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

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Congenital anomalies of the kidneys are not uncommon in nephrology, especially in children. In terms of prevalence, the leading position is occupied by such an anomaly as a doubling of the kidney, which belongs to congenital pathologies, since it develops during the period prenatal development fetus.

According to medical observations, doubling of the kidney in a child is diagnosed by chance during a planned or unscheduled ultrasound examination. In girls, this anomaly occurs twice as often as in boys. Pathology can affect one or both lobes of the organ, manifest itself on both sides, do not manifest itself in any way or provoke serious complications in the work of the urine. excretory system and internal organs of the child.

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

Doubling of the kidneys is an abnormal growth of the organ. In the process of the development of the disease, the kidney, its one or two lobes, doubles, forming three or four organs. Pathological growth of the organ in children develops during the period of active organogenesis of the first trimester of pregnancy.

Externally, the doubled kidney has the appearance of fused organs that have their own circulatory system. Pathology can affect the left or right kidney, but in 10% of cases, organs are doubled on both sides. Doubling right kidney much more common than the left. As practice shows, doubled kidneys in a newborn or an older child do not cause much discomfort. A person can live most of his life with an anomaly, unaware of 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 proliferation 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:

ionizing radiation of the mother in the first trimester of pregnancy;
the use of potent drugs during embryonic development fetus;
avitaminosis;
heredity;
alcohol abuse;
smoking.

There are other reasons that can disrupt the development of the fetus, provoke a violation of cell division, chromosome structure, followed by the formation of kidney anomalies.

Types of anomalies

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 drain into bladder. In some cases, abnormal PCS is present, in which the ureter passes into the urethra. Despite the abnormal structure, the lobes of the organ can filter urine.

Incomplete duplication of the kidney is much more common, while with the same frequency it can damage the right or left lobe organ. Sometimes there is the formation of two pelvises, but the pelvic system is poorly developed. Incomplete duplication of the left kidney leads to an abnormal increase in the organ, its structure is mainly asymmetric, while top part less developed than the lower one.

Symptoms of pathology

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

complaints of frequent headaches;
pain when urinating;
difficulty urinating;
increased weakness;
periodic increase in body temperature;
cloudy urine;
feeling of pain in the lower back.

characteristic feature inflammatory process when the tissue of the kidneys doubles, the appearance of pain in the lumbar region, which is mainly aching in nature, is considered. In the acute period of the disease, there is fever body up to 40 degrees, swelling of the face and limbs. Such symptoms should be the reason for contacting a nephrologist and undergoing ultrasound diagnostics.

Complications

An anomaly in which the organ is duplicated does not pose any threat to health, but such children are still at risk for the development of diseases of the urinary system. It is known that with this anomaly, 30% of patients at an older age develop pyelonephritis. 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, take lab tests.

Diagnostics

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

Urography.
Ultrasound of the kidneys.
Dopplerography.
Analysis of urine, blood.
Cystoscopy.

The doctor may prescribe other research methods that will help to get a complete picture of the disease, recognize the 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 has joined the anomaly.

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

In pathology with doubling of the 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, reduce the risk of complications. When a bacterial infection has occurred, the following may be prescribed:

Antibiotics.
Anti-inflammatory drugs.
Uroseptics.
Immuno-fortifying drugs.
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 kidneys. It all depends on the final diagnosis. If a congenital anomaly does not disrupt the functioning of the urinary system, does not manifest itself in any way during life, then there will be no indications for a deferment from the army. With constant infectious exacerbations, the medical board will give a conclusion on unsuitability for military service.

Prevention

A congenital anomaly of the kidneys is easier to prevent than to live with it throughout life. This anomaly refers to intrauterine pathologies, so the entire responsibility lies with the expectant mother. Some preventive rules will help reduce the risk of development:

Healthy lifestyle.
No contact with toxic substances during pregnancy.
Complete cessation of smoking and alcohol.
Regular ultrasound examination.
Balanced and fortified diet.
Hardening of the body.
Avoid hypothermia.
Avoid contact with sick people.

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

Kidney duplication is a congenital pathology, which in most cases occurs in girls and is more often unilateral. The reasons for this phenomenon are very different. The doubling of the kidney begins to form and develop in the child even in the womb.

