person, then drug therapy is not required. In this case, constant monitoring by a doctor is important. Treatment of internal organ duplication must be carried out if complications occur.

1. When an inflammatory process occurs, a course of taking anti-inflammatory drugs, as well as antibacterial agents, is indicated;
2. For urolithiasis, antispasmodics, painkillers and phototherapy (kidney collection, decoctions of medicinal herbs) are prescribed.

Surgery is indicated in severe stages of hydronephrosis, as well as in the presence of diseases that are not amenable to drug therapy. If possible, surgeons try to preserve the internal organ. A kidney is removed only if it loses its functionality.

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One way or another, when a double kidney is detected, a person must follow the most important basics that will help maintain his health and not provoke possible complications:

• Lead a healthy lifestyle;
• Give up bad habits;
• Monitor the quality of food;
• Be more careful and careful when taking certain medications;
• Do hardening;
• Do light exercise.

To summarize all of the above, it can be determined that kidney duplication is not a pathology; such an abnormal condition does not pose a threat to human health. A common question among young people is whether they are accepted into the army with this diagnosis? In answering this problem, it is necessary to determine that kidney duplication, not complicated by the presence of another pathology, is not an obstacle to enrollment in the ranks of conscripts.

But if the pathology is diagnosed in a woman, then she needs to plan her pregnancy in advance. Throughout the entire pregnancy, she must be observed by a doctor, regularly undergo prescribed examinations - urine and blood tests, ultrasound of the kidneys, urine testing according to Nichiporenko. Pregnancy is strictly contraindicated in women with renal failure and in the presence of clear indications for surgery.

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Duplicate kidneys can be defined as kidneys containing 2 pyelocaliceal systems (PPS) that are associated with a single ureter or with double ureters. Duplication occurs when two separate ureteric buds arise from a single mesonephric duct.

Based on the degree of fusion, it may present as bifidous renal forehead, partial ureteric duplication (Y-shaped ureter), incomplete ureteral duplication with ureters joining near or in the bladder wall (V-shaped ureter), and complete ureteric duplication with separate openings ureter.

Duplication of the kidneys can be unilateral (incomplete duplication of the left kidney, right kidney) or bilateral and can be associated with various congenital anomalies of the genitourinary tract. Most patients are asymptomatic, and genitourinary tract abnormalities are discovered incidentally on imaging studies performed for other reasons. Symptomatic patients usually have complete ureteral duplication, in which the ureters are prone to developing obstruction, reflux, and infection. Ureteral obstruction is more common in the presence of a duplicate kidney and may be inherited in an autosomal dominant pattern.

Doubling of the left kidney is a phenomenon considered the most common variant of anatomy. It has a predominance in women and an estimated prevalence ranging from 0.3% to 6% of the population. Diagnosis is important for surgical planning and long-term follow-up.

Kidney duplication is a congenital pathology, which is characterized by complete or partial duplication of the main organ of the urinary system

When one ureteric bud bifurcates before the ampulla bifurcates, a duplex kidney occurs with a bifida renal pelvis or bifida ureter. If 2 ureteric buds arise from the mesonephric duct, a double kidney appears with complete elongation of the ureter. The Committee on Terminology, Nomenclature, and Classification of the Section of Urology of the American Academy of Pediatrics suggests using the following terms to refer to dual collection systems:

1. Double kidney. A double kidney has one renal parenchyma, which is fused by two pyelocalyceal systems.
2. Upper or lower pole - the poles are one of the components of the double kidney.
3. Duplicate system - the kidney has 2 PCLs and is connected to one ureter or to the bifida ureter (partial duplication) or, in the case of complete duplication, to two ureters (double ureters), which drain separately into the ureter.
4. Bifid system. Two PLS are connected at the ureter-like junction (bifid pelvis) or 2 ureters are joined before draining into the bladder (bifid ureters).
5. Double ureters – two ureters open separately in the renal pelvis and drain separately into the bladder or reproductive tract.
6. Upper and lower pole ureters. The superior and inferior poles of the ureters join the superior and inferior poles of the kidneys, respectively.

The patient's double kidney is almost always more elongated than the second. The kidney may be enlarged with hydronephrosis and may be associated with rotational abnormalities. Excretory urographic findings are almost always diagnosed. Difficulties can arise when a function is bad or missing in one of the parts.

