Right-sided, left-sided and bilateral nephroptosis( omission of the kidney): causes, symptoms, treatment

In a healthy person, the kidneys are located in the renal bed and are securely fixed there by the work of fasciae, ligaments, adipose tissue, the action of intra-abdominal pressure. The artery and vein approach the kidney, and the ureter is removed from it. In some conditions and diseases, nephroptosis develops when one or both organs are displaced from a normal location.

Nephroptosis

Nephroptosis is a disease in which the mobility of the kidney exceeds the norm, so the organ can move in a vertical projection - to descend, to wander and not to have a clear and unchanged location. If an ordinary person with a change of position of the body, breathing organs can move 2 cm( no more), then with nephroptosis this indicator is much higher. Sometimes the kidney moves downward, including a small pelvis, 5-10 cm.

Nephroptosis is also called "omission of the kidney"( ICD-10 code is 28.8).In women, the disease is more common( about 1.5%), people of the stronger sex suffer from this pathology less often( no more than 0.1%).The omission of the kidney is registered, mainly after 30 years. Usually it is one-sided( right-sided or left-sided): 75% of patients are affected by the right kidney - it is even in the norm just below the left, which suffers in 15% of cases. Bilateral nephroptosis is recorded less frequently than right-sided - no more than 10% of cases. In children, the pathology occurs in 8-15 years, not earlier, since the kidneys occupy a permanent position only at the age of 8 years.

Causes of

Women are highly susceptible to nephroptosis, because they have a number of anatomical features in the structure of the kidneys:

• Shallow, but wide renal lodge;
• Loose fat capsule;
• Weaker muscles of the press.

The woman also nurtures and gives birth to children, which often becomes a starting factor for ovulation of the kidney, especially with multiple pregnancies, multiple pregnancies. Usually, in women, nephroptosis touches the right kidney. Other reasons for it may be hormonal disruptions, a sharp drop in pressure in the peritoneum after childbirth. In general, this disease in persons of both sexes is only acquired, and the prerequisites for it are very diverse.

The main are:

• Reduced fatty capsule;
• Changing the position of the renal peduncle;
• Decreased muscle tone;
• Weakened fascias and ligaments.

This can be caused by physical work, fast weight loss, strength training, kidney trauma, vertical operation. Bilateral nephroptosis occurs mainly in people with a birth of weakness of connective tissue and ligaments, as well as in individuals subject to constant shaking and vibration( for example, drivers).

Stages of

There are several stages of the disease, which are determined by the degree of displacement of the kidney from its natural position.

Also the stages include unequal structural disorders, kidney function and complications:

1. The first stage. The pole of the right or left kidney at 1 degree is shifted by 1.5 lumbar vertebrae. Even with the omission of two kidneys, it is not immediately possible to determine the pathology visually, only in lean people the doctor will be able to presume a diagnosis after palpation while standing on inspiration. The organs retain their functions completely.
2. The second stage. The lower renal pole moves to 2 or more lumbar vertebrae. Outwardly in the standing position on the inspiration, the right kidney will be noticeable, but lying prone pathology is still impossible. Already from this stage, the kidney can rotate along the longitudinal axis, which can provoke an inflection of the ureter or feeding vessel.
3. Third stage. The kidney is displaced on 3 vertebra and more. The right kidney is visually conspicuous and located in the right hypochondrium, the left kidney can be seen only on inhalation. In some people, the kidney is displaced into a small pelvis. As a complication in all patients there is chronic pyelonephritis, in half - vascular disorders and urolithiasis.

Clinical picture

The early stages of the pathology do not manifest themselves in any way, therefore it is possible to detect the disease only with the passage of a planned ultrasound. Later, unpleasant sensations from the side of the lesion begin to appear. If the budding kidney develops from two sides, pain and other signs are observed on the right and left. In general, the pain of a pulling, aching character is the most common symptom of the disease. The pain can quickly disappear, especially when placing the person in a horizontal position.

According to the type of renal colic, pain occurs when the ureter, nerve bundle or vessel is torsion, it gives into the groin, the genitalia. Such pain can occur with a sharp change in the position of the body, prolonged finding with a clench of the abdomen. Pain syndrome is combined with nausea, vomiting, pallor, hyperhidrosis, often with an increase in body temperature. In the chronic phase, nephroptosis can also be disturbed by regular attacks of nausea, heaviness in the abdomen, diarrhea or constipation, and poor appetite.

Other possible symptoms in kidney lowering are associated with chronic pain and concern the dysfunction of the nervous system:

• Irritability;
• Depression;
• Insomnia;
• Vertigo;
• Neurasthenia;
• Enhanced heart rate;
• Increased fatigue;
• Headache.

In stages, the symptomatology of the disease is characterized by such signs:

1. The first stage - rarely there are blunt pains in the back, lower back, increasing with exercise, disappearing after lying down lying down. Many patients have no clinical picture at all.
2. The second stage - the violation of appetite, other symptoms from the gastrointestinal tract, periodic severe pain, pain in palpation of the kidney.
3. The third stage - symptoms from the nervous system, increased pressure, frequent painful attacks, or non-vanishing aching pain.

