Duplication of the renal sinus of the left kidney. Kidney duplication in children

The main organ of the urinary system of the human body is the kidneys. Unfortunately, doctors are increasingly recording such an anomalous phenomenon in children as the bifurcation of one of them. This pathology is not life-threatening, but can become a prerequisite for the formation of other diseases.

Anomaly or disease?

Bifurcation is a condition characterized by complete or incomplete division of the pyelocaliceal system (PSS) of the organ into two parts. Most often it affects one of the kidneys, but it can affect both organs of the pair.

To see what a bifurcated kidney looks like and understand what it is, it is enough to carry out a simple diagnosis, for example, ultrasound: the affected kidney looks like two fused kidneys, each with its own renal artery.

The forked kidney is noticeably enlarged. In the case of incomplete bifurcation, the CL remains intact; with complete bifurcation, it turns into two independent systems with separate ureters - the main and accessory ones. The latter can independently grow into the cavity of the bladder or connect with the main one before entering the bladder. If two ureters merge, then a narrowing is formed at the point of their connection, which can cause disruption of the outflow of urine and its return into the pelvis. This course of the disease can threaten hydronephrosis - expansion of the cups and pelvis - and subsequent atrophy of the renal parenchyma.

There are several anatomical variants of kidney duplication

Causes

The reasons for the formation of bifurcation are due to factors that disrupt the gene apparatus, the structure of chromosomes and the process of cell division. These include:

• use of hormonal drugs by the expectant mother during pregnancy;
• exposure of the embryo to ionizing radiation;
• exposure to strong chemicals on a woman’s body during pregnancy;
• lack of vitamins and minerals.

Also, intrauterine pathologies are associated with the transmission of damaged chromosomes from parents to the unborn child. According to statistics, for every 150 babies there is one with a forked kidney, and girls are susceptible to this anomaly 2 times more often.

Symptoms

Surprisingly, many people with a bifurcated kidney live without knowing it until any of the concomitant diseases manifest themselves (pyelonephritis, hydronephrosis, urolithiasis). The symptoms of the latter are the symptoms of bifurcation:

• pain in the lumbar region;
• painful urination;
• elevated temperature;
• weakness;
• vomiting and nausea;
• swelling;
• hematuria (blood in the urine);
• azotemia (excess nitrogenous products in the blood);
• hypertension.

The listed symptoms can appear either individually or together, depending on the form of the disease.

As a rule, kidney duplication is asymptomatic and is detected incidentally during examination for another reason.

Diagnostics

Bifurcation is a disease that has no externally expressed signs. It can only be diagnosed using instrumental methods:

• ultrasound examination;
• magnetic resonance urography;
• cytoscopy;
• computed tomography.

Incomplete bifurcation is often accidentally discovered during a routine CT scan of the kidneys. Complete diagnosis can be made by cytoscopy upon detection of the third ureter.

Treatment

If a bifurcated kidney is detected in a child, conservative treatment is prescribed to eliminate the possibility of complications, and the condition of the kidney and the general well-being of the child are regularly monitored.

The bifurcation of the kidney itself is not considered a disease, but if associated complications develop, the doctor will prescribe a course of treatment.

For pyelonephritis, the patient takes antibacterial drugs; for nephrolithiasis, antispasmodics that prevent the formation of stones, and warm baths so that the kidney stone can more easily pass through the excretory tract. It is imperative to follow a diet that includes foods that help break down and remove kidney stones.

In case of acute hydronephrosis, surgical intervention is necessary, and in case of complete kidney dysfunction, its removal is necessary.

Hydronephrosis of the kidney is a serious complication of its doubling

Prevention

Although kidney bifurcation in itself is not dangerous, it must be remembered that it threatens the appearance of severe concomitant diseases. That is why a woman during pregnancy needs to lead a healthy lifestyle, avoid sources of ionizing radiation, monitor her diet and take special vitamins and minerals. In addition, it is extremely important to maintain a drinking regime and limit salt intake.

The use of hormonal drugs during pregnancy is contraindicated.

