Hydronephrosis

　　Hydronephrosis can be divided into primary and secondary types. Primary hydronephrosis is also known as congenital hydronephrosis, spontaneous hydronephrosis, idiopathic hydronephrosis. The main cause is the obstruction at the renal pelvis ureteral junction, which is often due to a large number of collagen fibers separating the muscle cells at this site, losing their normal arrangement, and being unable to effectively transmit electrical activity from the pacemaker cells, blocking the normal transmission of peristalsis.

　　Congenital hydronephrosis is mostly caused by mechanical obstruction, and its main causes include:

　　Abnormal blood vessels: such as vagus vessels from the lower pole of the kidney pressing on;

　　Fibrous strands;

　　High insertion of the ureter into the renal pelvis;

　　Narrowing and valve at the renal pelvis ureteral junction;

　　Local ureteral tortuosity caused by membranous adhesion, congenital hydronephrosis can also be caused by dynamic reasons, such as segmental non-dynamic functional disorder.

　　Two, secondary hydroureteronephrosis is often caused by other diseases of the urinary system. Generally, the primary disease can be found through routine examinations. Some diseases require special examinations for diagnosis. These diseases mainly include:

　　① Obstructive lesions of the upper urinary tract, tumors, polyps, stones, tuberculosis, inflammation, injury, malformation, diverticula, nephroptosis, etc.;

　　② External compression of the upper urinary tract, abdominal, pelvic, or retroperitoneal masses, idiopathic retroperitoneal fibrosis, ectopic vessels, venous compression by ovarian veins during pregnancy and menstrual periods;

　　③ Lower urinary tract obstructive lesions, benign prostatic hyperplasia, prostate cancer, urethral stricture, vesicoureteral reflux, etc.

　　The specific complications of hydroureteronephrosis are as follows:

　　One, renal atrophy

　　This is an important harm caused by hydroureteronephrosis. Due to the damage to the renal pelvis and ureter, urine excretion is obstructed, the renal pelvis expands, the intrarenal pressure increases, and the renal tissue vessels are compressed, leading to ischemic progressive atrophy and destruction of the renal tissue, and renal function damage. In severe cases, the kidney becomes a non-functional large cyst. In mild cases of hydroureteronephrosis, the renal pelvis shape can be restored after the obstruction is relieved, but in severe cases of hydroureteronephrosis, the atrophied renal tissue is difficult to repair.

　　Two, urinary tract infection

　　As the saying goes, only flowing water will not go bad. However, due to the inability of patients with hydroureteronephrosis to excrete urine, it accumulates in the renal and ureteral regions, which allows bacteria to grow and reproduce, leading to complications such as pyelonephritis, ureteritis, cystitis, or perinephritis.

　　Three, stone formation

　　Kidney stones blocking the urethra cause hydroureteronephrosis; hydroureteronephrosis can also cause the formation of stones, and they are intercausal. The bacterial flora, pus balls, and necrotic desquamated tissue cells become the core of stone formation. Especially, the salt crystals precipitated in the infected urine accumulate to form stones.

　　Four, giant hydroureteronephrosis

　　Due to the thin real wall of the kidney and high internal tension, it is easy to cause traumatic rupture or spontaneous tensional rupture, and complications such as acute peritonitis, which seriously threaten life safety.

　　Patients often have long-term asymptomatic symptoms until abdominal mass and lumbar distension are noticed. The mass is often found inadvertently and generally has a cystic sensation. Pain is usually mild, even completely painless. However, in intermittent hydroureteronephrosis cases (due to extrinsic vascular compression or nephroptosis), renal colic may occur, with severe pain radiating along the costal margin and ureteral course. It is often accompanied by nausea, vomiting, abdominal distension, and oliguria. It usually resolves in a short time or within a few hours, followed by the excretion of a large amount of urine.

　　Hydroureteronephrosis complicated with infection results in purulent urine and systemic toxic symptoms, such as chills, fever, headache, and gastrointestinal dysfunction. Some patients present with urinary tract infection as the initial symptom, and for those patients whose treatment for urinary tract infection is not effective, attention must be paid to the presence of obstruction factors. When obstruction is severe, inflammatory exudates cannot be excreted through urine, and there are no leukocytes in the urine, but in this case, local pain and tenderness are more pronounced. The enlarged hydroureteronephrosis is more susceptible to trauma, and minor injuries may cause rupture and bleeding. The flow of urine into the retroperitoneal space or peritoneal cavity can cause severe reactions, including pain, tenderness, and systemic symptoms.

　　Hydronephrosis is often caused by urinary tract obstruction due to various reasons, leading to urine retention. To prevent hydronephrosis, it is mainly necessary to prevent urinary tract obstruction, such as surgical treatment for urethral stricture and other diseases,根治urinary tract infection, especially those bacteria that decompose urea, avoid bladder foreign bodies, and reduce the occurrence of stones. Eliminate urinary tract obstruction factors, such as actively treating congenital urinary tract malformations. If the narrowing of the prepuce or urethral orifice is found early, it should be removed in time. In cases of trauma and inflammation, inflammation should be controlled in time, and urinary tract infections should be treated thoroughly to prevent urinary tract obstruction. For patients with urinary tract stones, the following preventive measures should be taken:

　　1. Review once every six months, increase exercise, and those who have been lying in bed for a long time should often turn over.

