Nephroptosis ( floating kidney ) - Causes, Symptoms and Treatment .MF .
Nephroptosis (mobile or wandering kidney) - a condition in which the kidney is from its normal position (in the lumbar region) is strongly biased towards the bottom (in the abdomen and even the pelvis).At the same time she can either return to their habitual and did not go back there.
Nephroptosis occurs predominantly in women (0.1% in men and 1.5% for women).This fact is explained by the peculiarities of the female body structure - a wider pelvis, decreased tone of the abdominal wall, a large elastic cords.Kidneys
like most organs of the human body are in relative mobility, though accurate have their place in the body.At the moment of inspiration kidney shifted down by 2-4 cm., With a deep breath goes to 4-6 cm. It reacts to movement and body movement.Such physiological fluctuations help normal urine.
But it happens, the body gets out of control, ligaments not holding the kidney, and its movements are unpredictable.She begins to wander through the body, can be moved up
disease first generally does not manifest itself, and declare themselves floating kidney begins discomfort in the lumbar region on the side of omission: most right - in 75% of cases, 10% - on the left and 15% - on both sides.The most frequent consequence of kidney displacement - pulling pain, aching nature, less piercing.At the beginning of the disease the pain is not pronounced, quickly disappear.But over the years, become more intense, constant, exhausting.
first pain occur after any physical exertion, heavy lifting, coughing or intense at the end of the working day.They are reduced in the supine position or on the patient side.
Pain in nephroptosis there are very intense - the type of colic.They can appear suddenly after a strong stress or change body position from lying to upright and last from several minutes to several hours - is weakening, the crescendo.Pain is often given in the groin, in the genitals.Sometimes the attack is accompanied by nausea and vomiting.The patient is pale, covered with cold sweat, temperature may rise.
Pain - is not the only symptom Nephroptosis .Many mobile kidney evident loss of appetite, nausea, feeling of heaviness in the pit of the stomach, constipation or, conversely, diarrhea.
Later possible 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 a doctor, hypochondriac.They are easily tired, suffer from dizziness, palpitations, insomnia.
The development Nephroptosis distinguish three stages, depending on the level of kidney ptosis:
- 1 stage.At this stage, lowered kidney can be felt through the abdominal wall to breath, exhale kidney goes to the upper quadrant (normal kidney can be felt only in very thin people, all the rest is not palpable).
- 2 stage.In the upright position of the patient is already full kidney hypochondrium exits, but returns to the supine position hypochondrium, or it can be safely hand straighten.
- 3 stage.Kidney completely out of hypochondria in any position of the body and can be displaced in a small basin.
Reasons Nephroptosis are the factors that lead to changes in the ligamentous apparatus of the kidney (infectious diseases, rapid weight loss) and a decrease in muscle tone anterior abdominal wall (eg during pregnancy), as well as injury, accompanied by overstretching or rupture of ligament apparatuskidney (sharp lifting, falls from heights, etc.).
At the time of significant kidney displacement, often down, the ureter is bent, twisted, passing urine more difficult.There is retention of urine, its stagnation in the renal pelvis renal system.Urine all comes, and the outflow is complicated, renal pelvis dilate, which may eventually lead to hydronephrosis transformation.
most often leads to stagnation of urine pyelonephritis - inflammation of the renal pelvis renal system.This is the first thing early and frequent complication Nephroptosis.In some cases, acute pyelonephritis can proceed with the development of severe pain syndrome - renal colic that requires emergency medical care.
pulls renal artery, sometimes it is extended twice naturally narrowed while.As a consequence of torsion of the renal arteries in nephroptosis often develops hypertension, accompanied by a marked increase in blood pressure and responds poorly to medical treatment.Kidney lacks blood, nutrients, and oxygen, resulting in even are hypertensive crises.Renal blood pressure is highest, especially through diastolic numbers, and can reach up to 280/160 mm Hg
Diagnosis is based on complaints, patient survey and palpation (probing), kidney, laboratory and instrumental investigations.
When nephroptosis there is a difference in blood pressure (BP) by 15-30 mmHgone and the same patient in the vertical and horizontal - vertical, it increases.
When urine study may show a small amount of protein, white blood cells and red blood cells even.
Nephroptosis main method of diagnosis, X-ray and ultrasound studies.The most informative instrumental methods of examination of the kidneys - panoramic X-ray of the urinary system, as well as excretory urography - X-ray method of study, combined with the introduction of a contrast agent into the vein of the patient.Pictures made in standing and lying down.Radioisotope scan and scintigraphy can determine the position and renografiya - functional state of pathologically movable kidney.Angiography gives an indication of the state of the renal artery, venography - of venous outflow.Sometimes you have to explore all the organs of the gastrointestinal tract (stomach and intestines x-ray, FEGDS, colonoscopy) to exclude or confirm the total omission of the abdominal cavity.
Treatment Nephroptosis can be both conservative and operative.
In the early stages of the disease in the absence of sharp pain, if you have not developed complications, nephroptosis can be treated with conservative methods.These methods include orthopedic treatment: special bandage in the morning, before getting out of bed, put on a deep exhale on her stomach while in a horizontal position, and remove in the evening.It offers many different bands, belts, corsets, but they must be made individually for each patient.Protivopo Kazan for orthopedic treatment is a kidney, fixed in the new location adhesive process.In all other cases, it is displayed.
At the first stage Nephroptosis beneficial spa treatment, massage the abdomen, therapeutic exercises aimed at strengthening the abdominal muscles and back muscles, providing a normal intra-abdominal pressure and limiting displaceability kidneys down.
of drugs is not possible to put the kidney in place.However, they treat complications Nephroptosis , such as pyelonephritis, hypertension in renal hypertension.Typically prescribed antispasmodic, analgesic-ing, anti-inflammatory agents.It is necessary to limit heavy physical exertion.If nephroptosis developed as a result of weight loss of the patient, it is necessary to adequate food in order to gain the lost weight.
to treat Nephroptosis also used a set of physical exercises to strengthen the abdominal muscles.
With the ineffectiveness of conservative treatment resort to surgical methods of fixing the kidneys - nephropexy (kidney fixation to adjacent anatomical structures).In this operation, the urologist kidney returns to its usual bed in the lumbar region and strengthens its there.
Currently, the most efficient method showed nephropexy laparoscopically.(The operation is performed through the puncture of the abdomen and the surgeon uses special controllers and digital cameras)
"old" abdominal surgery using muscle flap is quite traumatic and requires an extended sectional view of the waist 20 sm. TGO Furthermore, in the postoperative period is necessary to comply with bed rest for2 weeks to bud firmly entrenched in his bed.
Timely executed operation usually gives good results.Transient hypertension usually goes away and your blood pressure to normal.