Nephroptosis (kidney prolapse) is a pathological condition characterized by a displacement of the kidney from the bed. Its location is not normal: the kidney is below. Moreover, in the process of moving the body, the mobility of the kidney becomes greater than that assumed by physiological norms.
Mobility of the kidney is especially pronounced when the body is in an upright position. As a consequence, the second name for this ailment is pathological mobility of the kidney. In the normal state of the internal organs of the kidney in the process of respiration, they also shift only by 2-4 cm, which is an acceptable norm.
Most often it is women who are affected by nephroptosis. Certain physiological differences are considered to be the cause: a wider and shallow anatomical bed, a more loose fat capsule, and the abdominal muscles are weaker. The process of carrying and giving birth to children also becomes a serious stress for the body.
Why does nephroptosis occur, and what is it? Nephroptosis is a prolapse of the kidney on the right and left. There is a disease due to the anatomical or pathological features of the structure of the body. Excessive movement of the kidney appears due to weight loss, in violation of the normal position. In most cases, nephroptosis occurs with a sharp loss of body weight, when a woman "goes" on a diet.
The main precipitating factors in the development of this pathology are:
- sharp weight loss,
- damage to the ligament apparatus,
- pregnancy and childbirth,
- unbearable physical exertion
- passion for heavy sports,
- rapid growth in children
- genetic predisposition
- connective tissue weakness.
What is dangerous kidney dislocation? Each kidney fits the renal artery and vein, and the ureter moves away from the kidney. The renal vessels are rather short and wide. With the displacement of the kidney from its bed, these vessels have to stretch and taper. As a result, the blood supply to the renal tissue is deteriorating. In addition, the deviation of the kidney from its normal position can lead to the inflection of the ureter, which will cause a retention of urine in the kidney. Thus, all conditions are created for the development of acute pyelonephritis (inflammation of the renal tissue).
Nephroptosis 3 degrees
At this stage, it leaves the hypochondrium in any position of the body and may sink into the small pelvis. Due to a disturbance in the normal position of the kidneys, the ureter may twist and cause urine to stagnate. The blood supply to these organs may also be disrupted.
The second and third degrees of nephroptosis can lead to serious consequences: pyelonephritis, hydronephrosis, renal arterial hypertension and some others.
Symptoms of nephroptosis
Interestingly, the right kidney is often prone to the disease - physiologically it is located slightly lower and has a smaller artery in diameter, which, accordingly, stretches more strongly. Symptoms of nephroptosis of the right kidney are similar to the symmetrical manifestation of the disease, only dislocation of pain can vary.
In general, signs of kidney nephroptosis can be summarized as follows:
- At stage 1, the symptoms may not be expressed. Some patients have dull pains in the back, which are aggravated by physical exertion. To detect renal prolapse, you need to pass laboratory tests and perform an x-ray of the kidneys,
- At stage 2 of the disease, the appetite is disturbed. Possible strong pain in the lower back, a positive symptom of Pasternack. When determining it, the doctor hits the edge of the palm in the lumbar region. If this increases pain in the lower back, obviously, kidney disease (nephroptosis, urolithiasis),
- At stage 3 of the disease, an increase in blood pressure occurs due to the ejection of angiotensin into the blood (formed due to spasmodic contractions of the vessels).
The last two symptoms occur in case of a late visit to a doctor and are complications of nephroptosis. In the initial stages of the disease is diagnosed with difficulty and is often confused with other diseases. Nephroptosis of the 2nd degree on the right can be mistaken for appendicitis due to the similarity of symptoms. Sometimes the disease is confused with cholecystitis or with colitis, it usually happens with nephroptosis of the left kidney.
In the absence of timely medical care, the progression of nephroptosis can lead to the development of serious consequences:
- Hydronephrosis - develops due to violations of the outflow of urine due to the inflection of the ureter or its torsion.
- Secondary arterial hypertension - develops as a result of impaired physiological blood circulation in the kidney.
- Pyelonephritis - develops against the background of stagnation in the kidneys, creating a favorable environment for the reproduction of pathogenic microflora, which in turn cause an inflammatory process in the renal pelvis system.
Two methods are used to treat nephroptosis of the right kidney — conservative and operative. Which of the methods to apply in each case the doctor decides on the basis of history, examination results and tests. Drug treatment of nephroptosis is effective to alleviate pain, prevent complications, but it can not affect the abnormal position of the kidney.
In the early stages, for example, with nephroptosis on the right of the 1st degree and left-sided nephroptosis of the 1st degree, before the development of complications, conservative treatment is possible:
- use of an individually made bandage, except when the kidney is fixed in a new place due to adhesions,
massage of the abdomen,
- therapeutic exercises, special exercise therapy for nephroptosis, which helps strengthen the muscles of the back and abdominals,
- restoration of adequate nutrition in the development of the disease in case of excessive weight loss,
- limiting excess physical exertion
- Spa treatment, including hydrotherapy.