Doubling of the kidneys. What it is?

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

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

Structure of the renal pelvis

This funnel-shaped structure is formed by the fusion of the large and small calyxes of the kidney. It is in the pelvis that urine accumulates. The surface of the inner part of the pelvis is covered with a mucous membrane. In the wall of the pelvis there are fibers that make 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 substances dissolved in it never enters the peritoneal cavity, but always remains within the urinary system.

Complete doubling of the kidneys

Sometimes a person is diagnosed with a complete doubling of the kidney. What it is? This is an abnormal phenomenon when the kidney is divided into two parts by a groove. The upper and lower lobules stand out, 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. There are also own ureters. Each goes separately and ends in the bladder with its mouth. Perhaps the confluence of one ureter into another.

So, instead of one, there are two separate kidneys. In itself, the complete doubling of the kidney does not bother a person, so it does not need to be treated. But it leads to other diseases.

Problems that occur when a kidney is duplicated

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

Incomplete duplication of the kidney

This pathology is observed when a person has one large kidney with clearly defined upper and lower sections. Each of them has its own renal artery. H, each part of the doubled organ does not have its own pelvicalyceal system, they have one for two departments. There are two ureters, but they are interconnected and flow into the bladder as a single trunk, as one.

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

Causes of duplication of the kidney

If the pathology does not manifest itself in any way, which happens when a person has an incomplete doubling of the left kidney or the right one, it doesn’t matter, you may not 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 doubling of the kidney in a newborn baby. The reasons for this phenomenon can be very different. Let's consider some of them:

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

The presence of bad habits in a pregnant woman: alcohol abuse, drugs, etc.
Often and regularly manifested beriberi during pregnancy. There are many places on our planet where vegetables and fruits do not grow due to harsh climatic conditions. But even there women live and give birth to children. So the expectant mother suffers from a lack of vitamins and useful minerals. Well, if everything works out, and the child does not have such a disease as a doubling of the kidney. Of course, there may be other reasons, but this one can be excluded for the sake of the health of the unborn baby.

Diagnostics

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

When a person does not have pathology, then in his body there are only two mouths of the ureter: one for each kidney. If the doctor suspects a duplication of the kidney, the patient is assigned a cystoscopy. With its help, it is determined how many mouths the ureter has: if three, then the diagnosis of "doubling of the kidney" was confirmed. To determine the size of the enlarged kidney and to identify the presence or absence of the third renal pelvis and accessory ureter, the doctor prescribes excretory urography.

Doubling of the kidney does not manifest itself in any way. It does not need to be treated until it causes some other disease of this organ. Signs of duplication of the kidney are different. Usually inflammatory processes are characterized by:

An increase in temperature.
Weakness and swelling.
Nausea and vomiting.
Regular headaches.
An increase in pressure.
Cloudy urine.
Reverse flow of urine.
Discomfort and pain in the lumbar region.
Urinary incontinence.
Discomfort when urinating.
Renal colic.
The occurrence of infection in the urinary tract.

Whether all the symptoms appear at once or each separately, will depend on the disease.

Doubling of the kidneys 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 regularly undergo 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 fix a defect. He throughout life can not cause trouble to a person.

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 with conservative methods, then they 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 performance.

Prevention

If during the examination a doubling of the kidney was found, there is no need to panic. This diagnosis is not fatal. When the pathology of the organ does not bother, it will not affect the quality of human life in any way. You need to take better care of your health:

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

If one of the relatives has a doubling of the kidney, what it is is known to the whole family. Therefore, when a woman from your family will bear a child, you need to treat this period with double attention. A 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, medications that can cause poisoning of a child.

Currently, incomplete duplication 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 signs, but at the same time, a high tendency of the patient to damage the kidneys with chronic nephropathies is revealed.

With the development incomplete doubling There can be two options for the course of pathology:

The kidney receives its nourishment from one artery and has two pelvises.
It has only one pelvis, but at the same time there are 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 is not formed, even despite the appearance of two pelvicalyceal systems at once - this happens due to the preservation of the capsular coating of the organ.

Each half of the pathological organ has its own blood supply. The vessels of this organ can exit in a common column - this is how the division is formed already nearby, not far from or at the very sinus, or can depart directly from the aorta. Some arteries located inside are able to pass from one kidney to another - this is very important to consider when performing an organ resection.