Magnetic resonance (MR) urography can be used as a primary diagnostic modality to evaluate duplex ectopic ureter as well as complications associated with duplicate kidneys. Spatial resolution is the limiting factor. The availability of MRI is limited, the procedure is expensive and requires sedation for claustrophobic patients. However, MR urography is an extremely useful modality in patients who are likely to have an adverse reaction to radiocontrast agents.

If ureteral reflux exists, the presence of an ectopic ureter in the nonfunctioning fragment is best demonstrated using urethral urea.

Antegrade pyelography is useful in patients with hydronephrosis to demonstrate the presence of a second ureter and determine the level of urethral termination.

Contrast-enhanced computed tomography (CT) scans are superior to ultrasound and excretory urography in diagnosing the defective organ. On excretory urography, an obstructed, nonfunctioning upper or lower pole may mimic a renal mass. In CT scanning, a large Bertin column can simulate a double collection system. However, CT scanning is valuable in the evaluation of intravesical ureterocele, either orthotopic or ectopic.

Contrast-enhanced computed tomography (CT) scans are superior to ultrasound and excretory urography in diagnosing the defective organ

Ultrasonography is a non-invasive and extremely useful test, especially in children. The ultrasonographic appearance of a duplex kidney is specific but not sensitive. Ultrasonographic findings provide excellent anatomical information but do not necessarily differentiate a bifid renal pelvis from a biphasic ureter or from 2 complete ureters.

Scintigraphy is useful in assessing relative renal function and in detecting renal scars. Scintigraphy may reveal differential functioning. However, if functioning is noticeably suppressed, imaging is limited.

Plain radiography does not make a significant contribution to diagnosis. Plain radiographs may demonstrate a renal mass, which is a nonspecific finding. However, since a patient's duplicate kidney is almost always a second kidney, a renal mass may appear on plain radiographs. A hydronephrotic upper or lower pole in a dual collection system may also be observed as a renal mass.

Arteriography is an invasive procedure and is no longer used to diagnose dual renal systems. However, it can sometimes be useful when planning nephronomia surgery.

Radionuclide imaging

Twin buds appear as two separate collection systems on one side of the body. Scintigraphy may demonstrate ureteral reflux in a nonfunctional duplex kidney with ureteral elongation.

The presence of duplex renal and duplex ureter suggested by excretory urographic or ultrasonographic imaging findings can be confirmed by scintigraphy. The use of dimethylsuccinic acid (DMSA) scanning to assess parenchymal function in the duplex kidney is of great importance for its management.

Reflux of activity from the bladder may mimic cortical function in a nonfunctioning fragment. When a DMSA scan is to be obtained in a child with possible reflux, it is recommended that catheterization be performed prior to the study and images taken before DMSA appears in the collection system.

Ultrasound examination

A double kidney appears as two central echo complexes with intervening renal parenchyma. Hydronephrosis at one pole indicates incomplete duplication of the kidney. Although hydronephrosis can occur at either pole, it is more common at the superior pole. Sometimes two different collection systems and ureters can be observed on ultrasound images.

The ultrasonographic appearance of a duplex kidney is specific but not sensitive. It is difficult to differentiate the atrophied lower pole part of the double kidney from other kidneys.

Duplication of the left or right kidney is one of the most common congenital anomalies.

It can be complete or incomplete, one-sided or two-sided.

Clinical symptoms of the disease may appear immediately in the newborn or be asymptomatic.

The pathology is polymorphic, both in clinical symptoms and in the anatomical structure of the organs of the urinary system.

All causes of kidney doubling are divided into 2 categories according to etiological factors:

• Congenital;
• Purchased.

For congenital causes the anomaly is genetically determined. A child receives a pathological genome from one or both parents according to the recessive type.

Acquired causes of double kidney– mutations of the genetic apparatus caused by chemical, physical or biological factors.

Chemical causes - the pregnant mother drinking alcohol, smoking, taking drugs, poisoning with certain types of medications.

Physical reasons - exposure to ionizing radiation on the fetus.

Biological factors – viral mutations of the cell genome.