For the treatment of nephroptosis 2 degrees, the doctor applies an individual approach to the patient: some patients are assisted by conservative treatment, some require surgery. If the situation is only aggravated and grade 3 nephroptosis occurs (kidney prolapse below three lumbar vertebrae), then surgery is the main treatment option.
In cases where conservative methods do not give the desired effect, doctors are forced to resort to surgical intervention. The purpose of the surgery is a long-term fixation of the kidney (or nephropexy). Performs it exclusively surgeon-urologist. During the operation, the kidney is fixed in the kidney bed, which is at the level of the waist (normal anatomical location of the organ).
Currently, the majority of patients are undergoing laparoscopic surgery. This method of surgery is the most benign for the patient, since access to the surgical field is performed through several small incisions on the anterior abdominal wall.
This reduces the risk of postoperative complications and shortens the recovery period. If necessary, the surgeon can perform abdominal surgery. Usually, urine outflow is restored after surgery and blood pressure is normalized.
It is the prevention of nephroptosis in the formation of correct posture in children, strengthening the abdominal muscles, preventing injuries, eliminating the constant impact of adverse factors (heavy physical activity, vibration, forced vertical position of the body, drastic weight loss). Pregnant women are recommended to wear a prenatal bandage.
With the appearance of pulling back pain in a standing position, an immediate appeal to the urologist (nephrologist) is necessary.
Causes of kidney nephroptosis 1 degree
This disease occurs for various reasons. For example, the disease appears due to the low tone of the muscle tissue, which takes part in the process of forming the wall of the abdominal cavity. In addition, bilateral and other types of nephroptosis develop due to the fact that the ligamentous apparatus, which keeps the human kidneys in a fixed position relative to other organs, weakens. If there is a violation of the topography of the kidneys, it can affect the condition of the whole organism. The most common factor is significant weight loss. Fat tissue is also involved in holding the organ, therefore, the loss in weight leads to its omission on the right side or on the left.
Symptoms of the disease
At the initial stage, symptoms such as pain in the lower back (if the patient is standing), a feeling of heaviness in the abdominal cavity appear. When a person lies down, the pain subsides. In some cases, the initial stage of right-sided and other types of nephroptosis is not accompanied by clinical signs, so patients rarely communicate to a specialist.
At the primary stage, if kidney dislocation is suspected, palpation is performed, and then - a hardware study of the organ. Back to table of contents
At stage 1 of the disease, the examination of patients is based on their complaints and a medical examination. The specialist will try to probe the kidneys left and right. In this case, the person must take deep breaths. The doctor examines the patient in a standing and lying position. In laboratory studies of urine detect proteinuria (protein in the analysis). In the presence of bilateral and other types of nephroptosis, an ultrasound examination is necessary. The ultrasound results show how much the organs are displaced when the position is shifted and whether there is inflammation. In addition, radiological diagnostics is performed, and if necessary, additional angiography and magnetic resonance imaging are also performed. In turn, nephroscintigraphy (radioisotope examination) helps to form a more complete picture of the disease, which helps to choose a more effective treatment for the patient.
Prognosis and treatment
Initial grade nephroptosis requires the use of conservative therapeutic measures, but only if there is no pain and no complications. If necessary, the patient is prescribed wearing a bandage or belt, recommend special gymnastics to help strengthen the dorsal muscles and abs, abdominal muscle mass. To maintain the right and left kidneys, different types of bandages are offered, but they should be made individually, depending on the condition of the patient. Contraindication to orthopedic treatment is the fixation of the kidney through adhesions. In addition, it is necessary to limit the load, and with a weight below the norm - to increase the power. Timely nephropexy (fixation surgery), in most cases, helps to normalize blood pressure, eliminate pain in bilateral nephroptosis. But if the treatment of displacement of the right or left kidney started at the wrong time, various chronic diseases develop.
General recommendations and prevention
Disease prevention involves preventing slouching in young children, exercises to strengthen the muscle mass of the press, to avoid injuries and injuries, and to exclude the regular influence of negative factors (heavy loads, vibrations, and a sharp loss of body weight). Pregnant women are recommended to wear a special bandage. People suffering from nephroptosis should not work long standing and overwork.
Stages of nephroptosis
There are 3 stages of nephroptosis development:
- at stage 1 the lowered kidney is felt on the inhale through the abdominal wall, and on the exhale the kidney again goes under the costal edge and is not felt,
- at stage 2 nephroptosis, the kidney is completely palpable below the hypochondrium when the patient is in an upright position, but in the supine position again goes to the hypochondrium,
- at stage 3 kidney completely (regardless of the position of the body) out of hypochondrium and can be displaced even in the small pelvis.