A bifurcated kidney is not a death sentence; moreover, it may have absolutely no effect on the life of a person who cares about his health. To eliminate the risk of developing a bifurcated kidney in a child, expectant mothers need to be careful and follow the above recommendations.

Quite often, people who are faced with this diagnosis for the first time think about kidney duplication: what is it? How does a congenital anomaly of the body affect health? What could be the reasons for improper development of the genitourinary system? How to diagnose pathology and what to do next?

The presented kidney anomaly is one of the most common congenital disorders. Kidneys are vital. This anomaly is a dangerous manifestation that entails a lot of consequences and diseases, creating many problems for a person.

Detection of the disorder usually occurs in childhood and is more common in girls. As practice shows, doubling of the left kidney is a fairly common occurrence. Medical practice over many years of research has identified several possible congenital anomalies of kidney development. There is aplasia (the absence of one kidney), doubling (one large kidney with a neighboring one growing on it), an additional or third kidney. Doctors have proven that they do not cause much harm to health, and people live full and healthy lives.

Types of pathology

A double kidney looks like two organs fused together, each of which has its own circulatory system. Such a manifestation can only occur on one side; cases with bilateral bifurcation occur extremely rarely.

Doubling can be complete or incomplete. Let's look at the types in more detail.

Incomplete doubling of the kidney has the appearance of an enlarged organ, in which there are two sections - lower and upper. In the departments there are renal arteries, while the pyelocaliceal system (PS) of the kidney remains unified. Two ureters sometimes join into one, forming a common duct. But there are cases when one ureter flows into the bladder, and the second into the intestines or vagina. This creates a number of problems for the child (constant, partial entry of feces into the vagina). Incomplete duplication of the left kidney is the most common disorder, and some people live with this disease for many years, unaware of their anomaly.

Complete doubling of this organ is characterized by two solid organs located in one place, instead of the required one. In this case, the pyelocaliceal system of one of the kidneys will be underdeveloped. In this case, as with incomplete doubling, each system will have a separate ureter, each of which will flow into the bladder at different levels, that is, each of the systems will be able to independently filter urine.

The bifurcation of vital systems by nature is not considered a great tragedy. However, this feature increases the risk of various diseases of the renal system. For example, problems with the genitourinary system may arise, namely: early development of urolithiasis, the appearance of stones and sand. In this case, inflammatory processes, such as pyelonephritis, can occur as a result of common ARVI. The consequences of bifurcation can lead to nephroptosis, tumor, hydronephrosis.

Symptoms of the disease

Signs of kidney duplication:

• frequent inflammations;
• release of urine from the ureter into the bladder;
• pain when urinating;
• nagging pain due to inflammation.

To better understand the problem, let's study the symptoms and causes.
other doubling of the kidney. These include a genetic factor. As you know, it is impossible to change genetic predisposition. It often happens that parents with genetic diseases give birth to absolutely healthy children. But there are cases when one of the parents passes on a genetic disease to the child.

The mutagenic factor is one of the main causes of anomalies in children. It makes itself felt when the expectant mother behaves incorrectly during pregnancy - drinks alcohol, smokes, takes medications without consulting a doctor. The first 12 weeks influence the formation of a full-fledged fetus, so an accidental mistake can harm the child for life. Alcohol abuse or smoking are among a number of chemical mutation causes. The physical cause may be ionizing radiation or x-rays, so if you are planning a pregnancy, be careful about your health and the health of your unborn child.

Possible disorders may be a lack of vitamins and minerals, maternal infections, or taking hormonal medications.

Diagnosis of the disease

It is not difficult to diagnose such a manifestation as three kidneys in the body. Firstly, this can happen in the mother’s womb, when an ultrasound is performed during pregnancy and all the internal organs of the baby are scanned to determine possible anomalies. Even if this is not detected by ultrasound during a woman’s pregnancy, in childhood the problem will quickly manifest itself with the first inflammatory condition. If frequent, it is necessary to do an x-ray or ultrasound examination.