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

It is important! As a rule, incomplete duplication of an organ is not at all dangerous and does not imply any clinical conclusion, in contrast to the development of a full duplication. The only danger in this situation is the option in which the pyelocaliceal system doubles, as well as the ureters. To make a correct diagnosis, an 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 a doubled kidney open at once with holes directly into the bladder, occasionally the ureter splits, which has one hole in the pelvic region and one trunk, in its upper part splits and unites with the pelvis. The ureters can split into various levels. If there are two ureteral openings at once on one side of the bladder, then the opening of the lower pelvis adjoins the opening of the ureter of the pelvis located above. Often, the ureters intertwine along the way—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 preserved. The upper part of the right or left kidney is mainly affected, which slows down the continuous flow of fluid, therefore, contributes to the development of hydronephrosis of the kidney and the formation chronic process inflammation. If a pathological process does not develop in a double kidney, then clinical symptoms are not observed. In this regard, the disease is more often diagnosed by chance.

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

A person diagnosed with an incomplete duplication of the kidney can live long life without complaints and health disorders, and pathology is detected by chance ultrasound examination. Doubling affecting the ureters is more often the cause of vesicoureteral reflux due to the defective functioning of the closing functions of the mouths. Reflux is usually realized 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 the expansion of the ureter.

Usually incomplete duplication of the kidney does not involve special diagnostics. Full doubling in this case is detected after the onset of the development of the inflammation process. Any doubling can be easily detected by X-ray or ultrasound.

The diagnosis of the lesion is established on the basis of the results obtained after cystoscopy, excretory urography, ultrasound. Excretory urography makes it possible to examine the work of each of the parts of the doubled kidney, its anatomical and structural changes. An important role in the diagnostic process is played by ultrasound and computed tomography.

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

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

Treatment of the disease primarily involves the therapy of the acquired infectious process or pathology such as urolithiasis or pyelonephritis. By itself, incomplete doubling is not a disease, but this pathology significantly increases the risk of developing an inflammation process. If the lesion of the doubled kidney becomes chronic and difficult to treat, then the doctor prescribes a resection to the patient.

It is important to know that the identification of incomplete doubling of this organ in a person is recommended to start adhering to healthy lifestyle life. IN without fail it is necessary to prevent the influence of toxic factors on the body - for this you will need to stop using alcoholic beverages, from smoking.

Also, the doctor reviews drug therapy, turning Special attention to the diet. It is important to remember that the kidney will function properly until it becomes difficult due to malnutrition and adverse living conditions.

It is imperative to organize events aimed at hardening the body, as well as gradually lead physical training. Thus, a person can prevent many of the lesions and complications that a doubling of the kidney provokes. A specialist can help you shape your diet and lifestyle.

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

In this article, we will introduce you to the causes, signs, differences, methods for diagnosing and treating complete and incomplete duplication of the kidney. 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.

With a bifurcation of the kidney, the blood supply and parenchyma of the anomaly always bifurcate, and the ureter and renal pelvis do not always undergo doubling. The additional ureter arising from such a malformation can enter the bladder, connecting with 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, it 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.

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

Most often, such an anomaly of development 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 cavity of the bladder through the common duct. This kind of duplication of the kidney is more common. Not completely doubling equally often can both the right and left kidney. In this case, the following morphological structure of the altered 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 sinus of the kidney, or these two arteries depart directly from the aorta;
each part of the duplex kidney has its own blood supply.

In some cases, a person with an incomplete bifurcated kidney may not feel the presence of an anomaly for life, and the pathology is detected by chance when diagnosing other diseases.

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

With a complete bifurcation of the kidney, each of the formed organs is able to filter 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 a 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 connect with the main one and does not flow into the bladder, but opens into the intestinal lumen or vagina. In such cases, the child 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 differentiation induction in the metanephrogenic blastoma. Such a violation occurs even during fetal development. Most often such pathological changes arise due to the transfer of a mutated gene from parents or under the influence of teratogenic factors affecting the body of a pregnant woman and fetus.

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

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

In most cases, doubling of the kidney long time is completely asymptomatic or detected incidentally during preventive examinations in the diagnosis of other diseases.