Pathological displacement of the kidney can occur not only vertically, but also in the form of rotation (rotation) around the renal leg, or a pendulum. With the development of nephroptosis, there is a gradual stretching and twisting of the main vessels of the kidney - the veins and arteries. As the kidney vessels extend or lengthen, their diameter decreases.
Such changes in blood vessels lead to impaired blood supply to the kidney tissue: hypoxia and increased venous pressure, impaired lymphatic drainage. Changes in blood and lymphodynamics create the conditions for the development of chronic pyelonephritis (inflammation of the pelvis and kidney tissue).
At stage 3 of nephroptosis, the ureter may be bent, which will lead to disruption of urine outflow and expansion of the renal pelvis. Inflammatory, and then adhesions may occur around the kidney (perinephritis). These adhesions will fix the kidney in the pathological position. As nephroptosis develops with impaired hemodynamics and urine outflow, clinical manifestations of nephroptosis appear.
Symptoms of kidney prolapse
As the prolapse of the kidney increases, the intensity and frequency of pain increase, spilled abdominal pain may occur with irradiation to the back. In stage II nephroptosis, protein and erythrocytes appear in the urine due to hemodynamic disturbances in the kidney.
At stage III, pain is constantly disturbed and does not disappear in a horizontal position. This can reduce the patient's ability to work. Renal colic episodes are also possible when the pain becomes unbearable and may be accompanied by nausea and vomiting.
At the third stage of nephroptosis, appetite deterioration, dysfunction of the intestines, signs of depression appear. The progression of the disease leads to signs of pyelonephritis, an increase in blood pressure, and hydronephrosis (persistent, progressive expansion of the renal lobe system of the kidney due to a violation of urine outflow) can form.
An increase in blood pressure is initially noted only in the vertical position of the patient (orthostatic hypertension). In some patients, fornical bleeding (bleeding that occurs during exercise) or pyelonephritis symptoms are the first manifestations of nephroptosis.
Nephroptosis during pregnancy
In women, nephroptosis develops in 10 r. more often than the representatives of the strong half of humanity. This is due to the features of the anatomical structure of the female body: the kidney bed in women is wider and lower, the fatty capsule of the kidney in women is wider and shorter, the connective tissue of the ligament apparatus is more extensible, and the abdominal muscles are less developed than in men.
Previous pregnancies lead to stretching of the muscles of the abdominal wall, resulting in reduced intra-abdominal pressure. Therefore, most women celebrate the first symptoms of the disease after childbirth. With each subsequent pregnancy, the risk of nephroptosis increases. Therefore, in the postpartum period, so is gymnastics for the abdominals, especially if there are other predisposing factors.
If nephroptosis was first detected during pregnancy, the doctor will prescribe a therapeutic exercise (knee-elbow posture), which can significantly reduce back pain. The frequency of such a posture depends on the severity of the disease. Usually this measure has the desired effect, the pain is reduced.
Nephroptosis itself is not dangerous, complications that can result from kidney prolapse can be dangerous. Therefore, a pregnant woman in this case is assigned a comprehensive ultrasound and regular urine tests. With a decrease in the daily amount of urine or with the appearance of any disturbances in urination, a woman should immediately seek an examination and examination by a doctor.
Nephroptosis in children
Nephroptosis, or excessive mobility of the kidney, in children is associated with weakness of the ligamentous apparatus of the kidney. Most often, nephroptosis in children accompanies the curvature of the spine. Kidney prolapse is 4.7% in children. Girls suffer from this pathology in 8 r. more often boys.
Nephroptosis in children as well as in adults leads to impaired hemodynamics, urodynamics and contributes to the development of pyelonephritis, high blood pressure, urolithiasis and hydronephrosis.
Clinical manifestations of nephroptosis in children can occur in 3 options: asymptomatic, clinically manifest, and complicated nephroptosis.
Asymptomatic variant is observed in 13% of cases, nephroptosis is detected by chance, during examination for other diseases.
Clinically manifest option occurs in 43% of cases. Manifestations of it are: abdominal pain syndrome (abdominal pain), urinary disorders, urinary syndrome, increased blood pressure, neurological manifestations and the child's physical development lag.
Abdominal pain increases with physical exertion, decreases in the prone position. At the same time, nausea, relaxation of the stool may occur. Urinary syndrome is manifested by the appearance in the urine of erythrocytes, leukocytes, protein and bacteria. Dysuric syndrome is manifested by urinary incontinence (at night and daytime).