In many medical institutions, kidney disease is detected using ultrasound scanning, X-ray urography, and cystoscopy. With the help of cystoscopy, you can conduct a thorough and detailed examination of the bladder. For this procedure, a cable or probe with an attached camera is used, through which the walls of the organs are examined.

There is also a method. It is used to study and take x-rays of the kidneys and urinary tract. An MRI scan can be performed to look at the inner layers of the kidneys.

Treatment methods

It is not necessary to treat such a feature in the body at all, since, having three kidneys in the body, you can absolutely not feel any discomfort or other inconveniences. A visit to the doctor is only necessary when there is an inflammatory or other disease.

If a person has frequent exacerbations of chronic kidney disease or other processes in which the third kidney may interfere, then surgeons may insist on its removal. However, such cases are rare, and surgical intervention is resorted to extremely rarely, having carefully weighed the possible risks. Any treatment of the genitourinary system necessarily includes a diet in which you cannot eat anything fatty, salty, or fried.

If the condition of the kidneys worsens due to inflammation, a number of antibiotics are used, which are prescribed both in tablets and intramuscularly. For a child, the antibiotic is used in the form of syrup or intramuscularly, depending on the severity of the disease. Antispasmodic and analgesic medications are often prescribed to relieve pain. You can also use herbal teas and infusions, herbal teas for brewing kidney tea.

Surgeries are performed when the organ is unable to filter urine. The whole kidney or part of it may be removed. In addition, there is tunnelization of the ureteral canals for better urine conduction.

The disease associated with kidney duplication is often congenital in girls. What to do with pregnancy with such an anomaly of the body? Before planning a child, it is necessary to take blood and urine tests, and conduct... And only after making sure that there is no inflammatory process in the kidneys and the body as a whole can you start planning. If there is renal failure, then pregnancy is contraindicated, since the kidneys may not be able to withstand such a load, which will provoke an attack that is difficult to stop and save the woman.

If a young girl is doing well with her tests and pregnancy has occurred, then you need to register as early as possible, since if there is a doubling, doctors need to carefully monitor your condition.

To maintain the body with a disease such as kidney duplication, it is necessary to lead a healthy lifestyle, following some rules:

1. Eat rationally, avoid fried and heavy foods.
2. Do not drink alcohol or tobacco.
3. If you feel unwell, you should not self-medicate.

If you have three kidneys, don't panic. Some people live with this “kidney set” all their lives without even knowing it. Be healthy!

The intrauterine formation of the human excretory system is complex and multi-stage. This circumstance creates favorable conditions for the relatively frequent 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 conditions 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, they 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, the upper half of the kidney suffers. The outflow of urine from the upper pelvis is complicated because its ureter merges with the lower ureter at an acute angle; this delays the continuous flow of 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 vesical triangle: into the back of the urethra, into the intestines, into the neck of the bladder, in addition, in men - into the seminal vesicle or into the vas deferens, and in females - into the uterus or into the vagina.

Each half of a completely double kidney, 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 is a doubling of the parenchyma and vascular network of the 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 in the early stages of 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 a medical institution for some 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 a large size, it can put pressure on nearby large vessels and cause pain radiating to the leg, and in women it can 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 a high risk of stones forming 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 be exposed to 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 a congenital malformation of the organ. Despite drug treatment, this inflammatory disease with double kidney is characterized by a long, 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 urinate;
• 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 of the parenchyma and extinction 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 be distinguished by the presence of a large palpable formation in the 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 pelvises and ureters 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 of the defect. 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

Diagnosing renal duplication is not difficult and is usually available in an outpatient clinic setting. 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 required. Of great importance for correct diagnosis are the patient’s 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 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

In case of a pronounced decrease in the function of one of the parts of the organ and changes in it, retrograde (ascending) pyelography is used - an X-ray examination performed after the 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.

In the absence of 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 the frequent development in such patients of inflammatory diseases, fraught with chronic failure of kidney function. 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 disorders of the urodynamics of the upper urinary tract and is included in the list of diseases listed in paragraph “b” of Article 72 of the “Schedule 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. Simply put, 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 his current 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 have to experience significant physical exertion, endure cold and heat, and 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.

