Incomplete duplication of the renal pelvicalyceal system. Treatment of kidney duplication

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Congenital kidney anomalies are not at all uncommon in nephrology, especially in pediatrics. In terms of frequency of prevalence, the leading position is occupied by such an anomaly as kidney duplication, which belongs to congenital pathologies, since it develops even during the period intrauterine development fetus

According to medical observations, kidney duplication in a child is diagnosed accidentally during a scheduled or unscheduled ultrasound examination. In girls, this anomaly occurs twice as often as in boys. The pathology may affect one or both lobes of the organ, manifest itself on both sides, not manifest itself at all, or provoke serious complications in the functioning of the urine. excretory system and internal organs of the child.

Kidney duplication, what is it, how does the disease manifest itself, what treatment methods does modern nephrology offer and how to prevent the development of an anomaly? All parents who are planning a pregnancy or are already pregnant should know the answers to these questions.

Kidney duplication is an abnormal growth of an organ. During the development of the disease, the kidney doubles, its one or two lobes form three or four organs. Pathological organ growth in children develops during the period of active organogenesis in the first trimester of pregnancy.

Externally, a double kidney looks like fused organs that have their own circulatory system. The pathology can affect the left or right kidney, but in 10% of cases the organs on both sides are doubled. Doubling right kidney occurs much more often than the left one. As practice shows, double kidneys in a newborn or older child do not cause much discomfort. A person can live most of his life with an anomaly without knowing about it. In some cases, this condition increases the risk of developing pathologies of the urinary system, which threatens the development of diseases of the pelvic system.

Having information about what double kidneys are, it is important to know what are the causes of the anomaly?

Abnormal growth of the kidneys refers to intrauterine pathologies of the embryonic period. The epidemiology of the disease is based on two main factors: teratogenic and genetic. Exact reasons abnormal growth of the organ is not known, but there are still several factors that increase the risk of developing pathology:

1. maternal ionizing radiation in the first trimester of pregnancy;
2. use of potent drugs during embryonic development fetus;
3. avitaminosis;
4. heredity;
5. alcohol abuse;
6. smoking.

There are other reasons that can disrupt the development of the fetus, provoke a violation of cell division, the structure of chromosomes, with the subsequent formation of kidney anomalies.

Types of anomaly

In pediatric nephrology, pathology is divided into two main types: complete or incomplete.

With complete doubling of the kidney, two lobules are present, while the renal pelvis of one lobe is underdeveloped. The pelvis has separate ureters that empty into bladder. In some cases, there is an abnormal PFS, in which the ureter is discharged into the urethra. Despite the abnormal structure, the lobes of the organ can filter urine.

Incomplete duplication of the kidney is much more common, and with equal frequency it can damage the right or left lobe organ. Sometimes two pelvises are formed, but the pelvis system is poorly developed. Incomplete doubling of the left kidney leads to an abnormal enlargement of the organ; its structure is mostly asymmetrical, while top part less developed than the lower one.

Symptoms of pathology

With partial or complete doubling of an organ, Clinical signs may be completely absent or diagnosed completely by chance during an ultrasound examination. In some cases, the anomaly is not detected, there are no symptoms, and the child can live with the pathology for many years. Exception when this state inflammation of the kidney tissue is considered. Then the symptoms are pronounced, the child will have following signs diseases:

1. complaints of frequent headaches;
2. pain when urinating;
3. difficulty urinating;
4. increased weakness;
5. periodic increase in body temperature;
6. cloudy urine;
7. feeling of pain in the lower back.

A characteristic feature inflammatory process When the kidney tissue doubles, pain in the lumbar region is considered to appear, which is mainly aching in nature. In the acute period of the disease there is elevated temperature body up to 40 degrees, swelling of the face and limbs. Such symptoms should be a reason to consult a nephrologist and undergo an ultrasound scan.

Complications

The anomaly in which the organ doubles does not pose any threat to health, but still such children are at risk for developing diseases of the urinary system. It is known that with this anomaly, pyelonephritis develops in 30% of older patients. The risk of complications increases when joining bacterial infection, which can lead to the manifestation of diseases such as:

To reduce the risk of complications, a child who has been diagnosed with this pathology should periodically visit a nephrologist, undergo an ultrasound examination, and take lab tests.

Diagnostics

If the development of an anomaly is suspected, the doctor prescribes a number of laboratory and instrumental studies that can be performed on both adults and children.

1. Urography.
2. Ultrasound of the kidneys.
3. Dopplerography.
4. Urine and blood analysis.
5. Cystoscopy.

The doctor may prescribe other research methods that will help to obtain a complete picture of the disease, recognize pathology, and possible risks of complications. Based on the diagnostic results obtained, treatment tactics are prescribed.

Treatment methods

In the absence of morphological changes in the tissues of the organ, treatment is not carried out. Therapy can be prescribed only when both lobes of the organ are affected or an inflammatory process is associated with the anomaly.

In the presence of severe morphological changes in the organ, the patient may be prescribed heminephrectomy. The operation consists of removing one half of an organ lobe and has a good prognosis. IN postoperative period the patient must strictly follow all doctor's recommendations.

In pathology with double kidneys, conservative treatment does not exist, but the doctor can prescribe symptomatic treatment, which will help improve the functioning of the urinary system, and in the presence of inflammation, relieve symptoms and reduce the risk of complications. When a bacterial infection occurs, the following may be prescribed:

1. Antibiotics.
2. Anti-inflammatory drugs.
3. Uroseptics.
4. Immunoboosting medications.
5. Antispasmodics.

When drug treatment does not bring the desired results, inflammatory reactions in the tissues of the urinary system are repeated several times a year, the doctor recommends surgery.

Patients with a history of pathology are advised to adhere to proper nutrition, give up heavy physical labor, avoid hypothermia.

Many parents are interested in whether children with congenital anomaly kidney It all depends on the final diagnosis. If a congenital anomaly does not interfere with the functioning of the urinary system and does not manifest itself in any way during life, then there will be no indication for a deferment from the army. In case of constant infectious exacerbations, the medical commission will issue a conclusion on unsuitability for military service.