Prevention of nephroptosis in childhood is the proper physical education of the child, the exclusion of unbearable loads (including psychoemotional), ensuring rational nutrition and the prevention of child injury.
Conservative treatment is carried out in the absence of complications. К консервативному лечению относятся: ортопедическое лечение, массаж живота, лечебная гимнастика, санаторно-курортное лечение и диета.
Drug therapy is used only to treat complications of nephroptosis (pyelonephritis, urolithiasis, arterial hypertension).
Food for nephroptosis should be complete and varied. At the same time, the content of extractive substances should be excluded in order to reduce the irritating effect on the diseased organ. Of particular importance is the diet with a lag in weight and in the presence of complications.
Meals should be fractional, up to 6 p. in a day. In the diet should include fruits and vegetables. The volume of fluid should be at least 1.5 liters per day. It is not recommended to drink carbonated drinks, strong broths, legumes, pickles, canned products, smoked meats, cakes. It is useful to include seafood salads in your meals.
With the development of chronic renal failure, the amount of protein in the diet should be controlled (limit to 25 g per day). First of all, it concerns vegetable proteins contained in cereals, legumes, and flour products. These proteins overload the body with harmful metabolic products, which are excreted in the form of slags through the kidneys. When kidney dysfunction, slags remain in the body and have a toxic effect.
It is also necessary to control the amount of salt and phosphorus coming from food products. With kidney failure, salts linger in the body. Excess phosphorus leads to leaching of calcium from the bones (osteoporosis). The greatest amount of phosphorus is found in dairy products, legumes, cocoa, peanuts, beer.
Sodium causes fluid retention in the body, which contributes to the appearance of edema and an increase in blood pressure. Therefore, the use of salt should also be limited.
Orthopedic treatment (bandage)
Wearing a bandage is very useful for nephroptosis. Wear a bandage (or orthopedic belt or corset) should be in the morning, still lying in bed. The orthopedic bandage needs to be put on only on an exhalation, otherwise its carrying will be useless. Remove the bandage should be in the evening before bedtime.
Currently, there is a large selection of corsets, bandages, orthopedic belts. Before purchasing any of them, it is necessary to consult a doctor, as there are a number of contraindications for their use. One of the contraindications is "fixed nephroptosis".
Physical therapy and abdominal massage have an effect only in stage 1 nephroptosis. Perform therapeutic exercises should be daily in the morning for 30 minutes. Exercises are performed in the supine position. Under the lower back you can put a small roller.
1. The legs are somewhat bent at the knees. Make 5-10 respiratory movements with the participation of the diaphragm: while inhaling as much as possible to push out the stomach, and when you exhale as much as possible to retract it.
2. 5-8 p. lift up alternately straight legs.
3. 6-8 p. pull up to the stomach every knee bent leg.
4. Exercise "bike" to perform within 1-2 minutes.
5. For 6-8 seconds, squeeze a small ball between your knees. Exercise repeat 4-5 p.
6. 5-10 p. raise up on inhalation both legs extended, on exhalation - lower.
7. Raise straight legs up, knees and heels together. While inhaling, spread your legs apart, and while exhaling, cross your legs. Repeat exercise 5-6 p.
When the kidneys are omitted, sedentary games and walks through flat terrain are allowed. Jumping, hanging, stretching and running are prohibited.
In stage I nephroptosis, sanatorium-resort treatment is widely used, especially with the use of hydrotherapy - bathing, bathing, and drinking mineral water.
This treatment can be carried out in local sanatoriums, as well as in the resorts of the Caucasian Mineral Waters (Kislovodsk, Pyatigorsk, Essentuki, Zheleznovodsk) and in Truskavets (Ukraine).
Surgical treatment is carried out in the absence of the effect of conservative treatment and the development of severe complications of nephroptosis. Indications for surgical treatment: persistent pain, disability, chronic recurrent pyelonephritis, high blood pressure (orthostatic hypertension), hydronephrosis.
The purpose of surgical intervention is the fixation of the kidney (nephropexy) in its anatomical bed for a long time.
Currently, this operation is carried out mainly by the method of laparoscopy. It has several advantages: there is less risk of complications, the method is less traumatic, there is practically no blood loss, it is easier for the patient to recover after the operation.
Treatment of folk remedies
Recommendations of traditional medicine can be used in the initial stages of nephroptosis, along with conservative treatment. They contribute to the prevention of complications, reduce the intensity of pain, but it is impossible to return the dipped kidney to its normal position using traditional methods.
Recipes cooking folk remedies:
1. It is recommended to use seeds of sunflower, pumpkin, flax, any nuts. Flax seeds can be sprinkled with potable water, sprinkled with powdered sugar and roasted in a dry frying pan. Take 3-4 p. per day for 1 tsp (chewing thoroughly).
