Kidney Dystopy: Causes and Diagnosis

In Greek, the word "kidney dystopia" means an improper location of the organ, which may be accompanied by an offset in any direction. Can be shifted to the pelvic or iliac region, thorax or other place. The disease occurs in approximately 2% of all possible kidney pathologies and is considered congenital. An abnormal condition occurs both in one kidney and in both.

Causes of

Disease occurs during fetal development. Initially, the kidneys in the embryo are laid in the pelvic region. In the process of development begins the shift of organs from the pelvic region to the lumbar region, with the subsequent upward movement. The kidneys begin to unfold when they occupy a location above the aortic bifurcation.

The reason for the anomaly is the delay in movement in the process of child's growth due to unfavorable factors of intrauterine development. Therefore, if the organ is located at a lower level than it should, it can partially rotate. In this case, not only the location, but also the rotation is violated, which contributes to the appearance of disturbances in the work of the organ. The kidneys can move in different directions and stop at any level. A turn can be incomplete even with the correct location.

Types of dystopia

Dystopy of the kidneys are divided into 5 groups depending on their location. The structure of the vessels with this anomaly has its own peculiarities. On the kidneys there are many main arteries, from which the smaller vessels leave. The location and divergence of these vessels is atypical, therefore the disease is classified according to the level of vascular withdrawal:

1. Subdiaphragmatic dystopy assumes a very high location of the kidney. It can be even at the level of the chest. Vessels in it depart at the level of the twelfth vertebra and it is called thoracic.
2. Lumbar - assumes the location of the kidney below the required level. In this case, the vessels move away from the renal aorta to the aortic bifurcation at the level of the second lumbar vertebra.
3. iliac - suggests an arrangement of the organ in the iliac fossa. The arteries in it depart from the common iliac.
4. Pelvic - is associated with the passage of arteries from the internal iliac artery. The kidney, with this arrangement, is located in the sacral cavity between the rectum and the bladder in men, and in women in the Douglas space. Typically, this kidney has a short ureter.
5. Crossover( heterolateral) dystopy involves the displacement of the organ in the opposite direction. The offset can be one-sided or two-sided. Dystopia of the left kidney is less common.

Diagnosis of abnormal location of the kidneys

Impaired location of the kidneys is diagnosed during the period of the child's stay in the womb using ultrasound. Most often, a dystopia of the right kidney is detected in utero on the term of 12-39 weeks of pregnancy, less often left. Further more detailed diagnosis is carried out after the birth of the baby. Depending on the location, several types of examinations are used:

• ultrasound;
• chest X-ray( with a thoracic kidney);
• excretory and retrograde urography;
• MRI or MSCT.

If there are no complications, the pathology may not appear. Detecting dystopia can be accidental in adults with a planned medical examination by a gynecologist or urologist, while undergoing fluorography. Sometimes such a kidney is mistaken for neoplasm.

Symptoms of the disease

Symptoms of kidney dystopia can occur with too high or too low an organ position, especially with concomitant complications. In this case, pain appears in the location of the organ. In the pelvic position, pain can resemble pain in appendicitis. When the position is high, the pain is felt in the lower back or in the back. There may be constipation, diarrhea.

In women, the improper position of the kidneys causes painful menstruation or menstrual irregularity. At pregnant women it is accompanied by a toxicosis or threat of premature birth. Concomitant complications can cause problems with urination, painful urination. An untreated inflammatory infectious process can provoke renal failure, regardless of whether it is acute or chronic.

Treatment of

It is not possible to move the kidney to the desired place by surgery. This is due to the fact that a lot of vessels with a small cross section leave it from different directions, they often have a complex interlacing. Therefore, the treatment of kidney dystopia is carried out only with obvious disabilities and availability of concomitant diseases.

Treatment consists in the elimination of the inflammatory process with pyelonephritis, urolithiasis. Surgical intervention is necessary for neoplasm in the kidney, excretion of stones. With the death of the kidney, located abnormally, nephrectomy is used.