Prevention

It is easier to prevent a congenital kidney abnormality than to live with it throughout your life. This anomaly refers to intrauterine pathologies, so all responsibility lies with the expectant mother. Some preventive rules will help reduce the risk of development:

1. Healthy lifestyle.
2. No contact with toxic substances during pregnancy.
3. Complete cessation of smoking and alcohol.
4. Regular ultrasound examination.
5. Balanced and fortified nutrition.
6. Hardening the body.
7. Avoid hypothermia.
8. Avoid contact with sick people.

Observing simple rules you can reduce the risk of developing congenital anomalies of the urinary system, carry and give birth to a healthy child.

Double kidneys are a congenital pathology, which in most cases is observed in girls and is often unilateral. The reasons for this phenomenon are very different. The duplication of the kidney begins to form and develop in the child while still in the womb.

Double kidneys. What it is?

The kidneys in the human body are a paired organ. They perform the function of removing toxins from the body. Everyone knows about this. But not everyone has heard that kidney doubling occurs. What it is? This is the division of an organ into two halves, fused together at the poles. Each part is equipped with its own blood supply system. Externally, such a kidney is much larger in size. The development of pathology occurs during intrauterine development.

Double kidneys in children are the most common congenital anomaly of the urinary system. An altered kidney does not pose a threat to human life, but is often the cause of other diseases.

The structure of the renal pelvis

This funnel-shaped structure is formed by the fusion of the major and minor calyces of the kidney. It is in the pelvis that urine accumulates. The surface of the inner part of the pelvis is covered with mucous membrane. In the wall of the pelvis there are fibers that perform peristaltic contractions, as a result of which urine flows down the urinary tract.

Due to the impermeability of the walls of the pelvis and ureters, the liquid with the substances dissolved in it never enters the peritoneal cavity, but always remains within the urinary system.

Complete kidney doubling

Sometimes a person is diagnosed with complete kidney duplication. What it is? This is an abnormal phenomenon when the kidney is divided into two parts by a groove. The upper and lower lobules are distinguished, and the upper one is most often underdeveloped and smaller in size. Each of them has its own artery and its own renal pelvis, which is usually underdeveloped in the upper half. They also have their own ureters. Each goes separately and ends in the bladder with its own mouth. It is possible that one ureter flows into another.

So, instead of one, there are two separate buds. In itself, complete doubling of the kidney does not bother a person, so there is no need to treat it. But it leads to other diseases.

Problems that arise when a kidney doubles

Often, some kind of disease may begin to develop in one half of the doubled organ. Complete doubling of the kidney can provoke pyelonephritis, urolithiasis, nephrosis, and polycystic disease. It happens that the mouth does not flow into the ureter, but into some other organ. It can be the rectum, cervix, vagina. In this case, a person may feel urine constantly leaking from the ureter.

Incomplete bud duplication

This pathology is observed when a person develops one large kidney with clearly defined upper and lower sections. Each of them has its own renal artery. N, each part of the doubled organ does not have its own pyelocaliceal system; they have one for two sections. There are two ureters, but they are connected to each other and flow into the bladder with a single trunk, like one.

In medical practice, cases have been recorded where incomplete doubling of the left kidney is more often observed, rather than the right. Most people with this anomaly live until old age, unaware of its existence. Incomplete doubling of the kidney does not cause inflammatory processes in the organ.

Causes of kidney duplication

If the pathology does not manifest itself in any way, which happens when a person has incomplete duplication of the left kidney or the right one, it doesn’t matter, you may not even know about the abnormal development of this organ. It is discovered by chance, during an ultrasound examination of some other organ located next to the kidney. Doctors often diagnose a double kidney in a newborn child. The reasons for this phenomenon can be very different. Let's look at some of them:

• Radioactive exposure of the fetus in the womb, if her work activity during the entire period of pregnancy takes place at an enterprise whose production cycle is associated with radiation.
• The predisposition is inherited if one or both parents have a double kidney. What it is is described above in this article.
• Poisoning with drugs during pregnancy, including hormonal drugs.

• Presence of bad habits in a pregnant woman: abuse of alcohol, drugs, etc.
• Vitamin deficiency occurs frequently and regularly during pregnancy. There are many places on our planet where vegetables and fruits do not grow due to harsh climates. climatic conditions. But women live and give birth to children there too. So the expectant mother suffers from a lack of vitamins and useful minerals. It’s good if everything works out and the child does not have a disease such as kidney duplication. Of course, there may be other reasons, but this one can be ruled out for the sake of the health of the unborn baby.

Diagnostics

If no examination was carried out when the person was a child, kidney duplication is diagnosed, usually after an inflammatory disease of the organ begins or accidentally, during preventive examination by using diagnostic devices. First you need to do an ultrasound examination. If this is not enough, the doctor prescribes other methods.

When a person does not have pathology, there are only two ureteric orifices in his body: one for each kidney. If the doctor suspects kidney duplication, the patient is prescribed a cystoscopy. With its help, it is determined how many orifices the ureter has: if there are three, then the diagnosis of “double kidney” is confirmed. To determine the size of the enlarged kidney and identify the presence or absence of the third calyceal pelvis and additional ureter, the doctor prescribes excretory urography.

Kidney duplication does not manifest itself in any way. It does not need to be treated until it causes some other disease in this organ. Signs of kidney duplication vary. Typically, inflammatory processes are characterized by:

• Increasing temperature.
• Weakness and swelling.
• Nausea and vomiting.
• Regular headaches.
• Increased pressure.
• Cloudy urine.
• Reverse flow of urine.
• Discomfort and pain in the lumbar region.
• Urinary incontinence.
• Unpleasant sensations when urinating.
• Renal colic.
• The occurrence of infection in the urinary canal.

Whether all signs appear at once or each one separately will depend on the disease.

Kidney duplication is characterized by complete or incomplete division of the organ into two parts. If it doesn't bother the person, nothing needs to be done. It is enough to lead a healthy lifestyle and undergo regular preventive examinations. This pathology provokes inflammatory processes in the kidney when it completely doubles. Even in this case there is no point in doing complex operation to correct the defect. It may not cause trouble to a person throughout his life.

Therapeutic treatment is usually used when diagnosing some serious disease, for example, pyelonephritis, if it was caused by this anomaly. When the disease becomes chronic and cannot be treated using conservative methods, then resort to surgical intervention, which is aimed at correcting the cause that caused the complication. But they always try to save the kidney. It is removed only when it has completely lost its functionality.