　　2. For patients with urinary stone disease, if the urine volume is increased by 50%, the incidence of urinary stones will decrease by 86%, especially before going to bed, more water should be drunk to develop the habit of drinking water and keeping the daily urine volume not less than 2000-2500ml.

　　3. Adjust diet. For patients with calcium oxalate stones, they should eat less vegetables such as spinach, reed, tofu, and chocolate, which contain a lot of oxalate or calcium; for patients with uric acid calcium stones, they should avoid eating meat, crabs, spinach, and animal viscera such as liver, brain, and kidney.

　　4. Actively treat various infectious diseases.

　　5. It is not advisable to take sulfonamides, acetazolamide, and other drugs that are easy to cause urinary crystallization for a long time.

　　After the renal calyces of patients with hydronephrosis expand, red blood cells and protein are generally present, which can be detected through routine urine tests. When both kidneys are severely damaged by hydronephrosis, blood creatinine and blood urea nitrogen levels increase, and renal function tests such as blood urea nitrogen, creatinine, and clearance tests can be performed.

　　One, X-ray:Urography can show enlarged renal shadows and stones.

　　Two, Ultrasound:This method is simple and convenient, non-invasive, and relatively accurate in detecting the amount of hydronephrosis and renal cortex thickness. It can also differentiate it initially from renal cysts and renal tumors.

　　Three, Color Doppler Ultrasound:Reflects the hemodynamic changes in the affected kidney by measuring the frequency spectrum values of renal arterial and venous blood flow.

　　Four, IVU Intra-venous Urography:It can understand the location and extent (partial or complete) of hydronephrosis and obstruction on one or both sides. When hydronephrosis seriously affects the renal function on the affected side, it may not be well visualized.

　　Five, Retrograde Pyelography:Insert the ureteral catheter to the obstruction site and rapidly inject contrast medium, which can show the location of the obstruction. If hydronephrosis is severe, after retrograde imaging, the ureteral catheter can be retained to drain urine, in order to alleviate the renal function on the affected side and wait for further treatment.

　　Six, CT:It can clearly show the size, contour, renal parenchyma, hydronephrosis, and lesions outside the urinary tract. CT enhancement imaging can understand renal function and differentiate renal lesions.

　　Seven, MRI:For renal dysfunction, contrast medium allergy, obstructive lesions, to avoid interventional infection and when the patient cannot tolerate IVU, MRI urinary tract water imaging can be performed. Utilizing the urine as a strong signal in T2-weighted imaging, it is possible to perform coronal, sagittal, and cross-sectional scans of the urinary tract system, which is of great value for the diagnosis of the location and nature of obstruction.

　　8. Renal Pelvis Infusion Test:Used for cases where urinary tract obstruction is difficult to determine, it is considered a valuable examination method in recent years.

　　Patients with kidney hydrops should increase their energy intake, but should not eat too much protein-rich food. The intake of energy mainly relies on carbohydrate and fat foods. This can reduce nitrogen retention in the blood, alleviate the burden on the kidneys, and thus delay the progression of chronic renal failure. For unilateral kidney hydrops, there is no need to limit water intake. If there is kidney dysfunction due to bilateral kidney hydrops, it is necessary to limit the daily water intake. If kidney disease patients do not have edema or hypertension, they do not need to limit salt intake and can take 10 grams of salt per day like normal people. The restriction of salt intake is mainly for patients with edema and hypertension, because not limiting salt can worsen water and sodium retention, making edema difficult to subside and causing blood pressure to rise. Avoid eating foods rich in oxalates, including beans, beetroot, celery, chocolate, grapes, green peppers, coriander, spinach, strawberries, and vegetables of the Brassicaceae family. Also avoid alcohol, caffeine, tea, chocolate, dried figs, lamb, nuts, opium poppy seeds, etc.; avoid high cholesterol diets such as animal internal organs, squid, fatty meat, fish, and cuttlefish, etc.

　　Traditional Chinese medicine believes that the accumulation of kidney fluid is often due to deficiency of the spleen and kidney, leading to poor water movement; or due to sandstone obstruction, affecting water flow; or due to damp-heat burning the yin, causing poor gasification and unsmooth water channels. In addition, different clinical manifestations may occur in different locations where fluid accumulates, but the cause is insufficient yang to warm and transform fluid, causing fluid to accumulate and leading to yang deficiency and qi damage. Qi damage due to yang deficiency cannot transform fluid. The treatment of this disease should adopt the following methods: warming the yang, promoting diuresis, invigorating the spleen and benefiting the qi, and tonifying kidney yang.

　　Composition of the Prescription:Cassia twig 8 grams, Epimedii 10 grams, Alisma 9 grams, Poria 15 grams, Precooked Aconitum 9 grams, Precooked Rehmannia 18 grams, Chinese Yam 18 grams, Lysimachia christina 18 grams, Coix Seed 15 grams, Talcum (wrapped in cloth) 10 grams, Atractylodes 18 grams, Plantago 9 grams, Codonopsis 18 grams, Chinese Angelica 12 grams, Astragalus 24.

　　Usage Method:Decoct the medicine, take it twice a day, once in the morning and once in the evening. Avoid cold and spicy foods during the medication period.