Nephroptosis( wandering kidney) - Causes, symptoms and treatment. MF.

Nephroptosis ( wandering or mobile kidney) is a condition in which the kidney from its normal position( in the lumbar region) is strongly shifted to the bottom( into the abdomen and even the pelvis).At the same time, it can both return to its usual place and never return there.

Prevalence of nephroptosis

Nephroptosis occurs mainly in women( 0.1% in men and 1.5% in women).This fact is explained by the peculiarities of the structure of the female body - a wider pelvis, a lowered tone of the abdominal wall, greater elasticity of the ligaments.

Kidneys, like most organs of the human body, are in relative mobility, although they have their clear place in the body. At the moment of inspiration, the kidney moves downward by 2-4 cm, with a deep inspiration it leaves 4-6 cm. It reacts to movements and movements of the body. Such physiological fluctuations help the normal release of urine.

But it happens, the body goes out of control, the ligamentous apparatus does not hold the kidney, and its movements become unpredictable. She begins to wander through the body, can move up and down, rotate around a vertical or horizontal axis, move in the opposite direction. As a rule, then she returns to her place on her own, but not for long. With a long stay in some other place, the kidney can be fixed there forever for an adhesive process.

Symptoms of nephroptosis

The disease does not appear at all in the beginning, and a wandering kidney begins to manifest unpleasant sensations in the lumbar region on the side of the omission: more often on the right - in 75% of cases, 10% on the left and 15% on both sides. The most frequent consequence of the displacement of the kidney is the pain of a pulling, aching character, less often stitching. At the beginning of the disease, the pain is not pronounced, it quickly disappears. But with the years become more intense, constant, exhausting.

First, pain occurs after some kind of physical strain, lifting of heaviness, intense coughing or at the end of the day. They decrease in position on the back or on the sore side.

Pain with nephroptosis can also be very intense - by the type of renal colic. They can appear suddenly after a strong strain or a change in the position of the body from lying to the vertical and last from several minutes to several hours - then weakening, then growing. Pain is often given to the groin, to the genitals. Sometimes such an attack is accompanied by nausea and vomiting. The patient is pale, covered with a cold sweat, the temperature may rise.

Pain is not the only symptom of nephroptosis .In many, the mobile kidney is manifested by loss of appetite, nausea, a feeling of heaviness in the epigastric region, constipation or, conversely, diarrhea.

In the future, functional disorders of the nervous system in the form of increased excitability, neurasthenia. Such patients are excessively irritable, distrustful of the conclusions and advice of the doctor, hypochondriac. They easily get tired, suffer from dizziness, palpitations, insomnia.

Three stages are distinguished in the development of nephroptosis, depending on the level of kidney depression:

• 1 stage. In this stage, the lowered kidney can be probed through the anterior abdominal wall on inhalation, on exhalation the kidney leaves in the hypochondrium( normally the kidney can be palpated only by very thin people, it is not palpable in all others).
• 2nd stage. In the vertical position of the patient, the entire kidney leaves the hypochondrium, but in the prone position it returns to the hypochondrium, or it can be painlessly adjusted with the hand.
• 3rd stage. The kidney completely leaves the hypochondrium in any position of the body and can move into the small pelvis.

Causes of nephroptosis

The causes of nephroptosis are factors that lead to changes in the ligamentous apparatus of the kidney( infectious diseases, sharp weight loss) and to a decrease in the tone of the muscles of the anterior abdominal wall( for example, in pregnancy), as well as trauma accompanied by overgrowing or rupture of the ligamentous apparatus of the kidneylifting weights, falling from a height, etc.).

Complications of nephroptosis

At the time of a significant displacement of the kidneys, more often down, the ureter curves, twists, and the passage of urine becomes more difficult. There is a retention of urine, its stagnation in the calyx-pelvis system of the kidney. The urine arrives, and the outflow is difficult, the renal pelvis widens, which in time can lead to hydronephrosis transformation.

Most often, stagnation of urine leads to pyelonephritis - an inflammation of the calyx-pelvis system of the kidneys. This is the first, the earliest and most frequent complication of nephroptosis. In some cases, pyelonephritis can be acute with the development of severe pain syndrome - renal colic, which requires urgent medical attention.

The renal artery is stretched, sometimes it is doubled, naturally narrowing at the same time. In consequence of the torsion of the renal arteries, nephroptosis often develops hypertension accompanied by a marked increase in blood pressure and poorly amenable to drug treatment. The kidney lacks blood, nutrients and oxygen, resulting in even hypertensive crises. Renal arterial pressure is highest, especially due to diastolic digits, and can reach up to 280/160 mm Hg.

Diagnosis of nephroptosis

Diagnosis is based on complaints, examination of the patient and palpation( probing) of the kidney, laboratory and instrumental examinations.

With nephroptosis , there is a difference in blood pressure( BP) by 15-30 mm Hg.in the same patient in a vertical and horizontal position - in the vertical it increases.

When studying urine, a small amount of protein, white blood cells and even red blood cells can be found.

The main method for the diagnosis of nephroptosis is X-ray and ultrasound. The most informative instrumental methods for examining the kidneys are an overview X-ray of the urinary system, as well as excretory urography, an x-ray method of study, combined with the introduction of a contrast agent into the patient's vein. Pictures are taken in a standing and lying position. Radioisotope scanning and scintigraphy make it possible to determine the position, and renography is a functional condition of the pathologically moving kidney. Angiography allows you to judge the state of the renal artery, venography - about the venous outflow. Sometimes it is necessary to investigate all the organs of the gastrointestinal tract( x-ray of the stomach and intestines, PHEGS, colonoscopy) to exclude or confirm the general omission of the abdominal organs.

Treatment of nephroptosis

Treatment of nephroptosis can be both conservative and operative.

In the early stages of the disease in the absence of severe pain, if complications have not yet developed, nephroptosis can be cured by conservative methods. Such methods include orthopedic treatment: a special bandage in the morning, before getting out of bed, put on a deep exhalation on the stomach, being in a horizontal position, and removed in the evening. There are many different bandages, belts, corsets, but they must be made individually for each individual patient. Contra-indication for orthopedic treatment is only a kidney fixed in a new place by a commissural process. In all other cases it is shown.

At the first stage of nephroptosis, sanatorium-resort treatment, abdominal massage, therapeutic gymnastics aimed at strengthening the abdominal and back muscles, providing normal intra-abdominal pressure and restricting the displacement of the kidneys down, are useful.

Drugs can not put the kidney in place. However, they treat complications of nephroptosis , such as pyelonephritis, high blood pressure in renal arterial hypertension. Usually prescribed antispasmodic, analgesic, anti-inflammatory drugs. It is necessary to limit heavy physical exertion. If nephroptosis developed as a result of weight loss, then sufficient food is needed in order to gain lost weight.

For the treatment of nephroptosis, a set of physical exercises is also used to strengthen the abdominal muscles.

In case of ineffectiveness of conservative treatment resort to surgical methods of kidney fixation - nephropexy( kidney fixation to neighboring anatomical formations).In this operation, the urologist returns the kidney to her usual bed in the lumbar region and strengthens her there.

Currently, the most effective method has shown nephropexy laparoscopic method.(The operation is performed through abdominal punctures and the surgeon uses special manipulators and digital cameras).

The "old" cavity operation using a muscle flap is quite traumatic and requires an extended lumbar incision up to 20 cm. In addition, in the postoperative period, it is necessary to observe bed rest for 2weeks, so that the kidney is firmly entrenched in its bed.

Timely operation usually produces good results. Transient arterial hypertension, as a rule, goes away and blood pressure is normalized.