Prevention

If during the examination a doubling of the kidney is discovered, there is no need to panic. This diagnosis is not fatal. When the pathology of an organ does not bother you, it will not affect a person’s quality of life in any way. You need to take a closer look at your health:

• Give up bad habits, if any: stop drinking, smoking, taking drugs.
• Change your job if it involves toxic chemicals.
• Urgently switch to a properly balanced diet.
• Strictly monitor the work and rest schedule.

If one of your relatives has a doubling of the kidney, what it is is known to the whole family. Therefore, when a woman from your family is bearing a child, you need to treat this period with double attention. The child in the womb must develop, receiving the necessary vitamins. A woman is obliged to take care of her health and not take alcohol, drugs, or medications that can cause poisoning to the child.

Currently, incomplete doubling of the kidney is considered the most common form of pathological development of the organs of the urinary system. This disease, in fact, is not considered a disease and does not have its own symptoms, but it reveals a high tendency of the patient to damage the kidneys with chronic nephropathies.

During development incomplete doubling There may be two options for the course of the pathology:

1. The kidney receives its nutrition from one artery and has two pelvises.
2. It has only one pelvis, but at the same time two arteries that exit the aorta separately.

Incomplete duplication of the left or right kidney develops due to the formation of two infectious foci at once in the metanephrogenic blastema. Complete separation of the blastema does not occur, even despite the appearance of two pyelocaliceal systems at once - this occurs due to the preservation of the capsular covering of the organ.

Each half of the pathological organ has its own blood supply. The vessels of this organ can emerge in a common column - so the division is formed nearby, not far from or at the sinus itself, or they can extend directly from the aorta. Some arteries located inside are capable of passing from one kidney to another - this is very important to consider when performing organ resection.

Partial doubling is a type of organ doubling, which is characterized by the peculiarity of the structure and structure of the organ, when the doubling of blood vessels and renal parenchyma is carried out without bifurcation of the pelvis. It turns out that the renal sinus is divided by a bridge of parenchyma into two separate sections. Such division provokes an increase in the size of the organ.

It is important! As a rule, incomplete organ duplication is not at all dangerous and does not imply any clinical conclusion, unlike the development of full duplication. The only danger in this situation is the option in which the pyelocaliceal system, as well as the ureters, doubles. To make a correct diagnosis, excretory urography is required.

Incomplete doubling of both kidneys or one of them is manifested by doubling of the renal vessels and parenchyma, but is not accompanied by doubling of the pelvis. Usually the upper part of the affected organ is smaller than the lower part.

Usually, two ureters of the double kidney open at once with holes directly into the bladder; occasionally the ureter splits, which has one opening in the pelvic region and one trunk; in its upper part it splits and unites with the pelvis. The ureters are capable of splitting into various levels. If there are two ureteric openings on one side of the bladder, then the opening of the ureter of the pelvis located above is adjacent to the opening of the lower pelvis. Often the ureters intertwine along their path - usually once or twice.

At the site of the union of the two ureters, a narrowing is formed, which, at the site of their complete fusion, interferes with normal urodynamics, even if the anatomical patency of this section is maintained. The upper part of the right or left kidney is mainly affected, which slows down the continuous flow of fluid, therefore contributing to the development of kidney hydronephrosis and the formation chronic process inflammation. If a pathological process does not develop in the double kidney, then no clinical symptoms are observed. In this regard, the disease is more often diagnosed by chance.

Signs of incomplete duplication of the left or right kidney in children mainly consist of infectious lesions of the urinary canals - this process is considered an indication for a comprehensive examination.

A person diagnosed with incomplete kidney duplication can live long life without complaints or health problems, and pathology is detected by chance when ultrasound examination. Duplication affecting the ureters is more often the cause of vesicoureteral reflux due to inadequate functioning of the closing functions of the orifices. Reflux usually occurs in the lower part of the bifurcated kidney. The mouth of the ureter in the upper part of the organ narrows, and this provokes the formation of a cyst, which flows into the lumen of the bladder and causes expansion of the ureter.

Typically, incomplete kidney duplication does not imply special diagnostics. In this case, complete doubling is detected after the development of the inflammation process begins. Any doubling can be easily detected by x-ray or ultrasound.

The diagnosis of the lesion is established based on the results obtained after cystoscopy, excretory urography, and ultrasound. Excretory urography makes it possible to examine the functioning of each part of the double kidney, its anatomical and structural changes. Ultrasound and computed tomography play an important role in the diagnostic process.

It is important! When there are pronounced changes in one of the halves of the kidney and deterioration of its functions, retrograde pyelography is used.

Clinical studies indicate a high incidence of various pathologies on the side opposite to the side of the kidney duplication. When both kidneys are doubled at once, an acquired or congenital pathology is often diagnosed - dysplasia, hydronephrosis, etc.

Treatment of the disease primarily involves therapy for acquired infectious process or pathology such as urolithiasis or pyelonephritis. Incomplete doubling in itself is not a disease, but this pathology significantly increases the risk of developing the inflammation process. If the damage to the double kidney becomes chronic and difficult to treat, the doctor prescribes resection for the patient.

It is important to know that when identifying incomplete duplication of a given organ in a person, it is recommended that he begin to adhere to healthy image life. IN mandatory it is necessary to prevent the influence of toxic factors on the body - for this you will need to stop using alcoholic drinks, from smoking.

The doctor also reviews drug therapy, addressing Special attention on the diet. It is important to remember that the kidney will function properly until it becomes difficult due to poor nutrition and unfavorable living conditions.

It is imperative to organize activities aimed at hardening the body, as well as gradually physical training. In this way, a person can prevent many lesions and complications that are caused by kidney duplication. A specialist can help you form the right diet and lifestyle.

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 structure urinary tract at the confluence 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 the development of hydronephrosis.

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 renal anomaly is detected 2 times more often in girls and is usually unilateral (in 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, such a developmental anomaly is provoked by genetic causes and is detected in children as early as early age. The defect can have various morphological configurations, and only a detailed diagnosis allows you to choose the right tactics for its treatment.

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 right sides may not double equally often. left kidney. 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.

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;
• pyelonephritis;
• urolithiasis disease;
• nephroptosis;
• tuberculosis;
• kidney tumors.

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.

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 disorder occurs during intrauterine development. Most often these pathological changes arise 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.