Often, pathology manifests itself only after the occurrence of its complications. One of the most common consequences of duplication of the kidneys in children is an infectious lesion of the urinary tract. In addition, narrowing of the ureters at the point of their confluence can lead to circulatory disorders, worsening of the outflow of urine and its 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 an infectious lesion of the urinary organs (frequent urination, fever, pain and discomfort during urination, pus in the urine, etc.);
swelling of the limbs;
pain in the lumbar region (from the side of doubling the kidney);
positive symptom of Pasternatsky;
expansion of the upper 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 probability of occurrence of certain symptoms from the above signs of duplication of the kidney 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 complete diagnostic examination: pass urine and blood tests, conduct an ultrasound scan and, if necessary, others instrumental research. After analyzing the data obtained, the doctor will be able to determine the possibility of planning a conception. The onset of pregnancy with such a pathology is contraindicated in the detection of renal failure and indications for surgical treatment.

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

Doubling of the kidney in the fetus can be detected by ultrasound at 25 weeks of gestation.

Usually, signs of kidney doubling are detected by an ultrasound 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 (general view);
ascending and excretory urography;
radioisotope scanning;
cystoscopy.

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

If the doubling of the kidney proceeds without complications, then the patient is recommended for follow-up with a urologist. He will need to periodically conduct an ultrasound of the kidneys and take urine tests at least once a year. To prevent complications, compliance is required 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 for the prevention of infectious diseases.

Drug treatment for doubling the kidneys is prescribed for 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;
adherence to a diet for the prevention of urolithiasis.

Surgical treatment for duplication of the kidney is prescribed only in cases where the resulting complications 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 become indications for its implementation:

urolithiasis, not amenable to conservative therapy;
vesicoureteral reflux;
severe forms of hydronephrosis;
urethrocele (expansion of the urethra with the formation of a cavity).

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

Ureteral stones can be removed after crushing through a cystoscope. If such an endoscopic procedure is ineffective, then the removal of the calculus 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;
the imposition of ureterouretero- or pyelopyeloanastomosis - the creation of anastomoses to eliminate the reverse reflux of urine;
ureteral tunneling 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 kidney function, the patient is recommended dialysis. If the kidney ceases to cope with the filtration of urine, then the patient is assigned a nephrectomy. Subsequently, the patient may undergo a kidney transplant operation from a donor.

When the ureter is abnormally drained 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 the creation of a new mouth of the ureter;
transurethral incision - endoscopic surgery to remove the urethrocele.

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

If a duplication of the kidney is detected, the patient is recommended to be observed by a urologist. For dynamic monitoring of the anomaly of the kidney, ultrasound and urine tests will be performed. For a more detailed clarification of the clinical picture of the pathology, the following methods studies of the urinary system:

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

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

The doctor of ultrasound diagnostics talks about doubling the kidney:

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

IN modern medicine duplication of the kidney is understood as a complete or partial duplication of the renal system as a result of congenital pathology kidneys.

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

Causes

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

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

Incomplete duplication of the kidney

The most common violation is incomplete doubling, here the organ is enlarged, and the upper and lower sections are clearly defined in it, with each section having its own renal artery. With incomplete doubling of the kidney, there is no bifurcation of the pelvicalyceal system, it works alone.

With full doubling, instead of one kidney, two are formed. When the left organ is doubled on the left, a double 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 that flows 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 happy ignorance of this anomaly.

The diagnosis is usually made by chance at a routine examination in the clinic.

To clarify the diagnosis, use:

ultrasonography;
method computed tomography;
radiography;
magnetic resonance urography;
cystoscopy or ascending urography helps to clarify the diagnosis even more.

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

With ascending urography coloring substances are introduced, distinguishable on X-ray pictures. The picture shows the ureters, their place of entry, and in case of incomplete doubling, the dilated pelvicalyceal system.

Treatment

Treatment of duplication of the kidney they are prescribed only with the development of any complications, and if this anomaly does not cause special concerns to a person, then they are limited to monitoring it.