A double kidney is a congenital developmental anomaly. Normally, a person has two kidneys - one on the left side, the other on the right side. In case of fetal development disorders, they can double in one or two lobes, or form as a third or even fourth kidney (with a complete bilateral defect). Girls are more susceptible to this feature; in boys, the anomaly is much less common.

According to statistics, the mutation occurs in one newborn child out of 150. As a rule, kidney duplication does not pose a threat to life; in most cases, the patient learns about the defect by chance, for example, during an examination. However, in some cases, doubling can contribute to the appearance of secondary diseases of the urinary system and require treatment.

Kinds

Many people get scared when faced with a diagnosis of “double kidneys” in themselves or their loved ones, and try to understand what it is and how much this condition poses a threat to life and health.

Most often (in 80% of cases) incomplete doubling of the left or right kidney is observed. In this case, the division of the organ does not occur; its enlargement and a bridge in the sinus area are observed, dividing the kidney into two sections that have a single pyelocaliceal system (PPS). Each lobule is fed by separate arteries. Visually, the lower part of the double bud is larger than the upper part.

Sometimes the kidney is formed in both sections, but the vascular system of such a kidney is common. With incomplete duplication, the ureters depart from the pelvis and join into a common urinary stream.

Much less often (in 10% of cases) a diagnosis of “complete doubling of the kidney” is made. The left-sided anomaly is somewhat more common than the right-sided one. The development of a separate organ with its own pulse rate and blood flow is noted. Sometimes doubling the PV of the right kidney or the left leads to functional changes. In some cases, doubling of the pelvis is accompanied by underdevelopment of one of them. The ureter of a double kidney is separate, having its own opening in the bladder. Sometimes the ureter is connected not to the bladder, but to the large intestine, and in females - to the vagina. In this case, urine exits through the corresponding organs, which requires surgical intervention.

Kidney duplication is one of the types of anomalies that are not a pathology. Often the diagnosis is made to adults who have not experienced problems with the urinary system throughout their lives.

Reasons for appearance

The defect occurs during intrauterine development. This can lead to:

1. Genetic factor (including hereditary). In families where the parents themselves or their close relatives have congenital structural features of the kidneys, there is a high risk of having a child with the same defect.
2. Taking medications during pregnancy that have a teratogenic effect, leading to deformities and abnormalities in the fetus. It is necessary to be careful about all medications taken during this important period.
3. Exposure to ions, staying in places with increased radiation.
4. Insufficient intake of vitamins and minerals into the pregnant woman's body.
5. Drug addiction, smoking, drinking alcohol during pregnancy.

Symptoms

As a rule, partial doubling does not cause any special problems in life and is not accompanied by functional changes. Complete doubling is a more dangerous feature; it is often accompanied by an abnormal physiological structure and requires mandatory supervision by a specialist throughout life. The situation becomes more complicated if there is a doubling of the right kidney and the left one at the same time.

Often, the first signs of a special structure may appear during times of increased stress on the body, for example, during pregnancy in women, as well as during hypothermia or after lifting weights in men. In other cases, a structural anomaly due to vulnerability gradually leads to diseases of the urinary system and is accompanied by the following symptoms:

• disturbance of urination - urinary retention, pain and pain, weak stream;
• pain in the back of the lumbar region, which intensifies when tapping with the edge of the palm;
• urinary retention is a threatening condition that may be accompanied by symptoms of intoxication - nausea, vomiting, weakness, unpleasant body odor;
• increase in body temperature from subfebrile (37º-37.5ºC) to high values;
• hypertension - blood pressure above age norms;
• swelling (legs, body, face);
• sallow complexion.

These signs are accompanied by both diseases of the genitourinary system and disorders of functional abilities (for example, insufficient outflow of urine due to doubling and underdevelopment of the maxillary tract). If you have double kidneys, you should take care of your body and follow your doctor’s recommendations. In children, such symptoms can be acute and therefore require immediate hospitalization. Pregnant women should undergo regular monitoring of the condition of the baby's organs.