In most cases, kidney duplication long time is completely asymptomatic or detected incidentally during preventive examinations, when diagnosing 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 problems, impaired 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.);
• swelling of the limbs;
• 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;
• appearance renal colic(with development urolithiasis);
• promotion blood pressure;
• 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.

A woman with a double kidney should plan to conceive a child in advance. To do this, she needs to go through a complete diagnostic examination: take urine and blood tests, perform an ultrasound and, if necessary, others 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 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 shown clinical observations, in most cases, kidney duplication in a pregnant woman rarely leads to severe complications. As a rule, doctors succeed only with the help conservative methods treatment to control blood pressure, eliminate swelling and other consequences of this anomaly.

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 urography;
• radioisotope scanning;
• cystoscopy.

Except instrumental methods examinations, laboratory tests of blood and urine are prescribed.

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, compliance is required the following recommendations doctor:

• 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.

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

• antibiotics;
• antispasmodics;
• painkillers;
• anti-inflammatory and diuretic herbal teas;
• following a diet to prevent urolithiasis.

Surgical treatment for kidney duplication is prescribed only in cases where the complications that arise cannot be eliminated with the help of 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. Sometimes the removal of urinary stones can be carried out by crushing them with electromagnetic waves (by 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 a cystoscope. If such an endoscopic procedure is ineffective, then removal of the stone is carried out after surgical opening of the bladder.

At severe forms 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. At severe violation renal function, the patient is recommended to undergo dialysis. 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.

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 pathologies in more detail, the following techniques urinary system studies:

• excretory and ascending urography;
• cystoscopy;
• radioisotope scanning;
• MRI, etc.

Incomplete and complete doubling of the kidney in many cases does not pose a health risk and is often detected by chance during a preventive ultrasound examination of the kidneys or during examination for other diseases. In the absence of any symptoms, such a defect does not require treatment and only requires dispensary observation. In some cases, this anomaly of the urinary system leads to the development of complications: pyelonephritis, hydronephrosis, vesicoureteral reflux and urolithiasis. If such consequences of kidney pathology occur, the decision on the need for conservative or surgical treatment is determined by the doctor. As a rule, kidney duplication has a favorable prognosis and rarely requires surgery to remove and transplant the organ.

An ultrasound diagnostic doctor talks about kidney doubling:

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The most common congenital anomaly of the urinary system is kidney duplication. Such a pathology does not pose a particular danger to humans, but it can initiate the development of more dangerous conditions for health.

IN modern medicine Kidney doubling means complete or partial doubling of the renal system as a consequence congenital pathology kidney

In this case, the organ consists of two kidneys connected together, but each of them has its own blood supply. In most cases, this kind of anatomical disorder occurs only on one side, but there are also cases of bilateral doubling.

Causes

• Reason similar pathology It happens harmful effects various factors on a woman during pregnancy;
• A variant with altered, defective genes of both parents is possible.

When the urinary organs are blocked, exposure to harmful agents is possible - ionizing radiation, smoking and alcohol, a number of medicines, deficiency of vitamins and minerals, which can cause developmental abnormalities.

Incomplete bud duplication

The more common violation is incomplete doubling, here the organ has increased dimensions, and its upper and lower sections are clearly defined, with each section having its own renal artery. With incomplete doubling of the kidney, there is no bifurcation of the pyelocaliceal system; it works alone.

With complete doubling, instead of one bud, two are formed. When the left organ is doubled on the left, a doubled pyelocaliceal system of the left kidney develops, but one of the parts of this system has an underdeveloped pelvis, and each pelvis has, in turn, a separate ureter flowing into different levels into the bladder.

Diagnostics

Incomplete doubling any kidneys often does not manifest itself in any symptoms, and a person can live his whole life in blissful ignorance of this anomaly.

The diagnosis is usually made accidentally during a routine examination in a clinic.

To clarify the diagnosis use:

• ultrasonography;
• method computed tomography;
• radiography;
• magnetic resonance urography;
• Cystoscopy or ascending urography can help clarify the diagnosis in more detail.

Cystoscopic examination allows the doctor to examine the orifice of the ureters.

With ascending urography coloring substances are introduced that are visible on X-ray images. The image identifies the ureters, their place of entry, and in the case of incomplete duplication, the expanded pyelocaliceal system.

Treatment

Treatment of kidney duplication They are prescribed only in the event of the development of any complications, and if this anomaly does not cause any particular concern to a person, then they are limited to monitoring it.

The observation consists of:

• Ultrasound of the renal system;
• Clinical urine examination once a year.

Treatment of complications:

• If they arise inflammatory complications, then the doctor will need to select antibiotics, usually wide range actions;
• When the kidney doubles, stones can often appear with all the ensuing consequences, for example, in the form. In this case, analgesics, antispasmodics and herbal medicines such as kidney tea are prescribed;
• Surgical intervention is prescribed only in severe cases of hydronephrosis, or when complications develop that are not amenable to drug treatment, and the main task of the surgeon here is to preserve the organ;
• If double kidneys are determined in a woman, then she must plan her pregnancy in advance and must undergo a full clinical and laboratory examination And .

Duplication of the kidneys in a child can be determined in the prenatal state by performing an ultrasound after twenty-five weeks of pregnancy.

Prevention of complications

A kidney with a developmental anomaly is more vulnerable, and preventive measures are urgently needed:

• a person should avoid eating excessive amounts of salty foods;
• do not overcool;
• It is imperative that all infections are treated immediately genitourinary system.

With such a pathology, people should not forget about the rules for preventing complications and monitor their health.

The intrauterine formation of the human excretory system is complex and multi-stage. This circumstance creates favorable conditions for the relatively common birth of babies with defects of the urinary organs. Such anomalies deserve close attention due to the fact that congenital inferiority of intrarenal circulation, coupled with accompanying urodynamic disorders, creates suitable ground for the development of serious inflammatory diseases, For example, chronic pyelonephritis. The most common pathology of kidney development is their unilateral or bilateral doubling; the majority of those suffering from this defect have the first of them. This anomaly occurs in approximately 1 in 150 newborns.

What is kidney doubling?

The doubled kidney has a significantly greater length compared to the normal one. Like other anomalies in the development of urinary organs, this defect occurs three times more often in women than in men. The embryonic structure of the kidney is sometimes preserved even in an adult. The lower half of the doubled organ is in all cases larger than the upper half. Such buds are located in their usual place.