Observation consists of:

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

Treatment of complications:

If there are inflammatory complications then the doctor will have to select antibiotics, usually a wide range actions;
When the kidney is doubled, stones can often appear with all the ensuing consequences, for example, in the form. In this case, analgesics, antispasmodics and herbal remedies such as kidney tea are prescribed;
Surgical intervention is prescribed only in severe cases of hydronephrosis, or with the development of complications that are not amenable to drug treatment, and the main task of the surgeon here is to save the organ;
If a doubling of the kidneys is determined in a woman, then she must plan the pregnancy in advance, must undergo a complete clinical and laboratory examination And .

Doubling of the kidneys in a child can be determined even in utero, by performing an ultrasound scan after twenty-five weeks of pregnancy.

Prevention of complications

A kidney with an abnormal development is more vulnerable, and preventive measures are urgently needed here:

a person should stop eating excessive amounts of salty foods;
can not be supercooled;
it is essential to treat all infections promptly 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 frequent birth of infants with malformations of the urinary organs. Such anomalies deserve close attention due to the fact that congenital inferiority of the intrarenal circulation, coupled with the accompanying urodynamic disorders, creates a suitable ground for the development of serious inflammatory diseases, For example, chronic pyelonephritis. The most common pathology of kidney development is their one- or two-sided doubling; most of those suffering from this defect have the first of them. This anomaly occurs in about 1 in 150 newborns.

What is kidney duplication

The doubled kidney is much longer than the normal one. Like other anomalies in the development of the urinary organs, this defect is three times more common 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. Such kidneys are located in their usual place.

There is both complete and incomplete doubling. In the first case, each of the halves has its own ureter and pelvic-cup system. The pelvises are placed one above the other and, despite the fact that they are united by an isthmus from connective tissue, do not communicate with each other.

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

The additional ureter is completely separated from the main ureter, in this case both of them are connected to the bladder separately and each has its own mouth. In this situation, they speak of a complete doubling of these organs. The mouth of the lower half is always located higher on the bubble than the mouth of the upper half.

However, incomplete duplication of the ureters is also possible, when they are connected in one place in one direction and end in the bladder with a common mouth. Most often, the fusion occurs in areas of physiological narrowing, but it can also occur on any segment of the trunk. Even with preserved anatomical patency of the junction of the ureters, there is a violation of the passage of urine in this segment; in this case suffers upper half kidneys. The outflow of urine from the upper pelvis is difficult 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 section of the doubled kidney (excessive expansion and stretching of its hollow parts).

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

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

The incomplete form of the anomaly is a doubling of the parenchyma and vasculature organ with a normal number of pelvises and cups.

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

Both halves of the kidney are supplied with blood 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 the flesh supplied by them.

Doubling of the kidneys and ureters occur in various combinations

Causes of pathology

intrauterine simultaneous formation of both ureters from their two rudiments;
bifurcation of a single ureteral 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 - the bifurcation (or partial doubling) of its trunk. In different patients, both types of impaired embryonic development are observed with the same frequency. Sometimes this anomaly is inherited from parents.

Symptoms

Functional and anatomical failure of the kidney with doubling of its structural elements, difficulties in the passage of 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 and complaints. Therefore, doubling of the kidney is often detected by chance, when examining a patient in medical institution for any other ailment or urological problem on the other side of the body.

In the case of a complete duplication of the ureter and the location of an additional mouth in an unnatural place, for example, in women in the uterus, in the vagina or in the urethra, a characteristic and very unpleasant symptom is observed: constant involuntary urination, while the ability to an independent act of urination and urge to it remain. Not knowing about the existence of an additional excretory opening, the phenomenon is mistaken for urinary incontinence caused by weakness of the external bladder sphincter.

If one of the ureters of a doubled kidney ends not in the bladder, but, for example, in the urethra, then there is a constant leakage of urine.

Another frequent companion of a doubled ureter is a ureterocele - a sac-like protrusion of its end into the bladder. It is usually formed in the region of the mouth of the accessory ureter of the upper part of the doubled kidney. This pathology may not cause any inconvenience to the patient, but if the formation has reached large sizes, it is able to put pressure on nearby large vessels and cause pain that radiates to the leg, besides, in women, it mimics the prolapse of the bladder (cystocele). The ureterocele is characterized by a 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 the formation of stones in its cavity.

The ureterocele interferes with the normal emptying of the bladder, so it occurs in two stages

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

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

Why does a double kidney cause pain

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

moving the mouth of the ureter down or sideways;
shortening of one or both trunks of a bifurcated ureter;
ureterocele in the vesical region of one of the ureters.