2. Take 2 tbsp. crushed stalks of vein kohia, pour 300 ml boiling water, leave for 12 hours, drain. Take 5 ml in between meals 3 p. in a day.
3. 100 g of natural honey mixed with 100 g of fresh butter and add 1 tbsp. almond and acorn coffee, 4 egg yolks from chicken eggs. Take a mixture of 1-2 tsp. after meals several times a day.
4. Take 3 tsp. chopped onion peel, pour 400 ml boiling water, insist 30 minutes, strain the infusion and take 1 tbsp. 4 p. in a day.
5. Take in equal proportions the leaves of sage and mint, St. John's wort, wormwood, horsetail and chicory. Pour 2 tbsp. Collect 400 ml of boiling water, cook for 10 minutes. on low heat. Strain and take a decoction of 50 ml 3 p. in a day.
6. Therapeutic bath is prepared as follows: grind 1 kg of oat straw and pour 20 liters of water, simmer for 1 hour over low heat, leave for several hours and use 2 r for the sit-down bath. in a day. The broth can be reused, reheating before the procedure. The duration of the bath is 30 minutes. The next day - a break.
Do they take nephroptosis to the army?
Examination of citizens when registering for military registration and conscription for military service (including under contract) is carried out in accordance with the document "Schedule of diseases".
Nephroptosis in the Schedule of Diseases is classified according to Article 72. The category of shelf life is determined depending on the degree of nephroptosis.
Conscripts with nephroptosis of 1 degree are classified according to Art.72 paragraph "G" - suitable for military service.
Surveyed with nephroptosis II Art. and with secondary pyelonephritis are classified according to Art.72 item "B" and are exempted from military service, they are credited to the reserve.
Examination of kidney disease is carried out on the basis of inpatient examination and treatment.
Causes of pathology
Nephroptosis of 1 degree of the right or left kidney is in most cases an acquired disease.
Although doctors pay attention to possible genetic causes, when heredity predetermined pathological changes in the connective tissue.
First degree nephroptosis
The kidneys are kept in the kidney bed with the help of several natural "mechanisms". First of all, the renal organ supports the fat capsule, not allowing it to move long distances.
Also contribute to the successful retention of the kidney abdominal muscles and fascia fascia.
The most common cause of nephroptosis of grade 1 kidney is a sharp decrease in body weight, which is most often characteristic of women who want to have a model figure.
With weight loss, there is an excessive loss of the inner fat layer that makes up the kidney capsule.
Due to this artificial depletion, the renal capsule becomes rather weak, therefore it is not able to hold the kidneys in a natural place.
Bilateral nephroptosis of 1 degree can be triggered by injuries to the fascia joints, which often happens when a person suffers injuries due to a fall or blows.
Often diagnosed with right-sided nephroptosis of 1 degree in those whose professional activity is associated with heavy physical exertion.
Nephroptosis of the right kidney is much more common, since it is the right renal organ that is located lower than the left renal organ.
Also, women are more likely to undergo nephroptosis of the right or left kidney of 1 degree, this is due to the peculiarities of their anatomical structure of the body.
In women, the pelvis is much wider than in men, which favors the occurrence of nephroptosis under certain circumstances.
In addition, one of the reasons provoking the dropout of the first degree kidney is pregnancy and difficult childbirth, because at this moment the female body experiences excessive stresses.
Symptoms of pathology
Nephroptosis is divided into three stages of development, each of which is accompanied by characteristic signs.
The initial stage is nephroptosis of the kidney of 1 degree. What it is, how to deal with it successfully should be prompted only by the attending physician.
It is strictly forbidden to engage in self-treatment, because instead of positive changes, you can provoke additional deterioration.
When the kidneys are lowered at the initial stage, the organ is displaced relative to its natural bed by no more than one and a half vertebra. The doctor can reveal such displacement, carrying out a palpation.
If the patient is in a horizontal position, the renal organ returns to its original position.
Often, even those patients who are prone to this pathology do not know what grade 1 nephroptosis is, since the initial stage of kidney prolapse is often asymptomatic.
Nevertheless, there are circumstances when the patient may feel symptoms indicating nephroptosis of the 1st degree on the left or on the right. What are these symptoms, it is easy to understand, because when the displacement of the body often there is pain.
Pulling pain can be stopped in the lumbar region, as well as move down. Pain occurs mainly during physical exertion, a sharp change in body position.
If the patient takes a horizontal position, the pain immediately disappears.
Pain can occur due to the fact that during nephroptosis, the ureter can twist, which becomes an obstacle to the normal discharge of urine.
In addition, pain may indicate excessive stretching of the nerve endings, as well as the relief of blood vessels.
