Kidney congestion - causes and therapy

Stasis of the kidney
In a so-called renal congestion, it is not an independent disease, but a symptom that can be caused by various causes such as urinary stones, tumors or congenital malformations. In the case of a blocked kidney, the urine can no longer drain, which is often associated with severe pain. The treatment is carried out depending on the cause found, the goal is in any case to eliminate the "obstacle" and thereby ensure the outflow of urine again.

contents

• Symptoms and definition
• Urinary stones as a cause
• How do urinary stones develop??
• Kidney congestion in pregnancy
• Cause megaureter
• Stasis of the kidney by endometriosis
• Other causes of jammed kidney
• Treatment in congestion of the kidney
• Treatment with a megaureter
• Treatment options for kidney congestion
• Therapy kidney congestion during pregnancy
• Naturopathy with kidney congestion

Symptoms and definition

The kidneys (Latin: ren, Greek: nephros), which lie on either side of the spine at about the level of the lower ribs, have various functions such as the regulation of the fluid and electrolyte balance and the acid-base balance. Other tasks include the production of hormones to control blood pressure and the formation of red blood cells (erythrocytes). They function as a "detoxifier" of the body by producing urine, filtering out degradation products of the metabolism from the blood.

The kidneys take on important metabolic functions. (Image: natali_mis / fotolia.com)

The functions of the kidney can be interrupted by various events, disorders or illnesses, whereby the urine no longer flows unhindered to the bladder and accumulates in the sequence up to the kidneys. In this case, there is a "kidney congestion", which is therefore not a separate disease, but a symptom, which may have different causes.

Medically, a distinction is made between a "urinary stasis kidney" (medically "hydronephrosis" or "water sineen kidney") and a "blood stasis kidney". In the urinary obstruction kidney, the urine accumulates in many cases massively throughout the renal pelvis area, which then greatly expands and the tissue is finally destroyed by the burden.

As a result, the kidney can gradually no longer fulfill its functions sufficiently, so that the reduced excretion of urine many harmful substances (especially urea, uric acid and creatinine) remain in the body and can quickly lead to health problems. These include, for example, a urine poisoning (uremia) or heart problems.

The Hydronephrose is triggered by a disturbed urine drainage due to a narrowing of the urinary tract. The constrictions can occur either at the transition from the renal pelvis to the ureter (subpelvine or ureteropelvic stenosis), at the entry of the ureter into the urinary bladder (ostium stenosis) or at the exit of the urethra from the bladder (bladder neck stenosis).

A jammed kidney often remains symptomless for a long time and is only discovered at an advanced stage. In most cases, over time, the constant pressure on the adjacent organs causes back pain, back pain, or flank pain.

Those affected speak of a "stabbing" pain that feels as "as if a knife is in the kidney". Other possible symptoms include fever, severe tiredness and fatigue, and frequent urinary tract infections, as well as a marked decrease in urine, often less than 500 milliliters a day (oliguria)..

Due to the no longer functioning filter function of the kidneys, red blood cells (erythrocytes) are increasingly accumulating in the urine, which leads to a red coloration or blood in the urine (hematuria). In infants, usually failure to thrive, diarrhea and vomiting occur.

In a so-called "congestive kidney" kidney is changed in shape and condition, for example, as a result of heart failure or renal vein thrombosis. As a result, the organ no longer works properly, it is less urine excreted than usual and harmful substances, the so-called urinary substances, remain in the body. In the case of a congestive kidney, other organs are often damaged, which can quickly endanger the patient's life.

Urinary stones as a cause

A common cause of a jammed kidney are called urinary stones. These are diseased, solid mineral structures that can be formed throughout the urinary tract by the "crystallization" of substances normally excreted in the urine ("urinary substances"). Depending on where the stones have formed, a distinction is made between kidney stones, ureteral stones (or ureter stones) and bladder stones; in rare cases, stones may also form in the urethra. The largest proportion of stones contains calcium oxalate, but also uric acid is often found as a stone substance. Also possible are mixed crystals, for example calcium oxalate, calcium phosphate, uric acid, struvite, cystine and xanthine.

Urinary stones come in very different sizes and shapes. They can be a few inches small, reach the size of a hen's egg or even fill the entire renal pelvis (so-called "pouring stones"). Frequently, however, the stones remain so small that they are simply eliminated with the urine, without the affected person noticing. Partly a sharp pain occurs when urinating. It becomes difficult when the stones grow larger and get stuck in the renal pelvis or ureter - usually accompanied by extremely severe pain (colic).

If a urinary stone gets stuck in the ureter, it causes unbearable pain. (Image: Jeanette Dietl / fotolia.com)

In a "renal colic" or "urinary colic" (colic = spasmodic pain), the pain usually violently pungent, spasmodic and undulating, which results from the fact that the ureter is stretched through the stone. They often pull from the flanks in the back or lower abdomen, but can also radiate into the testicles or labia. In some cases, the pain is so severe that sufferers react with nausea and vomiting, moreover, there may be blood in the urine (hematuria) due to mucous membrane irritation due to the dissolved stones.

Since the kidney stone prevents the drainage of the urine and thereby expands the renal pelvis, a bacterial urinary tract infection can develop faster than usual. Typical of these are primarily frequent urination and a strong burning urination. In rare cases, a disturbed urinary outflow caused by a stone can also cause suppuration of the kidney (pyonephrosis) or septicemia (sepsis). In addition, there is an increased risk of chronic kidney failure (renal insufficiency) for those affected.

How do urinary stones develop??

Urinary stones can have various causes, such as a high acidity in the urine, too little exercise, overweight or certain diseases. These include, for example, hyperparathyroidism, chronic pancreatitis, diabetes mellitus and gout.

Inheritance seems to play a role here as well as organic problems in the form of malformations in the kidneys, such as scarring in the area of ​​the ureters, which can lead to the stones not being able to move on their own. Stones are common after patients had to surgically extract portions of the small intestine or gallbladder. The same applies to tumors and chemotherapies, since in the course of this increased uric acid is formed and excreted via the kidneys.

Nutrition and drinking behavior play a central role in the development of urinary stones: those who drink little or sweat heavily increase the concentration of stone-forming substances such as calcium, oxalate, phosphate, uric acid and cystine. Accordingly, frequent diarrheal diseases and inflammatory bowel diseases also promote the formation of deposits, since the body is deprived of fluid to a particularly high degree and the concentration of lithogenic substances increases.

Even with a one-sided or predominantly milk and dairy products diet increases the calcium level in the urine and thus the risk of urinary stones. In addition, a high-fat diet is suspected of favoring the development of stones, as well as a permanent over-consumption of highly oxalic foods (such as rhubarb, beetroot, black tea, peanuts, parsley, spinach and chocolate), as the oxalic acid in the intestine with calcium to insoluble calcium oxalate, which in turn can lead to a disturbance of calcium metabolism.

Kidney congestion often occurs during pregnancy - without the expectant mother noticing it. (Image: Sondem / fotolia.com)

Kidney congestion in pregnancy

A jammed kidney often occurs in advanced pregnancy. In most cases, the pregnant woman does not notice the stasis, but it can cause serious health consequences. There are several causes for kidney congestion during pregnancy: one is the hormonal changes in the ureter, which can lead to a faster return of the urine from the bladder to the renal pelvis (reflux) and thus to a drainage dysfunction. Another possible trigger is the ever-growing child, which presses against the ureters and thereby disturbs the urine drainage.

Cause megaureter

Another possible cause is a so-called megaureter. This is a one- or two-sided pathological dilatation of the ureter, whereby the outflow of urine can no longer function unhindered. As a rule, an enlarged ureter with a diameter of 10 mm or more is referred to as a megaureter and, in most cases, is a congenital disorder (primary megaureter). This may be due to a congenital constriction (stenosis) prior to entry into the urinary bladder, which arises due to a premature failure of the ureter. If this is the case, the pressure of the urine increases in the area of ​​the constriction, whereby the ureter greatly expands (primary obstructive megaureter, short POM).