X-rays should not be performed on pregnant women unless absolutely necessary.

X-ray room employees always ask patients whether they are pregnant or planning to conceive. If the answer to this question is positive, women are denied an X-ray examination.

You should not quarrel with the staff, as they protect the baby’s health. Under the influence of ionizing radiation, the likelihood of fetal abnormalities increases.

Other causes of kidney doubling:

1. Lack of vitamins in a pregnant woman while carrying a child;
2. Bacterial and viral infections during pregnancy;
3. A woman taking hormonal drugs.

The acquired form of the disease can be prevented if a woman is careful about her diet and lifestyle.

What is a full doubling?

Complete duplication is accompanied by the formation of two separate buds instead of one. Each of the daughter organs has its own ureter and pyelocaliceal system.

There are situations when one of the kidneys has an underdeveloped pelvis, as well as the flow of the ureter into the bladder is not at a physiological level. Each organ is capable of independently filtering urine.

Incomplete

With incomplete duplication, the ureter of each of the daughter formations does not flow separately into the bladder, but they are united together and open into the cavity of the bladder through a common duct.

Occasionally, a not quite typical configuration occurs, when the ureter of a daughter kidney is not united with another, but separately opens into the intestine or vagina. In such a situation, the child is found to have urine leaking into the stool or urine leaking into the vagina in girls.

In terms of frequency of distribution, incomplete doubling is more common than complete doubling. In this case, the frequency of localization of pathology on the right and left is approximately equal.

Morphological structure of a double bud:

• Preservation of a common capsule for subsidiary formations;
• Each half has its own blood supply;
• The division of the renal arteries is localized either in the region of the renal sinus, or the vessels arise directly from the aorta.

Morphological studies have shown that with incomplete doubling, 2 rudiments of a metanephrogenic blastoma are formed at once, from which organs are formed in the process of division.

In this condition, the renal arteries are separate for each mass, unlike the ureters.

Clinical manifestations

Clinical manifestations of kidney duplication in most cases occur without pronounced symptoms of pathology. Only in the presence of complications do signs of the disease appear.

The danger is a narrowing localized at the confluence of the ureters. In this area, the physiological movement of blood is disrupted, turbulence occurs, which often leads to dilation of the renal artery.

When bacteria join stagnation, an inflammatory process occurs.

Such pathological symptoms are quite rare. Urinary tract infections in children are the most common complication of the disease. It disappears with antibacterial therapy.

Most patients with incomplete or complete duplication of the kidney live with this anomaly without any problems. In this case, the pathology is discovered accidentally during an ultrasound examination.

Signs of doubling of the left or right kidney

Many patients with this anomaly have vesicoureteral reflux (backflow of urine from the ureter into the bladder). Narrowing of the urinary tract in the area of ​​the renal sinus is not its cause. Reflux occurs due to abnormal functionality of the anastomosis (where the ureter opens) of the bladder. Reverse reflux leads to dilation of the urinary tract, so a person feels pain when urinating.

1 Aorta; 2 inferior vena cava; 3 - ureter; 4 - kidney.

With a complete doubling, the risk of urolithiasis increases, since with the disease there is a violation of the removal of urine from the pelvis.

Complications of kidney abnormalities present problems:

1. Hydronephrosis – accumulation of fluid due to urine retention in the pelvis;
2. Inflammation;
3. Backflow of urine with difficulty urinating.

If complications develop, the person experiences lower back pain, fever, swelling of the limbs and weakness.

The abnormal structure of the urinary organs leads to the development of pyelonephritis in 30% of patients.

The disease is characterized by inflammatory damage to the pelvis and calyces, followed by the transition of inflammation to mesenchymal tissue. It is when diagnosing this disease that an ultrasound scan reveals a duplication of the left or right kidney in 10% of urologist’s patients.

Diagnosis of abnormal kidney structure

Diagnosis of renal anomalies is based on clinical and instrumental methods. With the help of ultrasound and X-ray excretory urography, most renal anomalies can be identified.

In surgical hospitals, the above diagnostic methods are supplemented by cystoscopy (probe examination of the bladder wall). Using an optical cable with a camera in the distal area, doctors examine the wall of the organ, studying the structure, number and location of the ureteric orifices.