Ignore the symptoms of nephroptosis 1 degree of the right kidney can not be, should begin immediate treatment, not allowing pathology to move to a new level, which is already a greater threat to human health.
Fortunately, nephroptosis of the 1 st degree to the left or to the right is very rare in a child, mostly adults are susceptible to such pathology. In this regard, they must understand that the key to their good health is in their own hands.
This pathology, such as unilateral or bilateral nephroptosis of 1 degree, is subjected to successful conservative treatment, therefore, following the instructions of the doctors, it is possible to return the renal organs to the natural bed.
Exercises for nephroptosis
Conservative treatment involves the implementation of several activities. In particular, it is quite important to wear a bandage, which is focused on the fixation of the kidneys in an anatomically correct place.
The bandage is worn after waking up to rise from the bed. In the horizontal position, the renal organs always occupy the correct position, therefore, putting on a bandage at this very moment, it is possible to fix them correctly.
Unfortunately, ignoring the rules of putting on a bandage, you can provoke additional problems by fixing the kidney in the wrong place.
In addition, patients are recommended to perform a set of therapeutic exercises aimed at strengthening the back muscles and abdominals, which contribute to the successful retention of internal organs.
Therapeutic gymnastics should be performed not occasionally, but systematically, in order to achieve high positive changes.
In order to strengthen the abdominal muscles, increase the elasticity of the connective tissue, a therapeutic massage is shown.
If nephroptosis of the first degree was triggered by a significant depletion of the fat capsule, the doctor prescribes a special diet to ensure its recovery.
Of course, a patient with nephroptosis of 1 degree is strictly forbidden to expose himself to excessive physical exertion, it is recommended to switch to light work.
More serious medical intervention is carried out only if there are concomitant complications in the form of urolithiasis, pyelonephritis, cystitis.
So, nephroptosis of 1 degree is subject to successful conservative treatment, as a result of which it is possible to return the kidney to the kidney bed.
In order to achieve positive changes, one must perfectly follow all the prescriptions of the attending physician.
The concept and causes of the disease
Kidney nephroptosis what is it? There are permissible limits within which any body can move from its place. Increased mobility of the kidneys in medicine has received the name of nephroptosis, in which the organs move into the small pelvis or change position relative to its axis. Often there is nephroptosis on the right, which is explained by the physiological structure of the body: above the right kidney is the liver, which can put pressure on it, the muscle fibers that hold the right organ are weaker than on the left side.
Root causes of kidney nephroptosis:
- Low abdominal pressure. It develops against a decrease in muscle tone of the abdominal section. The main causes are frequent constipation and diarrhea. In women, the weakness of the abdominal wall can be as a consequence of multiple pregnancy.
- Depletion of fatty tissue. It is a consequence of infectious diseases or a sharp decrease in body weight.
- Pathological structure of the muscular system.
- Injury of the lower abdomen and back and the formation of internal hematomas.
- Excessive regular exercise, heavy sports.
- The process of rapid growth of the body, which leads to imbalances in the structure and location of internal organs. The most common nephroptosis occurs in children during active growth.
- Genetic predisposition.
- Hormonal disruptions.
Excessive mobility of the kidney is found in people whose professions require a long standing position (surgeons), heavy loads and regular weight lifting (loaders), a long stay in a sitting position, which may be accompanied by vibrations (drivers).
Stages and symptoms
Kidney nephroptosis in its development goes through 3 stages, which are accompanied by various symptomatic picture. The degrees of nephroptosis express the level of organ prolapse.
The pathological condition of the kidney of 1 degree is characterized by a slight shift of the organ when the patient is standing. In a sitting position, the kidney is located in its anatomic bed. At this stage, it is difficult to diagnose the pathology, since palpation of the kidney can be on inspiration and in patients with underweight. The omission of kidney symptoms stage 1 is difficult to determine due to a slight feeling of pain, which can occur during intense exertion.
Grade 2 nephroptosis is accompanied by the following symptoms of kidney prolapse:
- Increased pain during activity and even while walking.
- Disruption of blood flow to the body.
- Stagnation of urine in the kidney, which leads to an increase in protein content.
- The development of inflammation, which is accompanied by symptoms of general intoxication (fever, weakness, fatigue) and severe pain in the lower back and lower abdomen.
The most frequently diagnosed nephroptosis of the right kidney 2 degrees. During the diagnostic activities in a vertical position, probing a kidney is not difficult; it cannot be done in a horizontal position. Nephroptosis of the 2nd degree on the right leads to a decrease in the volume of arterial blood that goes to the organ, which can later lead to nutritional deficiencies and atrophy. Grade 2 nephroptosis is also accompanied by an increase in pressure in the renal vein.