In a congenital megaureter may also be a so-called vesic-uretero-renal reflux, through which the urine repeatedly flows back from the bladder into the ureter or the kidneys. Another possible cause of urethral dilation is tissue weakness, which results in the ureter not being able to contract, filling up with urine, and eventually becoming distended, allowing the urine to accumulate back into the renal pelvis.

While a primary megaureter is innate, the causes for the secondary, acquired form lie outside the ureter. In many cases no clear cause can be identified (idiopathic megaureter). As possible triggers come here previous diseases such as a nervous bladder disorder or reflux of urine into consideration, which in turn is often caused by a narrowing below the bladder (secondary refluxive megaureter).

In many cases, there are no symptoms when the urethra is widened. Sometimes it comes to pain when urinating, in rare cases also to urinary tract infections with fever. If the usually quite pronounced urinary transport disorder is not detected early, in the further course of the disease in severe cases it can lead to kidney inflammation up to a urosepsis or an acute renal failure. However, these severe disease histories have become very rare today due to the frequent use of ultrasound examinations. Rather, the megaureter is often discovered during pregnancy or as part of the subsequent check-ups (U examinations) in the child and treated accordingly.

Reason for the renal jamming may be the chronic gynecological endometriosis. (Image: Sebastian Kaulitzki / fotolia.com)

Stasis of the kidney by endometriosis

Reason can be an endometriosis. It is a common, benign, but usually associated with chronic pain gynecological disease in which the endometrium (uterine lining) also outside the uterine cavity (for example, on the ovaries, on the vagina or in the intestine) grows. In this case, a jammed kidney may develop, for example, when the lining of the uterus forms in a pronounced form on the ovary, pushing on the ureter and eventually causing stasis.

The exact causes of endometriosis are not yet clear, but there are several theories - such as the idea that uterine lining cells are transported from the uterus through blood vessels or lymphatics through the body and thus theoretically e.g. can also get into the lungs. Among other things, the symptoms of endometriosis depend on which organs are affected; possible signs include cycle disturbances, difficult urination, pain during intercourse (dyspareunia) or back pain.

Other causes of jammed kidney

Considered among other things, the "ureter agenesis", which may be innate or acquired and in which either one or both ureters are missing. Possible is a so-called ureter duplication or a ureter duplex. This is a congenital anomaly, in which instead of the usually single ureter (ureter) is a complete duplication of the upper urinary tract with two separate renal pelvic systems and two separately opening into the bladder ureters.

In addition, benign and malignant tumors and disorders of the nervous system (for example, in spinal diseases or diabetes mellitus) interfere with the urine drainage and thereby lead to a congested kidney.

Treatment in congestion of the kidney

If a urinary stone disease is present, then in the acute colic case with cramping massive pain usually an antispasmodic drug is given in combination with a painkiller. In the case of smaller stones (stones under 6 mm) or in the case of not yet completely exposed urine drainage, one usually waits until the stone dissolves naturally and is excreted.

Supportive measures such as exercise, jumping rope, increased hydration or heat treatments work, and urine should be collected every time you urinate in order to examine the stone after its departure to its constituents. This is particularly important because the further treatment steps and the preventive measures are subsequently based on this.

If the stone does not dissolve by itself, it is possible to treat it by means of a shockwave therapy ("extracorporeal shockwave lithotripsy"). This shock waves are directed from the outside to the respective structure that it is "smashed" in the smallest pieces and thus can go off with the urine itself.

If this measure does not lead to success, there is another treatment option in the so-called Ureterorendoskopie (URS). In this, a special endoscope is inserted through the urethra, which is then advanced to the stone in the ureter and then removed together with the stone. As the procedure is usually quite painful, it is either performed under general anesthesia or in spinal anesthesia, but complications are rare in ureterorenoscopy.