What is excretory urography

Excretory urography is a qualitative method for diagnosing the urinary capacity of the kidneys.

The method is based on the property of some contrast agents (urografin) to be excreted in the urine.

After intravenous administration of contrast, photographs of the kidney area are taken. A series of radiographs are usually taken (at 7, 15 and 21 minutes).

By comparing images, the rate of urine excretion is determined, as well as the structure of the urinary tract.

With incomplete or complete doubling, additional pelvis and ureters are visible on the urogram.

If only one kidney is affected, it is rational to use ascending (retrograde) pyelography, which is performed by introducing contrast into the urinary tract.

Magnetic resonance imaging is also used to diagnose kidney diseases. MRI is used to carefully examine the renal structure layer by layer. If necessary, three-dimensional modeling of the organ is performed.

Treatment

Kidney duplication without complications does not require treatment. Only in the presence of urolithiasis, pyelonephritis or ureterohydronephrosis is symptomatic therapy performed. It includes the following steps:

1. Normalization of nutrition (exclusion of fatty acids);
2. Use of broad spectrum antibiotics;
3. Antispasmodics;
4. Painkillers;
5. Herbal infusions (kidney tea).

When severe hydronephrosis occurs, surgical treatment is performed. It involves complete removal of the affected kidney.

The intervention is performed only when absolutely necessary, since it is desirable to preserve the functionality of the organ for as long as possible.

When the affected kidney cannot cope with urine filtration, toxins accumulate intensively in the blood serum - in this situation, nephrectomy is resorted to.

Indications for surgical treatment of kidneys with doubling:

1. With functional and anatomical destruction of an organ or its segments;
2. Vesicoureteral reflux;
3. Urethrocele is an enlargement of the urethra with the formation of a cavity.

What types of operations are performed on the kidneys:

• Nephrectomy(heminefrureterectomy) – removal of one or more renal segments;
• Ureterouretero- or pyelopyeloanastomosis– anastomosis for reflux (reverse reflux of urine);
• Antireflux surgery– tunnelization of the ureters (creating a lumen for the movement of urine);
• Excision of ureterocele with sewing of the ureters into the wall of the bladder.

Is it possible to get pregnant if you have the disease?

If the kidney doubles, pregnancy is possible, but you should prepare for it in advance. Before conception, you should take laboratory tests of blood and urine, and do an ultrasound of your kidneys. If the tests do not show significant deviations from the norm, you can plan a child.

In the presence of renal failure, conception is contraindicated, since the body cannot withstand the high load on the kidneys. To save the woman's life, doctors will have to perform an emergency termination of pregnancy.

In most cases, kidney duplication does not lead to serious complications during pregnancy. With the help of conservative measures, doctors are able to control pressure, swelling and other complications that occur in women with a kidney abnormality who are carrying a child.

Let's sum it up

Incomplete or complete doubling of the kidneys in most cases does not pose a health hazard. Pathology is discovered accidentally in most patients. There are cases when renal abnormalities lead to complications such as pyelonephritis, hydronephrosis or vesicoureteral reflux.

Such conditions are treated with conservative or surgical procedures (as determined by the doctor). Pregnancy with double kidneys is contraindicated only in the presence of renal failure. The pathology is characterized by a benign course, so a person can live long and happily with it even without treatment.

Video on the topic

Duplication of the kidney is one of the most common congenital anomalies of the structure of the urinary system, in which the altered kidney has the appearance of a doubled organ. They seem to be connected together, and each of them has its own parenchyma and blood supply through two renal arteries, and the more functionally significant and developed organ in most cases is the lower lobe of the formation.

In this article we will introduce you to the causes, signs, differences, methods of diagnosis and treatment of complete and incomplete kidney duplication. This information will help you get an idea of ​​this malformation of the urinary system, and you will be able to ask your doctor any questions you may have.

When the kidney is bifurcated, the blood supply and parenchyma of the anomaly are always bifurcated, but the ureter and renal pelvis are not always doubled. The accessory ureter that occurs with this malformation can enter the bladder, connecting to the main one, or has an independent “gate” into the bladder cavity. This change in the structure of the urinary tract at the junction of the two ureters is accompanied by a narrowing, which causes difficulty in the outflow of urine and its reverse reflux into the pelvis. Subsequently, such functional disorders contribute to development.