Impaired blood flow leads to infringement of the urethra and the development of obstacles to the flow of urine from the bladder. Congestion in the urinary organs leads to the gradual accumulation of harmful compounds and decomposition products. Pyelonephritis is gradually developing.
Grade 3 nephroptosis is characterized by the exit of a kidney from the region of hypochondrium and a shift to the small pelvis. Chronic pyelonephritis and a number of other vascular pathologies and diseases of the genitourinary system join in stage 3.
Signs of nephroptosis 3 degrees:
- Constant pain at rest, which becomes unbearable during physical activity.
- Against the background of pain, the patient develops a depressive state and a state of depression, lack of mood.
- At stage 3, the symptoms of nephroptosis are accompanied by a violation of the digestive organs: the appetite decreases or disappears completely, vomiting and diarrhea appear.
- Increased pressure.
- Frequent are renal colic, which occurs during infringement of the urethra.
- Chronic pyelonephritis and hydronephrosis develops.
Danger of illness
Блуждающая почка может сопровождаться не только неприятными симптомами заболевания, но и стать причиной развития других заболеваний и осложнений, которые охватывают все органы мочеполовой системы. Mobility of the kidney in 20 out of 100 cases can lead to serious complications and cause temporary or permanent disability.
The greatest danger is the increased mobility of the right kidney, as it can lead to a large number of complications that affect the organs of the urinary system and the liver.
Motile kidney leads to the following complications:
- Hydronephrosis develops when the inflection and infringement of the urethra, resulting in a violation of the outflow of urine and its stagnation. This is a disease in which there is a rapid increase in the size of the renal pelvis system.
- Acute and chronic pyelonephritis is an inflammatory disease of the kidneys, which is characterized by the stagnation of urine and the accumulation of harmful decay products, which is a good nutrient medium for the development of pathogenic microorganisms.
- Secondary arterial hypertension - increase in blood pressure against the background of impaired blood circulation in the kidneys. If untreated, a stroke or heart attack can develop.
- Urolithiasis occurs on the background of stagnant processes that lead to the accumulation of salts and sand, not having the opportunity to go with urine.
- In women in the early stages of pregnancy, a wandering kidney can cause spontaneous abortion.
Kidney prolapse in pregnant women
What is nephroptosis and what are its features during pregnancy? Women are much more prone to nephroptosis. This is due to the physiological characteristics of the structure of the female body and is characterized by:
- Larger size of the renal lodge and lower location than men.
- Increased elasticity of the muscle tissues that hold the kidney.
- Wider adipose tissue.
- A slight development of the abdominal muscles, which increases the likelihood of a reduction in intra-abdominal pressure.
Pathological organ motility is diagnosed in women in the postpartum period - the fetus in the process of intrauterine growth leads to a stretching of the abdominal muscles and a decrease in pressure. The risk of developing the pathology increases with subsequent pregnancies.
Nephroptosis symptoms in women during gestation: pain in the abdominal and lumbar regions, impaired urination, and deviations of urine and blood levels. In the event of any signs of a woman is sent for re-examination of urine and blood and ultrasound.
Nephroptosis can lead to complications: pyelonephritis, hydronephrosis, inflammatory diseases of the urinary system and the prolapse of the bladder in women.
What is kidney nephroptosis in children, and what are the main causes and symptoms? In children, the prolapse of the kidney may be accompanied by an asymptomatic clinical picture, manifest and complicated. In the first variant of the development of pathology, the symptoms are absent and the detection of the disease is random.
The manifest clinical picture is manifested by back pain, a violation of the process of urination, and the neurological and psycho-emotional development of the child can also be affected.
Complicated nephroptosis is characterized by severe pain in the lower back and abdomen, which increase during activity, impaired urination and defecation.
A wandering kidney in a child is diagnosed together with curvature of the spine. The main causes of children's nephroptosis:
- weakness of the abdominal wall and low intra-abdominal pressure,
- underdevelopment and weakening of the ligaments of the organs.
What is kidney nephroptosis
The kidneys of a healthy person are in an almost immobile state and are located on the same level. Pathology due to the mobility of one or two organs is nephroptosis. The kidneys are shifted to the abdomen, groin or pelvis. The most common disease is nephroptosis or motility of the right paired organ. Women are more at risk due to the special physiological structure of the body.
Nephroptosis classification is used by doctors all over the world. Only a doctor can make a diagnosis after a patient is tested and an ultrasound scan is performed. Palpating a kidney is extremely difficult, especially for people who are overweight. After proper examination, prior consultation, the doctor must prescribe an appropriate method of treatment, based on the degree of complexity of nephroptosis.
