Kidney in a very localized thinning of the renal parenchyma What does it mean? How is it treated?

When physical examination found that B left renal cortical layer high echo 3.8x2.9CM renal cortical layer of oppression, it is recommended to do CT further examination. So I went to three A hospital for a check, Ct diagnosis: kidney in a very localized thinning of the renal parenchyma, I do not know what does that mean? How to treat
A) generous state
Discharge of urine from the renal pelvis blocked, causing increased pressure kidney, renal pelvis dilatation, renal parenchymal atrophy, called hydronephrosis.
(B) the clinical manifestations
Urinary system and its proximity to various diseases caused by urinary obstruction, and ultimately may cause hydronephrosis. Due to obstruction due to primary disease, location and extent of the differences in clinical presentation and course of hydronephrosis in different patients is not consistent. Congenital lesions, such as narrow PUJ, the lower pole renal vascular or fiber bundles oppression ectopic ureter caused by stagnant water, such as kidney, development has been relatively slow, long-term no obvious symptoms, abdominal mass occurs only up to a certain volume. Ministries of urinary stones, tumors, inflammation and tuberculosis caused by secondary hydronephrosis, clinical manifestations of primary signs and symptoms, rarely showing disease like hydronephrosis, often in complete obstruction and hair and when abrupt, such as renal and ureteral stones and renal colic incarcerated before they were found. Hydronephrosis secondary to infection, the primary disease symptoms usually increase.
Hydronephrosis was intermittent episodes sometimes called intermittent hydronephrosis. Ipsilateral severe abdominal attack cramps, nausea, vomiting, decreased urine output; after a few hours or longer, the pain disappeared, and then emit large amounts of urine. This situation is more common in ureteral obstruction.
Hydronephrosis caused by prolonged obstruction, will eventually lead to kidney function gradually decline. When completely solitary kidney or bilateral renal obstruction can occur without urine, resulting in renal failure.
Need to mention that during normal pregnancy often mild kidney, ureter water. In addition to the pregnant uterus oppression ureter, but is due to the secretion of progesterone during pregnancy causes muscle relaxation induced renal pelvis and ureter. This hydronephrosis is a physiological state, due to the anatomical relationships occur almost on the right.
(B) diagnosis
Should first determine the presence of hydronephrosis, and then to identify the cause of hydronephrosis, lesion extent, with or without infection, and renal damage situation. Differential diagnosis of abdominal mass should note that there may hydronephrosis. Tension hydronephrosis mass can not, such as tension lumps hard or soft lower, there is a sense of volatility person, then the possibility of renal water is very high. Some secondary hydronephrosis, the symptoms of their primary disease more significant, such as tuberculosis, cancer and so easy to ignore the presence of hydronephrosis. Urinary system urinary tract obstruction and renal water near the lesion caused by the frequently not diagnosed in time, even when renal failure or no urine to begin to be found. Laboratory tests should include blood tests, to understand whether azotemia, acidosis and electrolyte imbalance. Urine aspects, except for routine examination and culture, but if necessary to check the line and shedding of Mycobacterium tuberculosis cells.
Urography in the diagnosis of significant value. When developing renal prolonged one of the typical manifestations of excretory urography. Because of reduced glomerular filtration rate, renal tubular slow the flow of urine and water reabsorption increases, so that the contrast agents gathered in the renal cortex, mainly in the proximal tubule, leaving renal angiography clearer. Thus, the emergence of concentrated shadow so acute renal obstruction characteristics. Large doses delayed excretory urography in the diagnosis of hydronephrosis more helpful; contrast dose can be increased 2 to 3 times, delay time can be up to 24 to 36 hours. When excretory urography is not clear enough, via cystoscopy for ureteral catheterization, line retrograde pyelography; pelvis after catheterization, if hydronephrosis may be spending a lot of urine, while the side renal function measured points. Such as retrograde intubation difficulties, renal biopsy may be diverted angiography. When retrograde puncture contrast angiography and should prevent the bacteria into the water in the kidney.
Ultrasound, CT, MRI examination can clearly distinguish the kidney is enlarged water or solid mass may find oppression urinary system diseases, due to the popularity of ultrasound has been and is non-invasive, can be carried out in the previous urography. Radionuclide scanning and kidney diagram can be used for diagnosis of hydronephrosis. For dynamic obstruction cases, can be observed in urography renal pelvis, ureter motility and emptying. Neurogenic bladder visible cystography shape of "pagoda" success trabecular and false diverticula.
(C) Treatment
According to its etiology, pathogenesis Jihuan, with or without infection, and degree of renal dysfunction, combined heart and lung function, such as patient age and comprehensive consideration.
1 cause of treatment best treatment is to remove the cause of hydronephrosis, retain suffering from kidney. As yet caused serious obstruction unrecoverable disease, after removal of the cause, get good results. Surgical method depends on the nature of the cause, such as congenital ureteropelvic junction obstruction can be used for angioplasty of the renal pelvis, kidney, ureter stones feasible gravel or stone surgery, these procedures carried out in recent years, the endoscope can be used. Postoperative hydronephrosis and renal function will be improved.
2 nephrostomy in critical condition or cause hydronephrosis can not be removed if, should first drainage above the obstruction, to be infection control, and then remove the cause of surgical purposes. When the cause of obstruction can not be lifted, then as a permanent nephrostomy treatment.
3 nephrectomy severe hydronephrosis, the remaining renal parenchyma is too small, or with severe renal infection that empyema, such as the contralateral renal function, renal resectable disease.
(D) post-operative care of patients with hydronephrosis care issues
1Pc urine leakage
Related factors: associated with surgery
Care measures: (1) 10ml rinse with metronidazole for renal pelvis drainage tube, twice daily;
(2) TDP irradiation wound 30 minutes, once a day;
(3) note left kidney urine, wound drainage tube volume;
(4) dressings soaked inform your doctor promptly replaced.
(5) maintaining unobstructed drainage, the drainage tube properly secured to prevent compression, folding, twisting.
2 infection
Related factors: surgical trauma combined with indwelling catheter-related
Care measures: (1) use of antibiotics prescribed by a doctor;
(2) measuring the temperature four times a day;
(3) Daily cleaning with 0.1% benzalkonium bromide urethra twice daily to replace the drainage bag;
(4) maintaining unobstructed drainage, strict implementation of aseptic technique;
(5) After flatus, to encourage patients to drink more water, more than 3000ml per day, and eating
Nutritious diet.
3 Pain
Related factors: the surgical trauma
Care measures: (a) comfort the patient, so that relax the tension;
(2) to guide patients and their families the proper use of analgesia pump, protect the painful area, master alleviate
Methods of pain;
(3) analgesics prescribed to observe and record the results after treatment;
(4) Adjust the comfortable position.
4 there is the risk of skin damage
Related factors: bed-related postoperative
Care measures: (1) to patients and their families to explain the importance of keeping the skin intact, get their cooperation, and
Explain their skin self-care methods and risk factor for skin damage;
(2) the timing of order to help patients change position, and massage each bony protrusion at;
(3) underwear, mattresses remain soft, smooth, dry, clean and free of residue;
(4) to guide the patient in bed activity skills, develop bed activity plan.
5 constipation
Related factors: the bed-related
Care measures: (1) encourage patients to strengthen the bed activities;
(2) eat more vegetables, fruits and other foods containing high fiber, drink plenty of water;
(3) the patient may be given a physical defecation difficult to discharge;

(4) Instruct patient to develop good bowel habits.