With the anomaly of the kidneys under consideration, the following types of reflux occur:

Interureteric. Fluid is thrown from one ureter to another at the point of their articulation.
Urethral-ureteral. Occurs when the ureter in men flows into the back (deepest located) 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 at once on the side of the lesion.
Vesicoureteral. Usually occurs in the ureter belonging to the lower part of the doubled kidney. This trunk, as a rule, 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 doubled kidney, its reflux into the ureter of the upper half of the organ is observed when its mouth is located in the region of the bladder neck. Or in both trunks, if their holes are shifted downwards and are close to each other.

With vesicoureteral reflux, urine does not enter the bladder due to any obstacle, 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 one to undergo various diseases. This is predetermined by circulatory and urodynamic disorders in the abnormal organ.

Pyelonephritis

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

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

Hydronephrosis and hydroureteronephrosis

Often accompanying doubling of the kidney reflux, ureterocele, narrowing of the accessory ureter and incorrect location of its mouth 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 renal failure. In the second disease, the ureter of the pathological organ is also involved in the expansion process.

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

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

A characteristic clinical sign of hydroureteronephrosis that has arisen against the background of an incorrect (extravesical) localization of the ureteral opening is a constant leakage of urine from 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 doubled kidneys

Urolithiasis disease

In connection with the stagnation of urine caused by violations of urodynamics, calculi (stones) are often formed in the organs of the urinary system. Urolithiasis with doubled renal pelvis and ureters, it is interesting that pyelonephritis very often joins it.

Table: diseases that occur against the background of doubling the kidneys

Is pregnancy possible

Naturally, every young woman who has a duplication of kidneys is interested in the question: is she destined to know the joy of motherhood? Observations of doctors have established that yes, pregnancy and childbirth with such an anomaly is quite possible. However, the most complete and detailed urological examination of patients who want 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 future mother is of great importance for preventing the occurrence of serious complications during pregnancy, when the kidneys work under conditions of increased stress. It is impossible not to take into account the high risk of developing pyelonephritis during this period. But if the doubled 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 the case when the anomaly is accompanied by hydronephrosis, a significant narrowing of the ureter, urine leakage or other complications requiring urgent intervention, family replenishment can be planned only after surgical correction vice. If the doubling of the kidney was first detected against the background of an already onset pregnancy, then the issue of continuing and maintaining the latter is decided by the obstetrician-gynecologist together with the urologist.

Diagnostics

Diagnosis of duplication of the kidneys is not difficult and is usually available in outpatient settings polyclinics. The diagnosis is made on the basis of ultrasound, cystoscopic methods and X-ray excretory urography. Sometimes, a renal angiogram, the study and evaluation of blood vessels, may be needed. Great value for correct diagnosis have patient complaints about urine leakage while maintaining normal urination. They give reason to suspect the presence of an additional ureter, which opens into organs adjacent to the bladder.

ultrasound

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

This is how hydronephrosis of the lower half of the right doubled kidney looks on the ultrasound image

Video: the doctor talks about doubling the kidneys and about the ultrasound diagnosis of the anomaly

Cystoscopy and chromocystoscopy

Cystoscopic examination - examination of the bladder cavity through the urethra using an optical apparatus (cystoscope) - will provide invaluable support in the diagnosis of complete doubling of the ureters and kidneys. During it, with a one-sided anomaly, three are revealed, and with a two-sided - four mouths. Often this study is enough to detect such a pathology.

Cystoscopy can be performed with either a hard (in women) or a soft (in men) cystoscope.

If the interpretation of the data obtained is difficult, then to clarify the diagnosis, an additional chromocystoscopy is performed - an examination of the inner membrane of the bladder in combination with the determination of the evacuation and secretory functions of the kidneys. The doctor observes the mouths 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 state and functions of each part of the duplicated organ, to see the anatomical and structural transformations in the kidney. In connection with the frequent thinning of the parenchyma of the upper half, for its full-fledged study, it is necessary to inject a double amount of an iodine-containing radiopaque substance into the patient's vein.

