Renal pelvis hydrops

　　1. Narrowing of the ureteral orifice:When the bladder tuberculosis develops into fibrosis, the contralateral ureteral orifice may narrow due to scar formation, obstructing the urine drainage of the contralateral kidney, causing hydronephrosis of the contralateral kidney and ureter.

　　2. Narrowing of the lower ureter:The tuberculosis lesions near the contralateral ureteral orifice can spread directly from the mucosal surface or infiltrate under the mucosa, causing a segment of the ureter above the ureteral orifice to narrow due to scar formation, leading to hydronephrosis of the contralateral kidney and ureter.

　　3. Incomplete closure of the ureteral orifice:The normal ureter has a sphincter-like effect due to the oblique interstitial segment in the bladder wall. It can prevent urine reflux into the ureter and renal pelvis when the bladder contracts. The tuberculosis lesions around the ureteral orifice can lose the sphincter-like effect due to fibrosis, leading to incomplete closure of the ureteral orifice. Therefore, the urine in the bladder can often reflux into the contralateral ureter and renal pelvis, causing hydronephrosis of the kidney and ureter.

　　4. Bladder contraction:Severe bladder tuberculosis will inevitably lead to bladder contraction. Bladder contraction causes the bladder to lose the ability to gradually expand the volume during the filling process to maintain normal bladder pressure, resulting in high intravesical pressure, especially when the bladder is inflamed. The frequent contraction of the bladder is stimulated, causing the pressure to be even higher. The long-term high-pressure state in the bladder can obstruct the urine drainage of the renal pelvis and ureter, or cause urinary reflux from the bladder to the ureter and renal pelvis, causing hydronephrosis of the contralateral kidney and ureter.

　　1. Renal atrophy:This type of lesion is the most typical harm of hydronephrosis, mainly because of the obstruction of urine, the expansion of the renal pelvis, the increase of intrarenal pressure, the compression of renal tissue blood vessels, leading to progressive atrophy and destruction of the kidney due to ischemia, and damage to kidney function.

　　2. Urinary tract infection:Urine stasis in the kidney and ureter is conducive to bacterial growth and reproduction, and may lead to pyelonephritis, ureteritis, cystitis, or perinephritis.

　　3. Calculus formation:Calculi blocking the urethra can cause hydronephrosis, and the formation of hydronephrosis can in turn induce renal calculi, forming a vicious cycle. The bacterial flora, pus balls, and necrotic and sloughed tissue cells become the core of calculus formation. Especially, the salt crystals precipitated in the infected urine accumulate to form stones.

　　It occurs at the junction of the renal pelvis and ureter, the narrow segment is usually 1-2mm, but can also be as long as 1-3cm, causing incomplete obstruction and secondary twisting. Under an electron microscope, excessive collagen fibers can be seen around and between the muscle cells in the obstructive segment, which eventually damages the muscle cells, forming a non-elastic narrow segment mainly composed of collagen fibers that obstructs urine flow.

　　The main manifestations are:

　　8. Symptoms of the primary disease, such as pain in calculi, hematuria in tumors, and difficulty in urination in urethral stricture, etc.

　　7. Swelling and pain in the side of the kidney with hydrops.

　　6. Concurrent infection may cause chills, fever, and pyuria.

　　5. Cystic mass on the side of the affected kidney.

　　5. Chronic renal insufficiency and uremia may occur due to bilateral obstruction.

　　This disease is caused by calculi, so the clinical prevention should be aimed at the basis of calculi.

　　1. According to the results of the analysis of the composition of urinary stones and the shape of the stones on the plain film, the composition of the stones can be determined, and targeted preventive measures can be formulated.

　　2. For pediatric bladder stones, the main problem is to increase nutrition (dairy products).Here, we emphasize the importance of breastfeeding.

