In a healthy person, each kidney is located in the renal bed, to which a bundle of vessels and nerves fits. Kidney in the bed keeps at the expense of ligaments, fascia, surrounding fatty tissue, besides it is supported by intra-abdominal pressure. Normally, the kidney can move slightly, without leading to ureteral bends, development of stagnation of urine and other pathologies. But sometimes the body is capable of shifting so that this phenomenon causes serious consequences.
Rotation of the kidneys - what is it?
Dystopia, or kidney rotation is considered an innate pathology, refers to malformations of the organs and is a condition with increased organ mobility with respect to rotation around its axis( code on ICD-10 - Q61 Cystic kidney disease).Normally, in the vertical position of the human kidney during breathing can be shifted to 2 cm, a stronger displacement is considered pathological. Among all malformations and renal anomalies, rotation is recorded in 2.8% of cases. In newborn children, it is often noted - in 1 child out of 1000. The baby is born with already existing abnormalities, but they can be diagnosed only in adulthood.
The disease can affect any kidney, but is more often seen in the right than in the left kidney.
Depending on the number of organs affected, the classification will be as follows:
- Homolateral dystopia - one kidney is displaced.
- Heterolateral dystopia of both kidneys - organs are arranged incorrectly, crosswise.
Types of
Rotation can be incomplete and complete. When the rotation is incomplete, the kidney moves up or down, at full rotation - moves around its pedicle, performs pendulum movements.
According to the location of the affected kidney and the site of the renal arteries, the dystopia is as follows:
- Pelvic;
- Lumbar;
- Thoracic( sub-diaphragmatic);
- iliac.
In 67% of cases, pelvic dystopia occurs, in which the renal arteries are in the area from 2-3 lumbar vertebrae to aortic bifurcation. Such a kidney is turned with a pelvis forward, probed under the ribs, therefore it is often taken for a tumor or nephroptosis. With palpation, the iliac rotation can be taken as an ovarian cyst, a swelling of the abdominal cavity. Pelvic kidney dystopia is often perceived as inflammation in adnexitis, ectopic pregnancy, and thoracic - as an abscess and swelling of the lung, mediastinum.
Reasons for
In children, the anomaly develops during the embryonic development. Rotation is the result of a delay or disruption of the movement and rotation of the kidney from the pelvic area to the lumbar region. In the fetus, both kidneys are initially placed in the small pelvis, and only then move upwards and occupy a position at the level of the last thoracic - the first lumbar vertebrae on both sides of the spine. If the mother's organism is affected by pathogenic factors, the migration of the kidney may be disturbed. On the contrary, the thoracic dystopia comes from excessive migration to the chest, combined with a congenital hernia of the diaphragm.
At nephroptosis in the initial stages also rotations of the kidney are observed, the most vulnerable to it are women with asthenic physique.
The causes of acquired pathology are:
- Decreased tone of peritoneum muscles.
- Severe physical activity.
- Injury to the kidney area.
- Heredity.
- Sharp weight loss.
- Excessive vibration of the body during operation.
- Chronic infectious diseases.
Clinical picture
The signs of kidney rotation are due to its appearance and the place where the affected kidney has shifted. Its rotation rotation causes twisting of the vascular bundle and nerve fibers, which causes the appearance of symptoms in children and adults. Also, the kidney presses on the surrounding structures, because its location is abnormal.
In pelvic dystopia, pains in the lower abdomen are observed, intensifying with monthly, violations of the defecation process, frequent inflammatory diseases of the female sexual sphere. Lumbar dystopia practically does not give pathological signs and can be considered even a variant of the norm. If the kidney is located in the chest cavity, it gives pain to the sternum, shortness of breath, violation of passage of the food lump through the esophagus, a feeling of a coma in the throat.
Any improper location of the kidney entails the risk of an inflexion of the vascular pedicle or even a rupture.
Bends lead to impaired urination, the appearance of severe pain and the development of such signs:
- Increase in temperature.
- Nausea.
- Weakness.
- The loss of appetite.
- Insomnia.
- Frequent renal colic.
- Regularly occurring pyelonephritis.
- Depression.
- Blood in the urine.
- Pain in physical work.
Diagnosis
For the diagnosis is necessary to undergo a variety of examinations, because a person may have symptoms from the chest, peritoneum, small pelvis. Localization of the kidney in the thoracic area is revealed by means of an overview radiography, fluorography, ultrasound of the lungs and the pleural cavity. The kidney is visualized as a round dense structure under the diaphragm. Parallel ultrasound of the kidneys, which will show the absence of the organ in the right place.
Other methods to diagnose:
- Excretory urography;
- Renal angiography;
- Renal scintigraphy;
- Renography;
- MSCT, MRI of the kidneys.
Since dystopia often has an inflammatory process in the kidney, it is important to conduct general clinical laboratory tests. In the analysis of urine with concomitant pyelonephritis, leukocytes are detected, with glomerulonephritis there are proteins and erythrocytes. Differentiation of kidney rotation is necessary with tumors, nephroptosis, benign formations.
Treatment of
If the pathology does not bring pain, does not cause inflammation and other complications, treatment is not required. Nevertheless, observation of an abnormally located kidney in the dynamics is mandatory. With the development of the inflammatory process, antibiotics, sulfonamides, nitrofurans are prescribed. Conservative treatment may also include vascular drugs to improve renal blood flow, drugs for the prevention and excretion of calculi.
Surgical treatment is performed if the disease is complicated by urolithiasis, hydronephrosis. If the kidney does not function, or compresses the surrounding organs, it is removed. Moving the kidney to a normal place is not often done, as it presents huge difficulties due to the large number of small vessels.
Complications of
The organ can adversely affect other systems located side by side. Dangerous complications are cases of compression of large vessels or nerve plexuses. The inflection of the vascular bundles feeding the kidney in children often leads to its necrosis and complete death, which will require urgent removal. Among complications there are also urolithiasis, chronic nephritis, hydronephrosis, renal insufficiency, kidney neoplasms are rarely diagnosed.