Both complete and incomplete doubling occur. In the first case, each of the halves has its own ureter and pelvicalyceal system. The pelvises are placed one above the other and, despite the fact that they are united by an isthmus of connective tissue, do not communicate with each other.

With complete doubling, each half of the kidney has its own pyelocaliceal system and its own ureter

The additional ureter can be completely separated from the main one; in this case, both of them are connected to the bladder separately and each have their own mouth. In this situation, they talk about a complete doubling of these organs. The mouth of the lower half is always located higher on the bladder than the mouth of the upper half.

However, incomplete duplication of the ureters is also possible, when in some place they are connected into one channel and end in the bladder with a common mouth. Most often, fusion occurs in areas of physiological narrowing, but it can also occur in any segment of the trunk. Even with preserved anatomical patency of the junction of the ureters, a violation of the passage of urine in this segment is observed; in this case it suffers upper half kidneys The outflow of urine from the upper pelvis is complicated because its ureter merges with the lower ureter at an acute angle; it delays the continuous flow biological fluid and partly contributes to the hydronephrotic change in this part of the double kidney (excessive expansion and stretching of its hollow parts).

Throughout its entire length, the main and accessory ureters may intersect once or twice. It happens that one of them ends blindly or opens outside the bladder triangle: in back the urethra, into the intestines, into the neck of the bladder, in addition, in men - into the seminal vesicle or vas deferens, and in females - into the uterus or vagina.

Each half is completely double buds, from the point of view of anatomy and physiology, is an independent organ. However, her lower pelvicaliceal system is formed normally, and her upper one is lagging behind in development. Occasionally there is a dividing furrow between them, but usually it is almost invisible.

The incomplete form of the anomaly represents duplication of the parenchyma and vascular network organ with a normal number of pelvises and cups.

On the diagram of incomplete doubling of the kidney, the numbers indicate: 1 - parenchyma; 2 - large blood vessels; 3 - pelvis

The blood supply to both halves of the kidney is carried out by two arteries. The circulation of lymph in each part of the doubled organ is also separate. The diameter of the arteries supplying the upper and lower parts of the kidney is proportional to the volume of flesh they supply.

Duplication of the kidneys and ureters occurs in various combinations

Causes of pathology

• intrauterine simultaneous formation of both ureters from their two primordia;
• bifurcation of a single ureteric embryo into early stages embryogenesis.

The first circumstance explains the occurrence of an incorrect position of the mouth of any of the ureters, and the second explains the bifurcation (or partial doubling) of its trunk. In different patients, both types of embryonic development disorders are observed with equal frequency. Sometimes this anomaly is inherited from parents.

Symptoms

The functional and anatomical failure of the kidney with the doubling of its structural elements and difficulty passing urine create all the conditions for the development of a chronic inflammatory disease. If similar pathological phenomena do not occur in the abnormal organ, then the patient has no clinical signs or complaints. Therefore, kidney duplication is often discovered by chance, when examining a patient in medical institution for any other ailment or urological problems on the other side of the body.

In the case of complete doubling of the ureter and the location of the additional orifice in an unnatural place, for example, in women in the uterus, vagina or urethra, a characteristic and very unpleasant symptom is observed: constant involuntary urination, while the ability to independently urinate and the urge to do so is preserved. Not knowing about the existence of an additional outlet, the phenomenon is mistaken for urinary incontinence caused by weakness of the external sphincter of the bladder.

If one of the ureters of a double kidney ends not in the bladder, but, for example, in the urethra, then constant leakage of urine occurs

Another frequent companion of a double ureter is a ureterocele - a sac-like protrusion of its end into the bladder. It usually forms in the area of ​​the mouth of the accessory ureter of the upper part of the double kidney. This pathology may not cause any inconvenience to the patient, but if the formation has reached large sizes, it can put pressure on nearby large vessels and cause pain radiating to the leg, and in women, simulate prolapse of the bladder (cystocele). Ureterocele is characterized by two-stage urination: having barely relieved a small need, the patient immediately feels the urge again. Due to congestion in the bladder, there is high risk formation of stones in its cavity.

Ureterocele interferes with normal bladder emptying, so it occurs in two stages

Clinical practice shows a high frequency of all kinds of urological pathologies on the side opposite to the doubling. In the case of a bilateral defect, abnormal structure of the urinary organs, prolapse of the kidney (nephroptosis), and urolithiasis are often detected.

On the side opposite the duplication, pathologies and abnormal positions of the kidney are often observed.

Why does pain occur with a double kidney?

You should know that kidney duplication, even in the absence of an inflammatory process, can cause severe lower back pain; this indicates the presence of reverse urine flow phenomena, medically called reflux. The biological prerequisites for such a violation of urodynamics in an abnormal organ are:

• moving the ureteric orifice downward or sideways;
• shortening of one or both trunks of the bifurcated ureter;
• ureterocele in the vesical section of one of the ureters.

With the kidney anomaly in question, the following types of reflux occur:

1. Interureteric. Fluid reflux occurs from one ureter to another at the point of their articulation.
2. Urethral-ureteral. It occurs when the ureter in men flows into the posterior (deepest) part of the urethra. In this case, the ureterocele, which overlaps the neck of the bladder, in some patients leads to the reflux of urine into the accessory ureter or into two trunks immediately on the affected side.
3. Vesicoureteral. Usually occurs in the ureter, which belongs to the lower part of the double kidney. This trunk usually has a shorter intravesical part. The additional ureter opens into the bladder below the main one, i.e. closer to the neck. Reflux is promoted by the ureterocele of the accessory trunk, which damages the closing apparatus of the mouth of the main ureter due to stretching of the bladder in this place. Along with the return of urine to the lower part of the double kidney, it is observed to be thrown into the ureter of the upper half of the organ when its mouth is located in the neck of the bladder. Or in both trunks, if their holes are shifted downwards and are located close to each other.

With vesicoureteral reflux, urine does not enter the bladder due to any obstruction, but returns through the ureter back to the pelvis, expanding and deforming it

Clinical symptoms of complications of a double kidney

A double kidney is much more likely than a normal kidney to undergo various diseases. This is predetermined by circulatory and urodynamic disorders in the abnormal organ.