The image obtained by excretory urography shows a complete bilateral doubling of the pelvis and ureters

Before the procedure, the individual sensitivity of a person to such drugs should be checked. Excretory urography helps to detect duplication of the pelvis and ureter when the main and additional trunks merge before they flow into the bladder, which cannot be seen in any other way.

The survey urogram shows the shadow of the kidneys, increased in length. Several pictures taken one after another with 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 with this anomaly, based on the state of the cavity of the other, functioning half, doubling of the pelvis and ureter can be suspected.

With the help of excretory urography, both complete and incomplete doubling of the urinary organs can be determined: this picture shows how the two left ureters merge into one

With 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 the introduction 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:

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

Hydronephrosis and hydroureteronephrosis with a double kidney are treated exclusively by surgery. During the intervention, the cause that caused these complications should be eliminated. If, in case of damage by hydronephrosis, the presence of stones in the pyelocaliceal apparatus, or a 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. Kidney removal (nephrectomy) in young people, and even more so in children, is performed only in case of its complete irreversible non-viability.

In the absence of function of the affected part of the doubled 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, because if at least a small remnant of it 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 have to undergo complex surgical intervention again.

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

ureteroureteroanastomosis - the surgical organization of the fusion of the pelvic 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 doubled kidney.

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

These interventions are carried out with hydronephrosis of one of the halves of the doubled kidney in order to eliminate the reverse reflux 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 a doubled kidney

Forecast

Owners of a double kidney outwardly do not differ from ordinary people and, if complications do not join, they can lead a normal life. They have to be registered with a dispensary, often visit a urologist and undergo examinations from time to time, but this is not a big problem. In a number of cases, a double kidney will never disturb its carrier during a lifetime.

The danger of this anomaly lies in frequent development in such patients of inflammatory diseases, fraught with chronic insufficiency of kidney function. If this happens, then only a transplant of a donor organ can save a person's life.

Among those who died from chronic renal failure, doubling of the kidneys in any form was in every 125 of them.

Do they take with a double kidney 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 exertion on the body, and if the kidneys are doubled, complications can appear at any time, few of the young men of military age who were born and raised with this anomaly, and their mothers do not care about this topic. To find out if they take soldiers with such a defect, one should refer to the "Schedule of Diseases", which lists the diseases and categories of a young man's suitability for military duty in each case. It is this document that guides the draft board, passing a verdict on the possibility of attracting the future defender of the motherland to serve in the army.

Doubling of the kidneys refers to violations of the urodynamics of the upper urinary tract and is included in the list of diseases listed in paragraph "b" of Article 72 "Schedules of Diseases". Therefore, a conscript with this feature belongs to category "B" - limitedly 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", he is subject to exemption from conscription for health reasons, 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 the available this moment education and skills. For example, he will be able to work in a factory for the manufacture of parts or household items for the front or in a hospital to care for the wounded.

While serving in the army, soldiers have to experience significant physical exercise, to endure cold and heat, to endure burdens; 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 be classified as “B”, that is, the commission recognizes him as fit for military service with minor restrictions . The issue of belonging of this citizen to category "B" is decided individually. The same applies to conscripts who go into the army on a contract basis. After all, you can learn such a military profession, thanks to which the young man will take part in the defense of the Fatherland, without overstraining physically and without risking his health. So, the owner of a double kidney will never become a paratrooper or submariner, but service in the signal troops is quite accessible to 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 my own extensive experience in the treatment and care of patients.

Currently, duplication of the kidney in a child is the most common form of pathological development of the organs 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 defeat often comes to light at children, especially at 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 doubling, the organ is divided into two parts with its own ureters, which open with separate mouths into the bladder.

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

Signs of duplication of the kidney include:

Stones in the kidneys.
Pyelonephritis.
Omission of an organ.
Hydronephrosis.

The manifestation of pyelonephritis in the development of a doubling of the kidney in a child contributes to improper urine output, because this pathology is usually supplemented by a protrusion of the ureteral wall in the likeness of a hernia. These same reasons affect the formation of kidney stones.

Anatomical picture of a double kidney

According to its anatomical structure, a doubled kidney looks like 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. renal 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 be combined with the main ureter in any of its often before entering the bladder. At the junction of the two ureters, a narrowing often appears, provoking a violation of the proper discharge of urine, its reverse reflux into the pelvis and hydronephrosis.