If the structure of the kidneys is abnormal, primary diseases of the urinary system or exacerbation of old ones can be provoked by:

1. Pregnancy.
2. Hormonal imbalance.
3. Wrong lifestyle: bad habits, disruption of sleep and rest patterns.
4. Hypothermia.
5. Hard physical work.
6. Sports activities involving heavy lifting or overload.
7. Abuse of medications that affect kidney function.
8. Insufficient consumption of clean water.
9. Urinary tract infections.

Diagnostic measures

Timely assessment of the condition and structure of organs with unilateral and bilateral defects makes it possible to identify deviations in functioning and, if necessary, prescribe therapy. If the anomaly does not affect the condition of the body, does not cause malfunctions in the urinary system (in case of incomplete doubling of the kidney), then the attending physician gives recommendations on lifestyle and diet and prescribes an annual examination. In other cases, medication and sometimes surgical treatment for kidney problems are recommended.

If a developmental defect is suspected, as well as during an annual doubling examination, the following set of diagnostic measures is prescribed:

• Ultrasound diagnostics with examination of the blood supply to the organ (Dopplerography). Modern equipment makes it possible not only to determine the location and structure of the kidneys, but also to evaluate their structure, as well as the slightest changes in it. Ultrasound with Dopplerography determines blood flow in the organ and assesses the condition of the blood vessels. The procedure requires preparation: drink 0.5 liters of water an hour - the bladder should be full, do not eat for 8 hours before the test, exclude flour products and bread from the diet a day or two, as well as sweets, raw vegetables, and milk. The fact is that some foods cause excess gas formation in the large intestine, which can distort the results of the study. An acceptable diet before an ultrasound of the abdominal organs is porridge, soups, boiled meat and fish. Young children and people suffering from flatulence are advised to take carminative medications before diagnosis. Children are recommended to drink water already in the ultrasound room, since due to their physiological characteristics it is difficult for them to restrain the urge to urinate.
• X-ray with the introduction of a contrast agent. Prescribed for pain, as well as for suspected kidney disease or chronic processes. Indispensable for complications - urolithiasis, the presence of tumors and others. The procedure is as follows: the patient is given an intravenous injection (or drip infusion) with a contrast agent, then a series of x-rays are taken to determine the state of the kidneys' excretory function. Preparation for the study is the same as for an ultrasound.
• A modern and more informative method is computed tomography using a contrast agent. Thanks to it, the pictures are three-dimensional, clear, with their help you can see the condition of the kidneys, as well as the vessels that feed them. CT and X-rays are contraindicated in pregnant women to avoid disturbances in fetal development.
• Magnetic resonance imaging - gives an idea of ​​the structure of the organ, its functioning, the state of blood circulation, the presence of tumors, duplications, stones and other neoplasms. This is by far the best method for deep research. Prescribed for controversial diagnoses or suspected complications. The procedure is quite long - about 40 minutes. During the study, the patient is placed in a special closed tube, so MRI is not suitable for people with claustrophobia, as well as those suffering from diseases of the nervous system and mental health. The procedure can be performed on pregnant women when indicated.
• Cystoscopy is an instrumental type of diagnosis. It involves inserting a special catheter with a camera at the end into the urethra and bladder. Gives an idea of ​​the condition of the mucous membrane of these organs. It is carried out to clarify certain diagnoses - urolithiasis (UCD), tumors, cystitis and urethritis.

Treatment and prevention

It is impossible to cure congenital structural features with medications. Kidneys double during fetal development due to genetic failures or heredity, or due to external factors affecting the expectant mother.

Medicines are used to relieve pain during complications, as well as to eliminate infectious processes. For this purpose, painkillers and antibiotics are prescribed.

If there are stones in the organs of the urinary system, drugs are prescribed to dissolve or remove them.