Pyelonephritis

One of the most common complications during kidney duplication is pyelonephritis, the occurrence of which is caused by a combination of vesicoureteral reflux with congenital defect organ development. Despite drug treatment, this inflammatory disease with double kidney is characterized by long-term, persistent chronic course with frequent exacerbations. Standard antibacterial therapy for pyelonephritis brings the patient only short-term relief. Clinical symptoms of inflammation of a double kidney do not differ from those typical for a normal organ:

• pain above the lower back;
• bacteria and high leukocytosis in urine;
• pain and burning when urinating, frequent urge to him;
• difficulty trying to empty the bladder;
• temperature flashes.

Hydronephrosis and hydroureteronephrosis

Refluxes, ureteroceles, narrowing of the accessory ureter and incorrect location of its mouth that often accompany kidney duplication are important factors causing the development of hydronephrosis or hydroureteronephrosis. The first disease is a progressive expansion of the pelvis and cups against the background of difficulty in the normal outflow of urine from them. Without treatment, the result is complete atrophy parenchyma and decline of renal activity. In the second disease, the ureter of the pathological organ is also involved in the expansion process.

This is what a double left kidney with hydronephrosis of both halves looks like on an excretory urogram

The clinical symptoms of these two diseases are characterized by the same signs as with pyelonephritis, and may differ in the presence of a large palpable formation in lower hypochondrium, sometimes blood in the urine. Sometimes hydronephrosis with kidney duplication is almost asymptomatic, and only prolonged leukocyturia (a large number of leukocytes in the urine) indicates the disease.

A characteristic clinical sign of hydroureteronephrosis, which has arisen against the background of incorrect (extravesical) localization of the ureteral orifice, is the constant leakage of urine that has been present since birth, while the normal act of emptying the bladder is preserved.

Hydroureteronephrosis of the upper half of the right and lower half of the left double kidneys

Urolithiasis disease

Due to stagnation of urine caused by urodynamic disorders, calculi (stones) often form in the organs of the urinary system. Urolithiasis with double renal pelvis and ureters, it is interesting because pyelonephritis is very often associated with it.

Table: diseases that occur against the background of kidney duplication

Is pregnancy possible?

Naturally, every young woman who has been diagnosed with double kidneys is interested in the question: is she destined to know the joy of motherhood? Doctors' observations have established that yes, pregnancy and childbirth with such an anomaly are quite possible. However, the most complete and detailed urological examination of patients wishing to have a child is necessary. Knowledge by the attending physician of the type of anomaly and the condition of the urinary organs of the expectant mother is of great importance for preventing the occurrence of serious complications during pregnancy, when the kidneys work under conditions of increased load. One cannot ignore the high risk of developing pyelonephritis during this period. But if the double kidney does not manifest itself in any way and does not bother the woman, then she will be able to carry the pregnancy to the end and give birth to a healthy baby without any special difficulties.

In cases where the anomaly is accompanied by hydronephrosis, significant narrowing of the ureter, urine leakage or other complications requiring urgent intervention, planning to replenish the family is possible only after surgical correction vice. If kidney duplication was first discovered against the background of an already existing pregnancy, then the issue of continuation and management of the latter is decided by the obstetrician-gynecologist together with the urologist.

Diagnostics

Diagnosis of kidney duplication is not difficult and is usually available in outpatient setting clinics. The diagnosis is made on the basis of ultrasound examination, cystoscopic methods and X-ray excretory urography. Sometimes renal angiography, the study and evaluation of blood vessels, may be needed. Great value for correct diagnosis have patient complaints of urine leakage while maintaining normal urinary ability. They give reason to suspect the presence of an additional ureter that opens into organs adjacent to the bladder.

Ultrasound

Ultrasound scanning currently does not lose its relevance in identifying defects of the urinary system. However, only with its help it is impossible to reliably diagnose kidney duplication. Ultrasound can only suspect this anomaly due to an increase in the length of the organ, as well as detect possible complications.

This is what hydronephrosis of the lower half of the right double kidney looks like on an ultrasound scan

Video: the doctor talks about kidney doubling and ultrasound diagnostics of anomalies

Cystoscopy and chromocystoscopy

A cystoscopic examination - examination of the bladder cavity through the urethra using an optical apparatus (cystoscope) - will provide invaluable support in diagnosing complete duplication of the ureters and kidneys. During it, with a unilateral anomaly, three are detected, and with a bilateral anomaly, four orifices are identified. Often this study is enough to detect such a pathology.

Cystoscopy can be performed with both a hard (in women) and a soft (in men) cystoscope

If the interpretation of the data obtained is difficult, then to clarify the diagnosis, an additional chromocystoscopy is performed - examination of the inner lining of the bladder in combination with determining the evacuation and secretory functions of the kidneys. The doctor observes the orifices through a cystoscope, and at this time the nurse injects a dye, indigo carmine, into the patient’s vein. After 2–3 minutes, blue urine appears almost simultaneously from all openings of the ureters.

Excretory urography

Excretory urography allows you to judge the condition and functions of each part of the duplicated organ, to see the anatomical and structural transformations in the kidney. Due to the frequent thinning of the parenchyma of the upper half, for its full examination, it is necessary to inject a double amount of iodine-containing radiocontrast substance into the patient’s vein.

The image obtained by excretory urography shows complete bilateral duplication of the pelvis and ureter

Before the procedure, a person’s individual sensitivity to such drugs must be checked. Excretory urography helps to detect duplication of the pelvis and ureter at the confluence of the main and accessory trunks before they enter the bladder, which cannot be seen in any other way.

An overview urogram shows a shadow of the kidneys, increased in length. Several photographs taken one after another at a certain time interval make it possible to come to a conclusion about the anatomical location, structural changes and the functionality of the top and bottom of the double kidney. Even if one of its parts does not work at all due to this anomaly, based on the state of the cavity of the other, functioning half, one can suspect duplication of the pelvis and ureter.

With the help of excretory urography, it is possible to determine both complete and incomplete duplication of the urinary organs: this image shows how two left ureters merge into one

When there is a pronounced decrease in the function of one of the parts of the organ and changes in it, retrograde (ascending) pyelography is used - X-ray examination, carried out after injection of a contrast agent into the kidneys from the bottom up, through the urethra and ureters.