Reasons for the formation of doubling in the body

Doubling in the kidneys, as well as other intrauterine pathologies, is mainly correlated with the influence of teratogenic factors on the body, with the transfer of the pathological gene to the child from his parents.

The most popular and frequently occurring in modern medicine factors of pathological effects on the human body include ionizing radiation of the mother's body during pregnancy in the first months of gestation, the use of hormonal drugs, certain chemical compounds, and a lack 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 a doubling of the left kidney in a child or the 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 quite by accident when a targeted CT scan or radiography of the kidneys is performed.

Complete duplication with the development of the second ureter and the place of its confluence with the bladder can be diagnosed using cystoscopy after the discovery of the third mouth. However, most patients with incomplete duplication of the kidney, with the left or with right side, live full life and do not even suspect that this disease develops in their body.

With full doubling, clinical signs are based on symptoms of inflammation that form in the kidneys, on the development of urinary reflux and hydronephrotic transformation. So the person starts complaining 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. With the expansion of the lumen renal pelvis colic, edema develop, blood appears in the urine, blood pressure rises.

It is important! The listed symptoms are considered specific and appear simultaneously or separately - it depends on the form of the course of the disease.

The diagnosis of duplication of the kidney is made after the implementation x-ray examination, MRI, computed tomography, ultrasound 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, wrinkled, and the work of the segment atrophies.

An ultrasound examination establishes the formation of a cystic neoplasm in the upper part of the pole, and the diagnosis is made by excretory on the basis of the following indirect signs: the absence of the upper calyx in the lower pelvis, the displacement of the pelvis down, its deformity, the 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 healing process

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

It is important! Thus, with pyelonephritis, traditional therapy by taking antibiotics. With the development of acute nephrolithiasis or, in other words, colic, the patient is provided with the usual assistance: immersion in a bath with warm water, introduction antispasmodic drugs. Strict adherence to a diet prescribed by a specialist is recommended, which allows you to destroy already formed kidney stones.

Surgical operation is performed only with a pronounced hydronephrotic transformation or other conditions that make it impossible to carry out conservative treatment. Doctors in this case prefer organ-preserving operations, and nephrectomy, that is, complete removal organ, is performed when incomplete duplication of the right kidney or another form of the described anomaly provokes a complete loss of the ability of the kidney normal operation. But this happens only when the disease process is started and there is no necessary measures treatment and prevention.

Among developmental abnormalities, anomalies of the kidneys occupy one of the first places, and duplication of the kidney is the most common anomaly of this organ. This term refers to 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 can be noticeable, and blood flows to it through two renal arteries, although normally the blood supply is through one artery.

Kinds

There are complete and incomplete doubling of the kidney, and the anomaly can occur both in only the left or right organ, or in both at the same time. In the latter case, one speaks of a bilateral deviation in the number of kidneys. With complete doubling, each of the parts of such an organ has its own pelvicalyceal system and ureter. The accessory ureter can be completely separate and drain into the bladder (complete duplication of the ureters) or merge with another, thereby forming one common trunk ending with one mouth in the bladder (incomplete doubling of the ureters).

Attention! In some cases, duplication of the kidney is accompanied by the presence of malformations of the accessory ureter - ectopia of the mouth and opening not into the bladder, but into the vagina or intestines, which is fraught with involuntary excretion of urine while maintaining an independent controlled act of urination.

Pathology is diagnosed using:

cystoscopy;
urography;

Causes of the anomaly

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

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

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

Important: duplication of the kidney is more common in women.

Symptoms

Regardless of whether there is a doubling of the left kidney or the right one, this does not affect the state of the body and its performance. Therefore, in most cases, this developmental anomaly is detected quite by accident, for example, during examinations for other diseases, during pregnancy, etc.

But still, sometimes a double kidney can cause pain when total absence any pathological processes. This is due to the fact that due to an anomaly in the structure, urodynamics is distorted in it or interureteral refluxes may be present. Also, the patient may have a positive symptom of Pasternatsky.

Possible dangers

Incomplete duplication of the left kidney or the right one is associated with a lower risk of developing other diseases than with complete duplication, since urodynamic disturbances in this case are insignificant. Nevertheless, 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.