If doubling leads to severe disorders that lead to a significant decrease in kidney function, then surgery is performed. They are as follows:

1. nephrectomy - removal of part of a kidney or organ completely;
2. anti-reflux surgery - plastic surgery of the urinary tract, used for stagnation of urine;
3. connecting the ureters to the bladder by excision and creating a suture, as well as creating artificial septa. It is used when urine flows abnormally, for example, into the intestines, and also when urine is thrown back into the bladder.

To reduce the load on the organs of the urinary system, you need to lead a healthy lifestyle: avoid alcohol and tobacco consumption, professional sports, heavy lifting, and hypothermia. In order to avoid infection in the organs of the genitourinary system, it is important to maintain sexual hygiene - protect yourself with unfamiliar partners using a condom, and if sexually transmitted diseases are detected, both partners undergo timely treatment.

The diet of patients with double kidney should not contain foods that irritate the mucous membranes. You should also avoid foods that retain fluid in the body. Therefore, people with kidney abnormalities should consult a nephrologist before consuming the following foods:

• pickles and smoked meats;
• fast food, sausages, spicy dishes;
• sparkling mineral water.

To support the activity of the urinary system, you should drink 1.5-2 liters of water per day, and drink vitamin complexes in spring and autumn (only after consulting a doctor, since some minerals included in the complexes are contraindicated for urolithiasis). Overload, both physical and psycho-emotional, should be avoided.

Kidney activity is extremely important for the entire body. With serious complications of kidney disease, the patient may die within a few days due to intoxication of the body. Therefore, it is important to diagnose organs in a timely manner and follow all the specialist’s instructions. This could ultimately save lives.

The kidneys are a paired organ located next to the spinal column, deep in the tissues of the lower back. Anatomically, there are two layers - cortical and medulla. Arterial vessels bring blood, which, after purification, flows through the veins to the lungs and heart. The ureter drains waste fluid into the bladder. Normally functioning kidneys provide the most important task of protecting the body from toxic metabolic products. Any developmental anomaly in the urinary tract can become the basis for the formation of serious diseases that reduce a person’s quality of life.

Causes of kidney doubling

In most cases, kidney duplication occurs during the intrauterine stage of a person’s life (1st trimester of pregnancy - from 3 to 10 weeks, when the urinary organs are formed). According to statistics, about 40% of all fetal anomalies are malformations of one or both kidneys. In women, the problem occurs 2 times more often than in men. The following groups of factors are distinguished:

• Genetic defects;
• Negative influence of the external environment during the formation of fetal organs;
• Combined effect of causes.

Most often, it is impossible to accurately determine the factor that provoked a congenital change in the tissues of the urinary tract.

Options for quantity anomalies

Duplication of the renal cavity system can be unilateral or bilateral. In addition, depending on the severity of the vicious structure of the tissues, complete and incomplete doubling are distinguished. In each specific case, it is necessary to conduct the necessary examination in order to assess the situation with urinary excretion and blood purification as accurately as possible.

Full doubling option

An anomaly forms on both sides or in one kidney - doubling of the pyelocaliceal system (PPS). An important feature is that in most cases the lower part is better developed than the upper. And between the two connected organs there is a dividing groove of varying degrees of severity. 2 ureters depart from two pelvises. The result of a congenital defect is the formation of a double organ (even if the anatomical and functional separation is not complete).

Incomplete anomaly

The division of the parenchyma into two parts, the formation of a double renal sinus with one ureter refers to incomplete doubling of the kidney. One pelvis for 2 fused parts of the organ is also not a complete defect. In any variant of abnormal development, the blood supply is carried out through the doubled renal artery. It is necessary to conduct a full examination in order to most accurately assess the situation with the vicious formation of the urinary system.

Diagnostic tests

The basis of the examination is hardware techniques that allow visualization of kidney duplication. Given the importance of accurately assessing the number and location of renal structures, it is necessary to use ultrasound, endoscopic and x-ray diagnostic methods.

Ultrasound scanning

When performing an ultrasound, the doctor will be able to evaluate all congenital abnormal changes in the parenchyma, sinuses and pelvis of the left and right kidneys. The most accessible and non-invasive diagnostic method is used at the first stage of the examination, allowing a diagnosis to be made even in cases where there are no symptoms. Often, it is during preventive ultrasound examinations that doubling of the kidneys is accidentally detected.