　　3. Drinking plenty of water is very effective for preventing the recurrence of urinary stones.Drinking plenty of water can increase urine output (the daily urine volume should be maintained at 2000-3000ml), significantly reduce the saturation of urinary stone components (especially calcium oxalate). According to statistics, an increase of 50% in urine volume can reduce the incidence of urinary stones by 86%. The peak time for excretion is 3 hours after meals, and enough urine volume should be maintained. Drinking water before going to bed can make the relative density (specific gravity) of urine at night lower than 1.015. Drinking plenty of water can produce certain pressure in the proximal urinary tract of stones, promoting the excretion of small stones; it can dilute excretory products and some substances related to stone formation (such as TH protein). However, some people believe that excessive water intake also dilutes the concentration of inhibitors in urine, which is not conducive to the prevention of stone formation. In fact, in the influence of urinary stone formation, urine supersaturation plays an extremely important role; compared with this, the impact of excessive water intake on the reduction of inhibitor concentration is much smaller. Itoh et al. believe that green tea can prevent the formation of calcium oxalate stones. Green tea contains 13% of catechins, which have antioxidant effects and can reduce the excretion of oxalic acid in urine and the formation of calcium oxalate precipitates. Green tea treatment can increase the activity of superoxide dismutase.

　　4. Urolithiasis patients should limit excessive nutrition according to their calorie needs, maintain a daily protein intake of 75-90g to maintain energy balance, and reduce the risk of stone formation.For patients with familial hyperuricemia or gout, the protein intake should be limited to 1g/kg body weight. Control the intake of refined sugars. Avoid eating vegetables such as spinach, animal internal organs, and other foods.

　　5. Magnetized water has a certain preventive effect against stone formation:Generally, water passes through a strong magnetic field and becomes magnetized water. In 1973, it was found that placing stones in a container filled with magnetized water would cause dissolution. Through research, it was found that after magnetization, the charge of various ions in the water changes, the tendency to form crystals is significantly reduced, which can play a preventive role in the formation of urinary stones.

　　6. Treat the diseases that cause stone formation:Such as primary hyperparathyroidism, urinary tract obstruction, urinary tract infection, and so on.

　　7. Medications:Appropriate oral medications can be taken according to the condition of metabolic abnormalities within the body, such as thiazide drugs, allopurinol, and orthophosphates. Patients with recurrent calcium oxalate stones should avoid excessive intake of vitamin C.

　　8. Regular follow-up:Urolithiasis patients must undergo regular follow-up examinations after the stones are excreted. This is mainly because: ①For the vast majority of patients with stones, the factors causing the formation of stones are not resolved after the stones are excreted, and stones may recur. ②Regardless of the method used for stone fragmentation, some fragments of varying sizes may remain in the body, which may become the core of stone recurrence in the future, in addition to the fact that the stones have been completely removed during surgery.

　　First, auxiliary examination

　　1. Urinalysis may show microscopic hematuria, proteinuria, and in cases of hydronephrosis with infection, pus cells may be visible.

　　2. Ultrasound examination.

　　3. Intravenous pyelography can show hydronephrosis and dilation of the renal pelvis and calyces, or the contrast agent suddenly stops at the junction of the renal pelvis and ureter, and the lower ureter does not show or is normal.

　　Second, further examination items

　　1. Retrograde pyeloureteral angiography.

　　2. Diuretic renal imaging.

　　3. Renal pelvis pressure test.

　　4. CT and MAR are of great significance for the diagnosis of etiology.

　　1. What foods are good for hydronephrosis patients to eat:Nutritious and easily digestible foods should be consumed. For the elderly and weak, it is appropriate to extend the time of consuming liquid and semi-liquid foods to facilitate digestion. For general patients, after the condition stabilizes and improves, normal diet can be provided. Hydronephrosis patients usually consume sweet foods during the period of liquid diet, such as lotus root powder, orange juice, etc. However, some patients may develop aversion to sweet foods due to lack of habit, even nausea and vomiting, which can significantly affect health. At this time, if appropriate meat or fresh fish soups are selected, they can ensure nutrition and increase appetite, and the patient will recover quickly.

　　2. The diet of hydronephrosis patients should not be too refined.After surgery, a diet high in protein and calories is often consumed, neglecting the intake of vitamins. However, the body's repair requires various nutrients, especially roughage foods. For patients lying in bed after surgery, foods containing roughage can help promote gastrointestinal activity and keep the bowels regular. Therefore, a certain amount of vegetables, especially green leafy vegetables, should be included in the diet.

　　(The above information is for reference only, please consult a doctor for details.)

　　Different treatment plans are also available according to the etiology. For patients with hydronephrosis caused by pyelonephritis, active anti-infection treatment should be carried out. For patients with urinary system stones, different treatment plans should be selected according to the size of the stones, with those larger than 6mm and less than 19mm suitable for extracorporeal shock wave lithotripsy. Patients with stones larger than 20mm can undergo surgery with a renal scope for stone removal.