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  • Nephroptosis in pregnancy: causes and diagnosis of the disease

    Pregnancy is a period when taking care of one's health becomes one of the key tasks for a woman. Understanding the mechanism of the development of kidney diseases, including nephroptosis, makes it possible to prevent its occurrence, competently prepare for pregnancy and transfer it with minimal complications. And in this article we will talk about how nephroptosis proceeds during pregnancy.

    Species of the disease

    A healthy kidney is supported by the anterior wall of the peritoneum, the kidney ligaments and its own fatty bag. Mounting is not rigid - it can normally move 1.5-2 cm down, eventually returning to its normal position. If the kidneys "go" too far, the doctors talk about nephroptosis, that is, about their pathological displacement. The criterion of pathology is the distance exceeding the length of one vertebra of a person.

    The popular name of this disease - "omission of the kidney" or "wandering kidney" - quite accurately reflects the essence of the phenomenon. The sore organ is shifted to the pelvic or abdominal region, and with a serious extension of the renal ligaments to its former position, it can not return. Deviation from the natural location of internal organs leads to constant pain, it is difficult to feed the kidney from blood vessels, and the ureter obstructed due to displacement leads to a worsening of the outflow of urine. This provokes the development of various complications: pyelonephritis, intense stone formation, and in some cases, urination with blood( hematuria).

    There are 3 degrees of development of nephroptosis:

    • I degree, which is the basis for setting such a diagnosis - displacement of the lower edge of the kidney by 1.5 vertebra. As a rule, there are practically no clinical manifestations at this stage;
    • II degree - the lower edge of the renal pelvis descends to a distance of 2 to 3 vertebrae;
    • III degree - if the lower edge of the kidney falls more than 3 vertebra.

    Causes of nephroptosis in pregnancy and diagnosis of the disease

    This disease occurs more often in pregnant women, which is associated with less elasticity of the abdominal muscles and significant loads that these muscles experience during the bearing of the child. Among the main reasons not related to pregnancy, physicians call:

    • a very fast weight loss( an "extra fat" kidney "leaves");
    • intensive weight gain( while increasing kidney fat pulls the organ down);
    • trauma in the lumbar region, sudden weight lifting( kidney ligaments are stretched, twisted or injured);
    • heavy delivery( overpressure of the press on the impact on the kidneys is comparable to traumatic).

    This is important! The main manifestation of the disease "wandering kidney" is acute pain resembling renal colic, or on the contrary, pulling the pain in an upright position, which passes, if lying down. In addition, the disease is characterized by a decrease in the number of daily urination( up to 1-2 times a day) and a small amount of excreted urine.

    Even before the acute clinical manifestations of kidney displacement, it will help to find out:

    • ultrasound of the abdominal cavity, the basis for which can be complaints about changes in well-being, increased protein, leukocytes and erythrocytes in the urine;
    • differences in blood pressure measurements in the supine and standing( sitting) position: with nephroptosis this difference is 15-30 mm Hg;
    • review X-ray of abdominal organs, angiography, excretory urography.

    In pregnancy, diagnostic methods for detecting nephroptosis allow only an ultrasound examination and follow-up of dynamics by urinalysis.

    Features of the course of pregnancy with nephroptosis

    For the first time the diagnosis of "omission of the kidney" can be established both before the onset of pregnancy, and during and after childbirth. In the first case, conservative treatment is permissible and, if necessary, surgical intervention, after which it is necessary to undergo a recovery period. Malotravmatic methods of surgical correction allow to return the organ to its place, while it takes only 3-4 months to completely restore the organism before pregnancy.

    During the gestation period, the manifestations of nephroptosis usually increase, so regular examinations and maintenance therapy are necessary.

    If nephroptosis was detected during examination during pregnancy, it may be temporary, associated with uterine growth and abdominal wall stretching. Often, the course of this disease( in the initial stages) does not affect the fetus in any way. Nevertheless, it is recommended to be observed regularly with a urologist and gynecologist in order to avoid possible complications.

    To ease the pains that appear in the back, the so-called knee-elbow pose helps the expectant mothers. In this position, the lowered kidney is released from the pressure of the uterus, and its blood supply improves. The tactics of treating pyelonephritis, as one of the most frequent complications of nephroptosis during pregnancy, is chosen by the attending physician in the light of specific circumstances. Can be assigned wearing a bandage for the back.

    In complicated cases( with complicated II-III stages, accompanied by impaired renal function), urgent cesarean section is possible.

    After giving birth, women with a diagnosis of "omission of the kidney" should do special gymnastics aimed at strengthening the abdominal muscles, and also try to maintain a constant weight.

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