Treatment

All people with a double kidney can be divided into 3 groups according to the degree of need for treatment:

1. Patients who do not require therapy: in them the anomaly did not manifest itself in any way and was discovered by chance.
2. Patients without gross urodynamic disorders, but with associated pyelonephritis, who need drug therapy with antibiotics.
3. Patients who urgently and urgently need surgery.

Hydronephrosis and hydroureteronephrosis with a double kidney are treated exclusively by surgery. During the intervention, the cause that caused these complications must be eliminated. If, when affected by hydronephrosis, the presence of stones in the collecting apparatus, or significant expansion of the ureter due to reflux, it becomes necessary to remove the pathological part of the organ, then the operation is performed as early as possible, regardless of the patient’s age, in order to save the healthy part of the kidney from death. The intervention should be as organ-preserving as possible. Removal of a kidney (nephrectomy) in young people, and especially in children, is performed only in case of its complete irreversible non-viability.

If there is no function of the affected part of the double kidney, heminephrectomy (cutting off the dead half of the organ) or resection (removal of part of the kidney) is performed along with the complete elimination of the refluxing ureter, since if even a small remnant remains, vesicoureteral reflux will persist and progress.

With age, the size of the stump increases, a closed cavity is formed at its end, in which pus accumulates, and patients again have to undergo complex surgical intervention.

With complete doubling of the ureter and preserved function of the upper half of the kidney, it is possible to perform one of the following plastic surgeries:

• ureteroureteroanastomosis - surgical organization of the fusion of the adjacent part of the accessory ureter with the main one;
• ureteropyeloanastomosis, in which the main ureter is dissected and sutured to the additional pelvis of the top of the double kidney.

During such plastic surgery, the extra ureter, which has an extravesical opening, is completely removed, and the upper half of the kidney from which it originated is preserved. Sometimes the patient undergoes ureterocystoneostomy - transplantation of the pathologically opening ureter into the bladder, and a new orifice is formed there for it.

These interventions are carried out in case of hydronephrosis of one of the halves of the double kidney in order to eliminate the backflow of urine into the pelvis. The tactics of the operation and the time of its implementation for each specific patient are selected individually.

Photo gallery: schemes of operations on the ureters performed to eliminate reflux

Ureteropyeloanastomosis involves the formation of a single ureter for both pelvises of the double kidney. During the operation of ureteroureteroanastomosis, the upper ureter merges with the lower one near the pelvis Ureterocystoneostomy: 1-5 - stages of the operation of transplanting the ureter into the bladder with the formation of its mouth in the form of a nipple

Forecast

Owners of a double kidney are no different in appearance from ordinary people and, if there are no complications, can lead a normal life. They have to register with a dispensary, often visit a urologist and undergo examinations from time to time, but this is not a big problem. In some cases, a double kidney will never disturb its carrier during his life.

The danger of this anomaly lies in frequent development in such patients, inflammatory diseases are fraught with chronic renal failure. If this happens, then only a donor organ transplant can save a person’s life.

Among the patients who died from chronic renal failure, every 125th of them had doubling of the kidneys in any form.

Will people with double kidneys be accepted into the army?

Since army service is associated not only with the defense of the Fatherland, but also with colossal, almost round-the-clock physical stress on the body, and complications can arise at any time when the kidneys double, few of the young men of military age who were born and raised with this anomaly, and their mothers are not concerned about this topic. To find out whether they accept soldiers with such a defect, you should refer to the “Schedule of Diseases,” which organizes the list of diseases and categories of suitability of a young man for military duty in each specific case. It is this document that guides the draft commission when rendering a verdict on the possibility of attracting the future defender of the homeland to serve in the army.

Kidney duplication refers to disturbances in the urodynamics of the upper urinary tract and is included in the list of diseases listed in paragraph “b” of Article 72 “List of Diseases”. Therefore, a conscript with this feature belongs to category “B” - limited fit for military service. This means that the young man has an incurable disease with a moderate disorder of body functions, and in accordance with the law “On Military Duty and Military Service”, for health reasons, he is subject to exemption from conscription into the army, but is sent to the reserve. To put it simply, in the event of hostilities, such a person, along with everyone else, will be involved in the performance of a soldier’s duty, taking into account the resources available to him. this moment education and skills. For example, he will be able to work in a factory producing parts or household products for the front, or in a hospital to care for the wounded.

While serving in the army, soldiers experience significant physical exercise, endure cold and heat, endure heavy loads; all this requires good health and stamina

If a young man with a double kidney graduated from a higher educational institution that has a military department, and is preparing to defend his homeland as a reserve officer, then he will belong to category “B”, that is, the commission recognizes him as fit for military service with minor restrictions . The question of whether this citizen belongs to category “B” is decided individually. The same applies to conscripts who join the army under a contract. After all, it is possible to learn such a military profession, thanks to which the young man will take all possible part in the defense of the Fatherland, without overexerting himself physically and without risking his health. Thus, the owner of a double kidney will never become a paratrooper or submariner, but service in the signal forces is quite possible for him.

The topic of anatomy, physiology and human health is interesting, loved and well studied by me since childhood. In my work I use information from medical literature, written by professors. I have extensive experience in treating and caring for patients.

Currently, kidney duplication in a child is the most common form of pathological development of the genitourinary system. This lesion is not considered an independent disease and is generally not characteristic of it. clinical symptoms, but at the same time there is a tendency of the body to form inflammatory nephropathies in the kidneys.

The described lesion is often detected in children, especially girls. Kidney duplication in a newborn can affect one side or both kidneys at once, and it can also be complete or incomplete. With the development of complete duplication, the organ is divided into two parts with its own ureters, which open into separate mouths into the bladder.

With the development of incomplete duplication, fusion of the ureters is usually detected at a certain level. In this case, the lesion is often accompanied by protrusion of the wall of the ureter into the bladder.

Signs of kidney duplication include:

1. Kidney stones.
2. Pyelonephritis.
3. Organ prolapse.
4. Hydronephrosis.

The manifestation of pyelonephritis during the development of kidney duplication in a child is facilitated by improper discharge of urine, because this pathology is usually complemented by protrusion of the ureteral wall, similar to a hernia. The same reasons influence the formation of kidney stones.