Another treatment option is the "percutaneous nephrolitholapaxy" (PNL): In this a puncture needle from the outside of the body creates a thin channel to the kidney, through which an optical instrument is inserted with which the doctor then smash the stones and can remove. In most cases, a catheter or a ureteral splint is also placed for a few days in order to dilate the ureter and keep it open, thereby favoring the departure of further stone particles.

Urinary stones can be removed with the help of minimally invasive endoscopic procedures. (Image: reineg / fotolia.com)

After successful treatment of the urinary stone prophylaxis is the focus, because if stones have already occurred several times, there is a greatly increased risk for further deposits. Therefore, it is important to consistently follow appropriate preventive measures. Above all, it is important to ensure a sufficient fluid intake (water, unsweetened tea) of at least 2.5 liters daily, to ensure a regular excretion of urine and thus of urinary substances. Patients should have their urine regularly checked with test strips themselves or by a doctor and adjust the result according to their eating and drinking habits.

Depending on the stone composition, a special diet change is recommended - for example, those who tend to form calcium oxalate stones should avoid over-consumption of oxalate-rich foods (eg rhubarb, chocolate, nuts, spinach). The prevention of uric acid stones consists in a reduction of red meat and salt. In all cases, care should be taken to ensure adequate exercise and the reduction of obesity.

Treatment with a megaureter

In the case of a megaureter, the therapy is performed depending on the cause of the ureteral dilation. If there is another condition in the case of a secondary dilatation, it will first be treated - in most cases the megaureter will disappear as well. In the case of long-term growth - which is most pronounced in the first year - many affected children become elongated in the urethra and thus reduce their size.

If there is reflux (reflux) of urine from the bladder, usually a conservative treatment without surgery is sufficient, the same is usually true for the megaureter without detectable cause (idiopathic megaureter). If the examinations reveal occlusion of the ureter or impaired kidney function, surgery is usually indicated. Here, the re-implantation of the ureter is typically used. In children, this procedure is usually performed only after the first birthday - exceptions exist when the kidney functions have already worsened significantly before or febrile urinary tract infections occur.

By the time the megaureter "grows" or the operation takes place, the small patients need antibiotics to prevent infection. In many cases, the ureteral dilatation continues to exist after surgery, so that further urological examinations of the urinary bladder and urethra (micturition cystourethrography) may be necessary to check the healing success and in rare cases a reoperation.

Treatment options for kidney congestion

If there is a urinary obstructive kidney (hydronephrosis or water sac kidney), the exact therapy depends on the cause found. The aim of the treatment is in any case the elimination of the narrowing of the urinary tract, so that a normal flow of urine from kidney to bladder is possible again. In many cases, babies are not treated at all, instead regular medical examinations take place. However, antibiotics are often prescribed because of the increased risk of urinary tract infection.

First, a catheter is inserted into the urinary tract or through the skin into the renal pelvis (percutaneous nephrostomy) so that the accumulated urine can flow away. Since successful treatment requires the smooth discharge of urine, the next step is usually either endoscopic or surgical removal of the obstacle, with a variety of procedures depending on the cause or form of hydronephrosis. If a subpelvic stenosis or narrowing at the exit of the ureter from the kidney, for example, there is the possibility of an operation after "Anderson-Hynes", in which the bottleneck is removed. This is a routine procedure that can be performed open-ended or minimally invasive with a success rate of over 95%.

If the constriction was triggered by an unfavorable ureter, it can be surgically relocated. In some cases an artificial discharge of the urine through the skin (urostoma) is necessary, especially if the function of the urinary drainage system can no longer be properly established or if the urinary bladder has to be removed. Here, too, there are various surgical techniques, one example being the "ureteral skin drainage", in which both ureters - depending on the disease - are led either individually or together through the abdominal wall to the outside.

Often, following the opening of the urinary tract, a stent (or double-J catheter or ureteral splint) is left in the ureter for a few days or weeks to maintain drainage of the urine. If the kidneys are so severely damaged that the functions can no longer be adequately fulfilled, those affected receive dialysis or "blood washing" at regular intervals, during which the blood of metabolic products and water is "cleaned" by means of a dialyzer. In more severe cases there is also the possibility of a kidney transplant.