Kidney duplication can be complete or incomplete, unilateral or bilateral. According to statistics, the frequency of such a malformation of the urinary system is 10.4%. This kidney anomaly is detected 2 times more often in girls and is usually unilateral (approximately 82-89% of cases). In itself, it does not pose a threat to health, but its presence often contributes to the development of various kidney diseases.

Most often, this developmental anomaly is provoked by genetic causes and is detected in children at an early age. The defect can have various morphological configurations, and only a detailed diagnosis allows you to choose the right tactics for its treatment.

Incomplete bud duplication

The leading cause of kidney duplication is a genetic defect.

With incomplete duplication of the kidney, each of the ureters of the bifurcated organ does not flow into the bladder separately. They unite and enter the bladder cavity through a common duct. This type of kidney duplication is more common. Both the right and left kidneys may not double completely equally often. In this case, the following morphological structure of the changed organ is observed:

• both daughter formations have a common capsule;
• the pyelocaliceal system does not double, but functions as a single one;
• bifurcation of the renal arteries occurs in the region of the renal sinus or these two arteries arise directly from the aorta;
• each part of the duplicated kidney has its own blood supply.

In some cases, a person with an incompletely bifurcated kidney may not feel the anomaly present all his life, and the pathology is detected by chance during diagnosis for other diseases.

Complete bud duplication

With complete doubling of the bud, two daughter formations are formed. Each of these organs has its own ureter and pyelocaliceal system. One of these kidneys may have an underdeveloped pelvis, and its ureter may not flow into the bladder at a physiological level.

With complete bifurcation of the kidney, each of the resulting organs is capable of filtering urine, but the resulting functional disorders often lead to the development of various diseases of the urinary organs:

• hydronephrosis;

Sometimes complete doubling of the kidney is accompanied by the appearance of an atypical morphological configuration, in which the ureter formed in the daughter kidney does not join together with the main one and does not flow into the bladder, but opens into the intestinal lumen or vagina. In such cases, the baby will leak urine from the rectum or vagina.

Reasons

The main reason for the doubling of the kidney lies in the formation of two foci of induction of differentiation in the metanephrogenic blastoma. This violation occurs during intrauterine development. Most often, such pathological changes occur due to the transmission of a mutated gene from parents or under the influence of teratogenic factors affecting the body of the pregnant woman and the fetus.

The following reasons affecting the body of the expectant mother can contribute to the doubling of the kidney:

• ionizing radiation;
• vitamin deficiency and mineral deficiency during pregnancy;
• taking hormonal drugs during pregnancy;
• viral and bacterial infections suffered during pregnancy;
• poisoning with nephrotoxic drugs or toxic substances;
• active and passive smoking, drinking alcohol during pregnancy.

Symptoms

In most cases, kidney duplication is completely asymptomatic for a long time or is detected by chance during routine examinations or during the diagnosis of other diseases.

Often pathology manifests itself only after its complications occur. One of the most common consequences of kidney duplication in children is urinary tract infection. In addition, narrowing of the ureters at their confluence can lead to circulatory disorders, deterioration of urine outflow and reverse reflux. Subsequently, such changes can provoke the development of hydronephrosis.

With complete doubling of the kidney, the patient may experience the following symptoms:

• signs of infection of the urinary organs (frequent urination, fever, pain and discomfort when urinating, pus in the urine, etc.);
• pain in the lumbar region (from the side of the double kidney);
• positive Pasternatsky symptom;
• expansion of the upper parts of the urinary system;
• reflux of urine from the ureters;
• the appearance of renal colic (with the development of urolithiasis);
• leakage of urine (if the ureter enters the intestines or vagina).

The likelihood of occurrence of certain symptoms from the above-described signs of kidney duplication is variable and depends on the form of the anomaly.

Pregnancy with double kidney

A woman with a double kidney should plan to conceive a child in advance. To do this, she needs to undergo a full diagnostic examination: urine and blood tests, ultrasound and, if necessary, other instrumental studies. After analyzing the data obtained, the doctor will be able to determine the possibility of planning conception. Pregnancy with this pathology is contraindicated if renal failure is detected and there are indications for surgical treatment.