Anatomical picture of a double kidney

In its anatomical structure, a double kidney looks as if two kidneys have merged together and have independent blood flow - that is, they have two arteries. In this case, the lower part of the organ becomes more significant. Kidney tissue and the blood flow system doubles in any case, but the ureter and renal pelvis are not always removed, which means that an incomplete form of pathology develops.

It is important! Also, the accessory ureter can unite with the main one at any point, often before entering the bladder. At the junction of the two ureters, a narrowing often appears, causing a violation of the correct discharge of urine, its return into the pelvis and hydronephrosis.

Reasons for the formation of duplication in the organ

Doubling in the kidneys, just like other intrauterine pathologies, mainly correlates with the influence of teratogenic factors on the body, with the transmission of a pathological gene to a child from his parents.

The most popular and frequently occurring factors in modern medicine for pathological effects on the human body include ionizing radiation to the mother’s body during pregnancy in the first months of gestation, the use of hormonal medications, certain chemical compounds and deficiency of minerals and vitamins in the body.

These factors affect the gene structure and disrupt the construction of chromosomes; in addition, they negatively affect cell division, thereby provoking the doubling of the child’s left kidney or right kidney.

Clinical manifestations of pathology and its diagnosis

Incomplete duplication, in which there is no duplication of the renal pelvis, often has no manifestations and is detected completely by chance when a targeted computed tomography or radiography of the kidneys is performed.

Complete duplication with the development of the second ureter and its entry into the bladder can be diagnosed using cystoscopy upon detection of the third orifice. However, most patients with incomplete kidney duplication, with left or right side, live full life and do not even suspect that this disease is developing in their body.

With complete doubling, clinical signs are based on symptoms of inflammation that form in the kidneys, on the development of reverse reflux of urine and hydronephrotic transformation. Thus, the person begins to complain about severe pain in the lower back, increased body temperature and weakness. In addition, there is pain during urination, a positive symptom of renal effleurage. When the lumen expands renal pelvis Colic and swelling develop, blood appears in the urine, and blood pressure rises.

It is important! The listed symptoms are considered specific and whether they appear separately at the same time depends on the form of the disease.

The diagnosis of kidney duplication is made after implementation x-ray examination, MRI, computed tomography, ultrasound examination or cystoscopy.

The upper part of the affected kidney sometimes changes so much due to the development of pyelonephritis in it or an obstructive process, and therefore the parenchyma almost completely becomes thinner, wrinkles, and the function of the segment atrophies.

Ultrasound examination reveals the formation of a cystic neoplasm in the upper part of the pole, and the diagnosis is made through excretory based on the following indirect signs: absence of the upper calyx in the lower pelvis, downward displacement of the pelvis, its deformation, asymmetry of the calyces and the presence of a silent zone between the edges of the pelvis and the upper pole of the kidney , an increase in kidney size.

The need for a treatment process

Direct surgical treatment of kidney duplication in a child is performed only in cases of extreme necessity and serious complications. Often therapy remains conservative and involves prevention and stopping the development of possible complications.

It is important! Thus, for pyelonephritis it is carried out traditional therapy by taking antibacterial medications. With the development of acute nephrolithiasis or otherwise colic, the patient is given the usual assistance: immersion in a bath with warm water, introduction antispasmodics. It is recommended to strictly adhere to the diet prescribed by a specialist, which allows you to destroy already formed kidney stones.

Surgery is performed only in cases of pronounced hydronephrotic transformation or other conditions that make conservative treatment impossible. In this case, doctors give preference to organ-saving operations, and nephrectomy, that is, complete removal organ, is carried out when incomplete duplication of the right kidney or another form of the described anomaly provokes complete loss of the kidney’s ability normal operation. But this only happens when the disease process starts and there is no necessary measures treatment and prevention.

Among developmental abnormalities, kidney anomalies occupy one of the first places, and kidney duplication is the most common anomaly of this organ. This term means the presence of a kidney, the size of which significantly exceeds the norm, while its lower half is always larger than the upper. Also, in a doubled kidney, its embryonic lobulation may be noticeable, and blood flows to it through two renal arteries, although normally the blood supply is through one artery.

Kinds

A distinction is made between complete and incomplete doubling of the kidney, and the anomaly can occur in only the left or right organ, or in both at the same time. In the latter case, they talk about a bilateral deviation in the number of kidneys. With complete doubling, each part of such an organ has its own pyelocaliceal system and ureter. The accessory ureter can be completely separate and empty into the bladder (complete duplication of the ureters) or merge with another, thereby forming one common trunk, ending with one orifice in the bladder (incomplete duplication of the ureters).

Attention! Duplication of the kidney in some cases is accompanied by the presence of malformations of the accessory ureter - ectopic orifice and opening not into the bladder, but into the vagina or intestines, which is fraught with involuntary release of urine while maintaining an independent controlled act of urination.

Pathology is diagnosed using:

• cystoscopy;
• urography;

Causes of the anomaly

Kidney duplication is a congenital anomaly, so its formation occurs during the growth of the fetus in the mother's womb. Consequently, it has not yet been possible to reliably determine the causes of this phenomenon. However, it has been proven that exposure to the following factors during pregnancy contributes to the development of pathology:

• taking hormonal medications;
• deficiency of vitamins and minerals;
• exposure to ionizing radiation;
• drug poisoning;
• bad habits.

In addition, we should not forget about the genetic factor. If in the family of the child’s mother or father there are cases of complete or incomplete doubling of the right kidney, there is a risk of having a baby with the same anomaly.

Important: kidney duplication is more common in women.

Symptoms

Regardless of whether the doubling of the left kidney or the right one occurs, this does not in any way affect the condition of the body and its performance. Therefore, in most cases, this developmental anomaly is discovered completely by accident, for example, during examination for other diseases, during pregnancy, etc.

But still, sometimes a double kidney can cause pain when complete absence any pathological processes. This is explained by the fact that, due to structural anomalies, urodynamics are distorted in it or interureteral reflux may be present. The patient may also have a positive Pasternatsky sign.

Possible dangers

Incomplete doubling of the left or right kidney is associated with a lower risk of developing other diseases than with complete doubling, since urodynamic disturbances in this case are minor. However, the risk of kidney pathologies in people with both types of anomalies is still high. Therefore, they often suffer from:

• pyelonephritis;
• urolithiasis;
• hydronephrosis;
• tuberculosis;
• nephroptosis;
• tumor formation.