Therapy kidney congestion during pregnancy

If kidney congestion occurs during pregnancy, treatment should be given as early as possible to prevent infection that may be very dangerous for the baby. The most common complication is a premature birth due to a weakened by the infection cervix. If an infection is present, antibiotics are usually used that are normally safe for the unborn child.

With severe congestion due to a narrowing in the area of ​​the ureters, a ureteral splint may be necessary to ensure urinary drainage and thereby protect the health of the mother and child. In general, care should be taken to drink a lot and to go regularly to the toilet, so that the urine can not even build up.

Schüssler salts can naturally help relieve the discomfort. (Image: monropic / fotolia.com)

Naturopathy with kidney congestion

First, a jammed kidney is in urgent need of a medical examination or care to "clean up" urine drainage. Naturopathy offers a number of supportive procedures that can alleviate pain and discomfort. In the field of homeopathy, for example, there is the remedy "Berberis vulgaris" which is used in numerous complaints of digestion and excretory organs, which in most cases are accompanied by stabbing or colicky and radiating in all directions pain. Matricaria chamomilla or "real chamomile" generally helps with kidney pain, in urinary stones Lycopodium can provide good support.

If the kidney congestion is the result of urinary stones, Schüssler salts are an option. On the one hand, there is the salt No. 9 (sodium phosphoricum), which is also known as "the salt of the metabolism". It supports the conversion of uric acid into urea, which facilitates excretion and counteracts stone formation in the kidneys and bladder. On the other hand is the salt No. 16 (Lithium chloratum), which promotes the excretion of uric acid and urea. Which means in the individual case "the right thing" should be discussed with a naturopath or doctor or pharmacist, here can then be considered whether only one or possibly both salts are taken simultaneously.

The Schüssler salts are usually dosed three to six times daily in the form of one to three tablets (children in consultation with the doctor three to six times daily half a maximum of two tablets according to age and size), taken individually and slowly in the Mouth be melted.

The proven home remedy apple cider vinegar can be usefully used in a stone disease, as it acts in our metabolism in spite of the sour taste rather basic and thereby helps to split the deposits in the course of digestion better. There are different methods of using vinegar - for example, in the form of an "apple and vinegar cocktail", for which 2 tablespoons of naturally cloudy apple vinegar are mixed with some acacia honey and then infused with still mineral water.

Herbal medicine (phytotherapy) offers various approaches to the treatment of urinary stones. Thus, a tea infusion of dandelion roots or real lab herb may serve as an aid in the removal of the stone particles via the bladder. Birch leaves, bearberry leaves and stinging nettle herb are also said to have a positive supporting effect on the elutriation of the stones. The so-called orthosiphon (also "cat's beard") has an anti-inflammatory and anticonvulsant effect on the draining urinary vessels and can relieve pain in the case of an acute stone discharge or colic.

In general, especially with stones, the individual dietary habits should be critically reviewed and if necessary amended, because without appropriate changes, a stone suffering can not get under control. Accordingly, depending on the type of deposit, calcium-containing stones should be used on dairy products, uric acid on purine-rich foods (offal, liver and black pudding), and on oxalate stones on extremely oxalic foods such as spinach, rhubarb, peanuts, chocolate and tea be waived.

Especially important is the fluid intake, because only if the urine is sufficiently diluted, can be effectively prevented from recurrence. Those affected should drink at least 2.5 liters throughout the day. Particularly well suited here are drinks that do not affect the urinary pH. These include kidney, fruit and herbal teas, apple or grape juice as well as calcium and hydrogen carbonate-poor mineral water. On the other hand, sodas with high sugar content as well as alcoholic beverages are unsuitable, even those who drink a lot of coffee or black tea should drink a glass of water as a precaution. (nr, updated on 7.11.2017)
Specialist supervision: Barbara Schindewolf-Lensch (doctor)