Caliectasis

Definition

Caliectasis is a medical condition in which the calyces of the kidneys become dilated. The calyces are the kidney chambers through which the urine passes, being divided into two categories: minor and major. The minor calyces actually encompass the peak of each of the renal pyramids. The urine forms in the kidneys, passes through the renal papilla at the apex and reaches the minor calyx. The different minor calyces confluence together and form the major calyces; these are the ones through which the urine passes before reaching the area of the renal pelvis and the ureter.The distension of the kidney calyces is often found in association with other medical conditions, such as hydronephrosis. Hydronephrosis can be described as a medical condition, in which the renal pelvis and the calyces become distended. This condition is generally caused by the chronic obstruction of the urine flow from the kidney and, if left untreated, it can cause the kidneys to gradually become atrophied.

Symptoms of Caliectasis

These are the most common symptoms of caliectasis:

• Difficult urination
• Blood can appear in the urine (hematuria)
• Kidney area is tender upon palpation
• Pain can be present in the kidney area (between the hips and the ribs) as well, being aggravated by touching
• Swelling in the kidney area is present in some patients
• If the dilatation becomes chronic, the patient might experience no intense pain but rather a dull discomfort
• Nausea and vomiting can appear as systemic symptoms
• In case of severe infections, pus can be eliminated through the urine (characteristic foul odor)

Causes

These are the most common causes that lead to the appearance of caliectasis:

• Obstruction of the urinary tract
• Kidney stones
• Cancerous growths
• Iatrogenic obstruction
• Infection of the urinary tract Inflammation of the calyces as a result of the infection
• Blood clots obstructing the urinary tract
• Prostate enlargement
• Bladder cancer
• Cancerous growths in the area of the bladder or affecting the ureter or urethra
• Structural abnormality
• This occurs during the fetal development, causing the appearance of hydronephrosis
• Congenital defect/inherited condition
• Other causes of the structural abnormalities include:
• Injury
• Surgery
• Radiation therapy
• Pregnancy The fetus can press on the ureters, leading to the distension of the calyces, among other symptoms
• Retroperitoneal fibrosis (Ormond’s disease) Abnormal proliferation of the fibrous tissue commonly found at the level of the retroperitoneum
• Reversed urine flow into the kidneys – caused by:
• Bladder compression
• Prostatic enlargement
• The accumulation of feces in the colon
• Abnormal contractions of the muscles of the bladder (neurological disorder or different disorders of the muscles)

How is Caliectasis Diagnosed?

The condition can be diagnosed through the following methods:

• Ultrasound investigation
• Reveals the inflammation and the dilation of the calyces
• Can also be useful in determining whether there is an obstruction in the area or not
• Complete blood count
• Elevated levels of white blood cells indicate the presence of infection in the body
• Tests for the kidney function – elevated urea and creatinine indicate a poor functioning of the kidneys
• Electrolyte imbalances
• Reduced natrium levels (hyponatremia)
• Hyperchloremic metabolic acidosis
• Urine analysis
• As you will have the opportunity to discover below, the patient can present hematuria (blood present in the urine)
• Elevate pH – occurs as the nephrons of the kidneys are destroyed by the constant distension
• Intravenous urography
• A contrast substance is injected, so as to allow for the visualization of the area around the kidneys and the calyces
• Useful diagnosis test
• Physical examination In the situation that the caliectasis is encountered within the hydronephrosis, the doctor can feel a palpable mass in the abdomen (represented in fact by the swollen kidney)

Treatment

These are the most common measures of treatment that can be taken for caliectasis:

• Kidney drainage procedure
• Purpose – removal of the growth/stone that has caused the obstruction of the urinary tract
• The urine that has accumulated behind the obstruction will be drained through the procedure, thus relieving the pressure experienced by the patient
• Antibiotics
• Oral administration is preferred
• The antibiotics should be taken for as long as they are prescribed, otherwise the bacteria will develop resistance to the treatment
• Antibiotics can strip the body of healthy bacteria, so a good dose of probiotics is recommended to be taken during the treatment with antibiotics
• In more severe cases, with intense physical pain and discomfort experienced by the patient, intravenous antibiotic treatment might be administered (to prevent the life-threatening symptoms of kidney failure)
• Surgical intervention
• Recommended in patients who have kidney stones that are too large to be passed
• Also chosen for patients who present different cancerous growths – the surgical removal is recommended to relieve the patient of the symptoms but also to prolong life
• Insertion of a nephrostomy tube Recommended as a treatment for the acute obstruction of the urinary tract
• The chronic obstruction of the urinary tract can be treated through the following methods:
• Insertion of a ureteric stent
• Pyeloplasty
• Surgical reconstruction of the renal pelvis
• Purpose – drainage and decompression of the kidneys
• Three main approaches – open, partial (laparoscopic) or robotic
• If the obstruction of the urinary tract occurs at a lower level, such as it happens in patients who suffer from prostatic enlargement, the treatment consists of:
• Insertion of urinary catheter
• Insertion of a suprapubic catheter.

In conclusion, caliectasis is a serious medical problem that has to be addressed with the adequate treatment measures suggested above. It is important to remember that caliectasis and hydronephrosis in general can lead to the atrophy of the kidneys, causing their function to be completely impaired. The patients who suffer from kidney failure become dependent on dialysis and the quality of their life is severely impaired. Treating the symptoms of caliectasis and hydronephrosis in the correct time frame is essential, so as to prevent the atrophy of the kidneys and the potential renal failure. Also, recognizing the symptoms and recommending the correct investigation procedures is essential for providing a correct treatment approach.