Cystoscopy and chromocystoscopy

Endoscopic techniques are designed to locate the ureteral orifice in the bladder. Cystoscopy allows you to examine the cavity, and the use of a contrast agent (chromocystoscopy) clearly shows the doctor a change in location and the number of ureteric orifices (2, 3 or 4) extending from the kidneys.

Excretory urography

X-rays can be used to check how the contrast is progressing through the urinary tract. Excretory urography will help detect the following serious problems caused by double kidneys:

• Reflux from the bladder into the ureter, which occurs against the background of an abnormal structure.
• Incorrect location of the ureteric orifice (ectopia) in the wall of the bladder.
• Abnormal location of the ureter (finding the opening in the vaginal area or entering directly into the urethra).

If difficulties arise in diagnosis, you can use tomography (CT, MRI), which will create a three-dimensional picture of the pathology. General clinical tests will help assess renal function - most often, double kidneys do not have a negative effect on the formation and excretion of urine. But, as with any other congenital defect, the likelihood of complications remains, which requires monitoring the functioning of the urinary system throughout life.

Symptoms

The double kidney itself does not appear outwardly in any way. Symptoms of the anomaly are realized through concomitant pathological conditions associated with inflammation, organ enlargement or severe functional impairment. A clear sign of a fused double kidney is urine leakage through adjacent anatomical structures, indicating an ectopic location of the ureters. With urolithiasis or with hydronephrotic dilatation, the following symptoms appear:

• Severe pain in the side on the right or left;
• Temperature jumps;
• Blood in the urine.

Congenital pathology is often accompanied by pyelonephritis with typical symptoms.

Therapeutic measures

Asymptomatic and uncomplicated kidney duplication does not require treatment - it is enough to monitor the functioning of the urinary organs and prevent possible inflammation. If problems arise, the approach to therapy is individual and depends on the following factors:

• Age;
• Preservation of functions in abnormal kidneys;
• The presence of chronic diseases and complications.

Treatment tactics for children and adults are always different. When maintaining the functional activity of the organ more than 60%, drug therapy is used. If the situation worsens and there are indications, surgical intervention is used.

Drug effects

The main purpose of the medicinal effect when doubling the kidneys is to support the normal functioning of cleansing the body of unnecessary substances and preventing renal inflammation. The main thing is to prevent the formation of complications. In most cases, the use of herbal preparations that have a uroseptic effect is sufficient.

Surgery

If necessary and according to indications, surgical treatment methods are used. There are 2 types of operations - organ-preserving and radical. In the first case, partial removal of the duplicated kidney structures is performed. If the renal parenchyma is completely destroyed, nephrectomy must be performed.

Consequences and complications

There are often cases when a person lives peacefully, without even knowing about a congenital disease. But any developmental defect (and kidney duplication is no exception) is a constant risk of dysfunction and complications. In case of unfavorable development of events, the following complications are possible:

• Acute pyelonephritis with a high risk of blood poisoning (urosepsis);
• Formation of stones (urolithiasis);
• Hydronephrosis;
• Wrinkling;
• Progression of chronic renal failure;
• Malignant degeneration.

The most dangerous thing is when bilateral renal duplication is detected in a child - everything is still ahead, the chances of an unfavorable development of events are great, the “sword of Damocles” of the disease will hang over the baby all his life.

Prevention and prognosis

The only possible measure to prevent congenital malformations is to protect the pregnant woman as much as possible from any teratogenic environmental factors (the most dangerous time is the 1st trimester of pregnancy). You can try to exclude the genetic factor: by contacting a geneticist, preferably based on family history and the presence of risk factors, calculate the likelihood of having a sick child.

The prognosis is always individual, and largely depends on the functional state of the urinary system. You can live your whole life without problems with bilateral kidney duplication. Or, starting from childhood, constantly be observed and treated by a nephrologist for pathology on one side.