Degrees of nephroptosis
Nephroptosis of the painful right kidney occurs in adults and children. There are three stages in the development of pathology. Each stage is characterized by its own peculiarities of identifying the problem, signs and difficulties of treating nephroptosis. The following stages are distinguished:
The early stage of the disease, which is very difficult to identify the problem. Adults with overweight are particularly difficult to diagnose at this stage: to determine the pathology by touch is extremely difficult. The kidney can be studied only while breathing in, otherwise it “hides” in the area under the right hypochondrium. It is much easier to cure at this stage without surgical intervention nephroptosis on the right.
- Second degree
It is easier to diagnose grade 2 nephroptosis. In the upright position of the patient, the kidney exits the subcostal area and descends. In a horizontal position, it hides back up or it needs to be corrected by hand itself. The last point is not painful for patients. The position of the kidney at this stage does not depend on the respiratory process.
Characterized by the fact that the right kidney is omitted, in almost any position it leaves the usual groove in the hypochondrium. This development of nephroptosis is dangerous, is fraught with more serious consequences, additional pathologies. Treatment during this period should be intensive in order to reduce all possible risks to human health.
Kidney prolapse occurs due to fluctuations in intra-abdominal pressure, impaired ligaments or their stretching, and damage to the kidney cavities. Depending on the reasons, there is a unilateral or bilateral type of the disease. The reasons that the right kidney is prone to nephroptosis are:
- a large weight loss in the short term due to diet or illness,
- ligament damage due to excessive load
- injuries in the lumbar region, ligament and hematoma disorders,
- weakened tone of the abdominal wall (this applies to pregnancy and the postpartum period),
- congenital abnormality in the ligaments and tissue structure,
- prolonged strong cough
- rickets suffered in childhood, leading to deformation of bones and muscle hypotension.
Symptoms of kidney failure
The severity of the fact that the kidney has dropped, depends on the stage of development of the pathology, the sensitivity of the organ itself, the complications that have appeared. The organ that has moved affects all other nearby ones, including the ligaments with which it is held. The output of urine becomes more difficult, there are inflammations involving adhesions, additional damage.
Possible symptoms of nephroptosis:
- The “migration” of the kidney is felt to the touch.
- Difficult urination.
- Symptoms of diseases of other organs.
- Irritation of the artery of the kidney, tissue damage, subsequently arterial hypertension.
- Nausea, vomiting.
- Aggravated sleep
- Rapid pulse, edematous processes, severe headache.
- Sharp jumps in blood pressure.
The first stage of the disease is rarely traced. Sometimes it has a painful sensation in the lumbar region after physical exertion, jumping and carrying weights. The pain is not too strong, mostly aching in the area where the pathological condition develops. But the initial moments, as a rule, are completely invisible, only a visit to the doctor will help to detect.
The second degree of nephroptosis is painful. To lift the weight is unbearably difficult. The feeling of pain occurs often, hard, occurs not only in the lower back, but also in the abdomen, pelvis. The appetite of the person, work of intestines worsens, problems with an urination appear. The kidney in this case comes out of the usual position completely, the person is able to return it to its original position painlessly. Nephroptosis on the left is often mistaken for pancreatitis.
The third degree of pathology of the right kidney is almost always painful, often similar to appendicitis. Complications arise: pyelonephritis, hydronephrosis, renal failure, adhesions appear. In this case, it is necessary for a person to conduct a thorough diagnosis in order to identify possible complications and prevent their occurrence.
Classification of degrees of nephroptosis
According to the degree of displacement of the kidney below the limits of the physiological norm, urology distinguishes 3 degrees of nephroptosis.
When I degree of nephroptosis, the lower pole of the kidney is lowered by more than 1.5 lumbar vertebra. In nephroptosis of the II degree, the lower pole of the kidney shifts below the 2 lumbar vertebrae. Grade III nephroptosis is characterized by a lowering of the lower pole of the kidney for 3 or more vertebrae.
The degree of kidney prolapse affects the clinical manifestations of nephroptosis.
Prognosis and prevention of nephroptosis
After timely nephropexy, as a rule, blood pressure indicators normalize, pain disappears. However, with delayed treatment of nephroptosis, chronic conditions can develop - pyelonephritis, hydronephrosis. In individuals with nephroptosis, professional activity should not be associated with long standing upright or heavy physical exertion.
Prevention of nephroptosis includes the formation of correct posture in children, strengthening the abdominal muscles, preventing injuries, eliminating the constant impact of adverse factors (heavy physical activity, vibration, forced vertical position of the body, drastic weight loss). Pregnant women are recommended to wear a prenatal bandage.
With the appearance of pulling back pain in a standing position, an immediate appeal to the urologist (nephrologist) is necessary.