Some diseases of the genitourinary sphere appear in humans since birth. One of them is a kidney dystopia, the causes, symptoms, treatment of which will be discussed in the article.
Kidney Dystopia
According to the ICD-10, renal dystonia refers to the section "Congenital malformations of the urinary system", occupying the code Q 63.2 "Ectopic kidney".Under the dystopia( ectopia) of the kidney is understood the congenital malformation of the organ, manifested by its improper arrangement in the body( the kidney is not in the renal bed).Statistics are as follows: in 0.1-2.8% of babies born, this pathology takes place, manifesting with varying degrees of severity. More often the pathology covers the right kidney.
Disease in nephrology is considered complex, requiring medical response and adequate treatment. Kidneys in dystopia can be in completely different places - in the area of the small pelvis, waist, thoracic cavity, ileum zone. If the fetus or newborn is affected by both organs, the disease gives even more severe consequences.
The result is the incompleteness of the kidney rotation, than the dystopia is radically different from nephroptosis( secondary renal displacement).
Causes of pathology
Because pathology is congenital, the exact causes of it are associated with malfunctions in embryogenesis and are not entirely due to abnormal obstetricians' actions in childbirth. In the fetus, the kidneys are initially in the pelvic area and only then move higher, rising to a normal position - at the level of the last thoracic and first lumbar vertebrae opposite each other relative to the spine. If any pathogenic factors influenced the fetus during intrauterine development, the movement and fixation of the kidney( or two kidneys) is disrupted. The kidney is fixed in an abnormal position - a dystopia occurs.
Risk factors that can potentially affect the process of migration and rotation of kidneys in a child are as follows:
- alcoholism;
- smoking;
- addiction;
- poisoning with toxic agents;
- stresses, shocks;
- administration of drugs with teratogenic effect.
In some cases, hereditary predisposition to the development of kidney dystopia is noted.
Forms of
The disease is more often one-sided, much less often bilateral. Ectopia can cover the right or left kidney, and in 57% of cases the problem concerns the right kidney, in 10% - of both organs. When the organ is shifted in the opposite direction, the dystopia is called homolateral. If the kidneys are in the opposite parts of the peritoneum, then a heterolateral( cross) dystopia is diagnosed, in which even organ fusion can occur.
The classification of the disease by the anatomical position of the abnormal kidney is very important. It includes such species( refer to the left and right kidneys):
- Lumbar. Vessels of the kidney are present in the area of 2-3 lumbar vertebrae, and the pelvis is turned towards the abdominal cavity. Pathology can be detected by probing the abdomen, when the kidney will be felt in the zone of hypochondrium. Anomaly occurs in 65% of cases, initially mistakenly perceived as nephroptosis, neoplasm.
- Pelvic. In female children, the kidney is found between the rectum and the uterus, the male is between the rectum and the bladder. The ureter is shorter than usual. The frequency of pathology is 22% of the total number of dystopias. At women of childbearing age at times such dystopia reminds an ectopic pregnancy.
On video, a pelvic dystopia with a complete fusion of the kidneys:
- The iliac. Diagnosis leads to a large number of excess vessels from the iliac artery, and the kidney itself is located in the ileum. Frequency - 11% of cases, the disease is often perceived as a cyst, another neoplasm.
- Thoracic( subdiaphragmatic).In this case, the kidney vessels retreat from the 12th thoracic vertebra, and the kidney is strongly elevated toward the diaphragm( 2% of pathologies).Such a disease is often initially taken for lung cancer, pleurisy, mediastinum cyst.
Cross( rotational) dystopia is the arrangement of organs "criss-cross", or their location on the one hand with merger and functioning as a single organ.
a - pelvic;b) iliac;c - lumbar;in-lumbar;д - one-sided cross;d - double-sided cross;d - incompleteness of rotation in embryogenesis.
Symptoms
The clinical picture of the pathology depends entirely on the specific location of the kidney and the magnitude of its displacement. Thus, lumbar dystopia can generally not interfere with a person during life, or begins to manifest itself during pregnancy.
The ileal dystopia of the kidney usually gives more severe symptomatology.
The kidney interferes with other organs, nerve trunks, blood vessels, therefore its signs are as follows:
- Discomfort in the abdomen, epigastrium.
- Malfunction in urination.
- Dysfunction of the intestine, constipation.
- Increased gas formation.
- Dyspeptic symptoms.
Strengthening symptoms in women occurs during menstruation.
In pelvic ectopia of the kidney, the clinic may include:
- Pelvic pain.
- Severe discomfort during intercourse, menstruation.
- Pain when urinating.
- Reduced intestinal motility.
- Sometimes - imitating a clinic of acute abdominal pathology.
- Severe toxicosis in case of pregnancy.
- Complicated delivery.
Subdiaphragmatic dystopia leads to pain after eating, and sometimes even during meals. It can cause the development of hernia of the esophageal aperture of the diaphragm. As can be seen from the description, the symptoms of dystopia are never specific, so it is often diagnosed after the development of various complications.
Diagnosis
Assume the presence of a problem the doctor can already with palpation of the area of the peritoneum and waist. Pelvic dystopia is sometimes found when visiting a gynecologist( in women) or a urologist( in men).The doctor reveals tight formation in an abnormal place, directing the patient to a follow-up.
The presence of a tumor or cyst of the abdominal and pelvic organs must be excluded, as well as differentiation of dystopia with nephroptosis, inflammatory diseases.
With these objectives, the following types of diagnostics are performed:
- Radiographic examination of the chest cavity;
- kidney ultrasound;
- Urography;
- MRI( CT);
- Scintigraphy;
- Angiography of renal vessels.
Treatment and predictions of
A patient with a similar pathology is observed with a nephrologist or urologist. Compulsory treatment of the disease will be required in the presence of complications or the risk of their development. Unfortunately, patients with dystopia are very prone to the appearance of a variety of concomitant diseases, which determine the prognosis and treatment. Most often an inflammatory complication arises - pyelonephritis. He is treated conservatively by taking antibiotics and drugs that improve blood flow and urine outflow. Often there is a urolithiasis, which should be treated with a special diet, preparations for dissolving and removing stones, sometimes - by ultrasonic methods or surgery.
Many patients are also advised to change their lifestyle:
- Do special special exercises.
- Observe diet food.
- Do not allow hypothermia, SARS, sore throats.
- Restrict water intake.
In the presence of indications, surgical restoration of the anatomy of the kidneys is performed. The operation to return the kidney to a normal place is technically very difficult, since the organ can easily be damaged, and the vessels feeding it are numerous and small in size. In case of accidental damage to the tissue of the kidney, its vessel, pelvis, it is necessary to perform suturing, if this is not possible, remove the organ.
Particularly difficult situation in patients with crossed dystopia - they have no surgery already in their youth can develop arterial hypertension and renal failure. The prognosis depends on the presence of complications. With timely and successful intervention or conservative treatment of concomitant problems, it is favorable.