Nephroptosis (omission of the kidney) is a pathological condition, which is characterized by the displacement of the kidney from the bed. Its location is not normal: the kidney is lower. In addition, in the process of moving the body, the mobility of the kidney becomes larger than is assumed by physiological norms.
The mobility of the kidney is especially pronounced when the body is in an upright position. As a consequence, the second name of this ailment is the pathological mobility of the kidney. In the normal state of the internal organs of the kidney during the process of breathing, and also shift only by 2-4 cm, which is an acceptable norm.
Most often, women are affected by nephroptosis. The cause is certain physiological differences: a broader and shallower anatomical bed, a friable fat capsule, the muscles of the abdominal press are weaker. The process of bearing and giving birth to children also becomes a serious stress for the body.
Causes
Why does nephroptosis occur, and what is it? Nephroptosis is the omission of the kidney on the right and left. There is a disease due to anatomical or pathological features of the structure of the organ. Excessive movement of the kidney appears due to weight loss, in violation of normal position. In most cases, nephroptosis occurs with a sharp release from body weight, when a woman "sits down" on a diet.
The main provoking factorsin the development of this pathology are:
- a sharp decrease in body weight;
- damage to the ligament apparatus;
- pregnancy and childbirth;
- excessive physical load;
- enthusiasm for heavy sports;
- rapid growth in children;
- hereditary predisposition;
- weakness of connective tissue.
How dangerous is the displacement of the kidney? To each kidney, the renal artery and vein are suitable, and the ureter leaves the kidney. Kidney vessels are rather short and wide. With the displacement of the kidney from its bed, these vessels must be stretched and tapered. As a result, the blood supply to the kidney tissue worsens. In addition, the deviation of the kidney from its normal position can lead to an ureteral bend, which will cause a delay in urine in the kidney. Thus, all conditions for the development of acute pyelonephritis (inflammation of the kidney tissue) are created.
Nephroptosis of 1 degree
At this stage of the disease, the left or right kidney is palpable only during inspiration, as it expires in the right hypochondrium during exhalation. At the initial stage of the disease, it is extremely difficult to establish a diagnosis, especially if it is an adult without a body weight deficit.
Nephroptosis of the 2nd degree
Most often, the omission of the right kidney is diagnosed at this stage. In this case, the kidney leaves the hypochondrium only when the person is in an upright position. If the patient rises, she hides back. Sometimes it needs to be corrected by hand.
Nephroptosis of the 3rd degree
At this stage, it leaves the subcostal area in any position of the body, can fall into a small pelvis. Due to a violation of the normal position of the kidneys, the ureter may be twisted and urine stagnation may begin. Blood supply to these organs may also be impaired.
The second and third degrees of nephroptosis can lead to serious consequences: pyelonephritis, hydronephrosis, renal arterial hypertension and some others.
Symptoms of nephroptosis
It is interesting that the right kidney is more likely to be affected - physiologically it is located somewhat lower and has a smaller diameter artery, which, accordingly, is stretched more strongly. Symptoms of nephroptosis of the right kidney are similar to the symmetrical manifestation of the disease, only the dislocation of pain can differ.
In general, the symptoms of kidney nephroptosis can be reduced to the following:
- At stage 1symptoms may not be expressed. Some patients experience dull pain in the back area, which are aggravated by physical exertion. To reveal the renal omission, it is necessary to pass laboratory tests and perform a radiography of the kidneys;
- At stage 2the disease is disturbed by the appetite. There are strong pain in the lower back, a positive symptom of Pasternatsky. At its definition the doctor strikes with an edge of a palm in the field of a loin. If, at the same time, pain in the lower back increases, it is obvious that kidney disease (nephroptosis, urolithiasis);
- With stage 3the disease arises an increase in blood pressure due to the release into the blood of angiotensin (formed due to spasmodic contractions of blood vessels).
The last two symptoms occur in the case of late treatment to a doctor and are complications of nephroptosis. At the initial stages, the disease is diagnosed with difficulty and is often confused with other diseases. Nephroptosis of the 2nd degree to the right can be taken for appendicitis because of the similarity of symptoms. Sometimes the disease is confused with cholecystitis or with colitis, usually this occurs with nephroptosis of the left kidney.
Complications
In the absence of timely medical care, the progression of nephroptosis can lead to the development of serious consequences:
- Hydronephrosis- develops due to a violation of the outflow of urine due to uterine inflexion or torsion.
- Secondary arterial hypertension- develops as a result of impaired physiological circulation in the kidney.
- Pyelonephritis- develops against the background of stagnant phenomena in the kidneys, creating a favorable environment for propagation of pathogenic microflora, which in turn cause an inflammatory process in the renal-pelvic system.
Treatment of nephroptosis
Two methods are used to treat nephroptosis of the right kidney - conservative and operative. Which of the methods to apply in each specific case is decided by the doctor on the basis of anamnesis, the results of the examinations and analyzes. Drug treatment of nephroptosis is effective for alleviating the pain syndrome, preventing complications, but it can not affect the abnormal position of the kidney.
In the early stages, for example, with nephroptosis to the right of the 1 st degree and left-side nephroptosis of the 1 st degree, before the development of complications, conservative treatment is possible:
- application of an individually manufactured bandage except for cases of fixation of the kidney in a new place due to the adhesive process;
massage of the abdominal region; - therapeutic gymnastics, special exercise therapy with nephroptosis, which helps strengthen the muscles of the back and abdominal press;
- the restoration of adequate nutrition in the development of the disease in case of excessive weight loss;
- restriction of excessive physical exertion;
- sanatorium treatment, including hydrotherapy.
For treatment of a nephroptosis of 2 degrees the doctor applies an individual approach to the patient: some patients are helped by conservative treatment, some require an operation. If the situation is only aggravated and there is a nephroptosis of the third degree (omission of the kidney below three lumbar vertebrae), surgery is the main treatment option.
Operation
In those cases where conservative methods do not give the desired effect, doctors are forced to resort to prompt intervention. The purpose of the surgical operation is a prolonged fixation of the kidney (or nephropexy). It is performed exclusively by a urologist. During the operation, the kidney is fixed in the renal bed located at the level of the waist (the normal anatomical location of this organ).
Currently, most patients undergo laparoscopic surgery. This method of surgical intervention is the most sparing for the patient, since access to the operating field is performed through several small incisions in the anterior abdominal wall.
This reduces the risk of postoperative complications and shortens the recovery period. If necessary, the surgeon can perform a cavity operation. Usually, the outflow of urine is restored after the operation and blood pressure is normalized.
Prevention
The prevention of nephroptosis in the formation of proper posture in children, strengthening the muscles of the abdominal press, preventing injuries, excluding the permanent impact of adverse factors (severe physical activity, vibration, forced vertical position of the body, sharp weight loss). Pregnant women are recommended to wear a prenatal bandage.
When there are drawing pains in the waist in the standing position, an immediate reference to the urologist (nephrologist) is necessary.
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