If during the examination no contraindications for conceiving a child are identified, then after pregnancy the woman should be observed by a general practitioner and a urologist. If any complications are detected, she will be indicated for hospitalization in the urology department for treatment of emerging complications. As clinical observations show, in most cases, kidney duplication in a pregnant woman rarely leads to severe complications. As a rule, doctors are only able to control blood pressure, eliminate swelling and other consequences of this anomaly using conservative treatment methods.

Diagnostics

In most cases, kidney duplication is diagnosed in the prenatal period during a routine ultrasound of the pregnant woman.

Kidney duplication in the fetus can be detected by ultrasound at 25 weeks of pregnancy.

Typically, signs of kidney duplication are detected by an ultrasound diagnostic doctor when examining a patient for pyelonephritis or urolithiasis. If such an anomaly is suspected, the patient is recommended to undergo the following additional studies:

• radiography (overview image);
• ascending and excretory;
• radioisotope scanning;
• cystoscopy.

In addition to instrumental examination methods, laboratory and

Treatment

If kidney duplication proceeds without complications, then the patient is recommended to undergo clinical observation by a urologist. He will need to undergo periodic kidney ultrasound and urine tests at least once a year. To prevent complications, the following doctor’s recommendations must be followed:

• avoid hypothermia;
• minimize the consumption of salty foods and foods rich in fatty acids;
• observe the rules of personal and sexual hygiene to prevent infectious diseases.

Therapeutic treatment

Drug treatment for kidney duplication is prescribed to patients in whom this anomaly has led to the development of pyelonephritis, hydronephrosis or urolithiasis. The symptomatic treatment plan may include the following:

• antibiotics;
• antispasmodics;
• painkillers;
• anti-inflammatory and diuretic herbal teas;
• compliance .

Surgical treatment

Surgical treatment for kidney duplication is prescribed only in cases where the complications that arise cannot be eliminated with conservative therapy and lead to severe disruption of the functioning of the urinary system. The following conditions may be indications for its implementation:

• urolithiasis that is not amenable to conservative therapy;
• vesicoureteral reflux;
• severe forms of hydronephrosis;
• urethrocele (dilation of the urethra with the formation of a cavity).

In some cases, kidney duplication leads to the development of urolithiasis, the manifestations of which cannot be eliminated by therapeutic measures. If the stone very often bothers the patient, then instrumental or surgical techniques are used to remove it. Sometimes the removal of urinary stones can be carried out by crushing them with electromagnetic waves (using the method of remote lithotripsy). However, this method of breaking stones is not always possible. Some large stones can only be removed through surgery.

Ureteral stones can be removed after crushing through. If such an endoscopic procedure is ineffective, then removal of the stone is carried out after surgical opening of the bladder.

In severe forms of hydronephrosis and vesicoureteral reflux, the following types of interventions can be performed:

• heminephrectomy or nephrectomy - removal of one or more segments of the kidney;
• application of ureterouretero- or pyelopyeloanastomosis - creation of anastomoses to eliminate the reverse reflux of urine;
• Tunnelization of the ureters is an antireflux intervention aimed at creating a lumen for the normal passage of urine.

Surgical operations are performed only if it is impossible to eliminate the consequences of hydronephrosis. In case of severe renal impairment, dialysis is recommended for the patient. If the kidney can no longer cope with urine filtration, the patient is prescribed a nephrectomy. Subsequently, the patient may undergo a kidney transplant from a donor.

If there is an abnormal flow of the ureter into the intestine or vagina, a corrective operation is performed to restore the normal flow of the ureter into the bladder cavity.

If a urethrocele occurs, the following types of operations can be performed to excise it:

• ureterocystoneostomy – removal of the urethrocele and creation of a new ureteral orifice;
• Transurethral dissection is an endoscopic operation to remove a urethrocele.

The purpose of such interventions is aimed at suturing the ureter into the intact wall of the bladder.

Which doctor should I contact?

If kidney duplication is detected, the patient is recommended to be monitored by a urologist. Ultrasound and urine tests will be performed to monitor the kidney abnormality. To clarify the clinical picture of the pathology in more detail, the following methods for studying the urinary system are prescribed.