Diagnosis

In the event of a pain syndrome, the patient, as a rule, turns to the therapist or urologist, nephrologist. To presume the diagnosis the doctor can already after carrying out of functional tests with change of position of a body, an inhalation and an exhalation. With palpation, an incorrect kidney position and mobility can be established if its displacement reaches 2-3 stages. When measuring the pressure, it is possible to detect hypertension, as well as sudden pressure surges when the body's position changes rapidly from horizontal to vertical.

The examination procedure for suspected nephroptosis is indicated by the physician and may include such procedures( in the brackets - determined deviations):

1. The general analysis of urine( often - a hematuria, a proteinuria, at an inflammation of a kidney - occurrence of leucocytes).
2. Urine boiling( the presence of bacteria when attaching cystitis, pyelonephritis).
3. Kidney ultrasound in the supine and standing position( incorrect location and pathological mobility of one or two organs, inflammation, concrements, hydronephrosis, etc.).
4. Duplex of the vessels of the kidneys( dysfunction of vessels, changes in the degree of blood flow, decrease in renal hemodynamics, sometimes - kinking of blood vessels).
5. Excretory urography( degree of ovulation of the kidney, rotation of the kidney).
6. CT or MRI of the kidneys( complete characterization of the stage of nephroptosis and complications, if any).

If the patient already has displacement and compression of internal organs, fibro-gastroduodenoscopy, intestinal and gastric X-ray, pelvic ultrasound, colonoscopy and other techniques can be prescribed. Most often this situation is observed with bilateral nephroptosis. Differentiate nephroptosis of the left kidney with colitis, cholecystitis, damage to the right kidney - with appendicitis.

Treatment of

In the first and second stages of the pathology, conservative treatment is usually used. There are several treatment methods, their combination is chosen by the attending physician. Usually in the first stage, it is enough to wear a bandage specially made for the patient, as well as to carry out a stomach massage, exercise therapy to strengthen the muscles of the back and the press. Excessive loads, lifting of weights are excluded, surely the correct diet regime is observed with a refusal from the abundance of meat, fatty, fried, spicy, salty foods. It is useful to sanatorium treatment, water procedures.

In the second stage of the disease, pharmacotherapy is mandatory( in the first stage - only according to the indications), because in most cases there are already complications of nephroptosis.

The following preparations are prescribed:

• Painkillers;
• For dissolving stones;
• Antihypertensive;
• Antibiotics;
• Uroseptics;
• Vascular.

Orthopedic treatment( wearing a bandage, corset, belt) is shown constantly, the product should be worn in the morning without getting up from the bed on exhalation. You can remove the bandage just before bedtime. Some patients even in the second stage are shown surgery, in the third stage, surgical intervention is the main treatment option.

On the video about wearing a bandage when the kidney is down:

The main indications for the operation:

• No effect of conservative therapy.
• Persistent pain.
• Loss of ability to work.
• Regular complications( pyelonephritis, torsion of the ureter, etc.).
• Pressure increase.
• Hydronephrosis.

The task of surgical intervention is the fixation of the kidney or two kidneys in the anatomical bed. Usually, the operation is performed through laparoscopic access, while the recovery period is minimized.

Cavity operations are performed only with a serious displacement of organs from both sides, or with acute kidney ischemia and other severe conditions.

Prevention

To prevent pathology since childhood, it is important:

• Follow the correct posture.
• Strengthen the muscles of the press.
• Prevent injury to the kidney area.
• Eliminate sudden weight loss.
• Avoid regular heavy physical exertion.
• When pregnant and after childbirth wear special bandages.
• Get medical attention immediately and be treated for kidney disease.

With a tendency to nephroptosis, do not practice power sports, do not work with a long standing in the upright position.

Consequences of

In the absence of treatment, pathology can lead to serious consequences. In particular, kidney ischemia can develop due to impaired blood supply to the body. The point is that the renal artery and the vein are short and wide vessels, and when they drop the kidney they are forced to stretch. Because of the dilatation, the vessels contract, normal circulation in the organ is disturbed - oxygen starvation of tissues occurs.

Regular development of hypertensive crises is possible with extremely high rates( up to 280/160 mm Hg).If there is a torsion of the vessels, acute ischemia can lead even to necrosis of the kidney parenchyma with severe consequences.

In the vast majority of patients, cystitis and pyelonephritis occur due to congestive organ failure, urolithiasis develops. Stagnation of urine leads to the development of pathogenic microflora, which provokes a chronic inflammatory process. Another possible complication is hydronephrosis, associated with ureteral bend( chronic hydronephrosis) or its sharp twisting. Bilateral nephroptosis quickly leads to chronic renal failure. Thus, the wandering kidney is a serious disease, requiring prompt medical attention without delay.
On the video about the causes, varieties and treatment of nephroptosis: