Nephroptosis is a pathological process in which the kidney is displaced from its location. Wandering of this organ can occur with both the left and the right side, but studies have shown that right-sided nephroptosis is more often diagnosed. It is usually characterized by displacement of the kidney into bottom part abdomen or pelvis. Depending on the stage of the disease and pathogenetic characteristics, the necessary therapy is prescribed.

Causes of nephroptosis

There is a whole complex of reasons leading to nephroptosis right kidney. Classical medicine identifies the main etiological factors:

• anthropometric discrepancy, expressed by a decrease in body weight (dystrophy of the fatty capsule of the kidney occurs);
• injuries of various origins, which can lead to damage to the ligaments that hold the kidney in a locally limited space;
• systematic lifting of weights, jerking, sharp jolts(occupational chronic traumatization);
• change abdominal wall after labor.

Depending on the described etiological aspects, the severity of this disease is determined. The most serious changes in the dislocation of the kidney occur due to the traumatic component, in which the fixing apparatus of the kidney is disrupted. As a rule, disruption of the duodenal ligament or hepatocolic fixation leads to significant displacement of the right kidney.

Right-sided nephroptosis can also occur due to sprained ligaments due to extreme stress during childbirth.

The following are responsible for fixing the kidneys in humans:

• peritoneal ligaments (differentiated at the right and left kidney);
• retrorenal and prerenal membrane;
• fatty membrane;
• mesentery of the colon;
• renal receptacles.

Based on these reasons, you need to understand that nephroptosis can manifest itself, as in certain reasons, and in their totality. This point is taken into account during diagnosis.

There are differences in the occurrence of nephroptosis in women and men. Due to the anthropometric structural features of the female fixation apparatus, nephroptosis is diagnosed in them more often than in men.

Stages of the disease

The course of nephroptosis is characterized by three stages:

• Stage 1 characterized by lowering of the lower pole of the kidney by more than 1.5 lumbar vertebrae, while part of the kidney leaves the hypochondrium during inspiration and can be determined by palpation;
• Stage 2 it is justified by lowering the pole of the kidney to a distance equal to 2-.2.5 vertebrae, in a vertical position of the body the kidney completely leaves the hypochondrium and is freely defined, in a horizontal position its return is observed, the patient during this stage begins to experience pain of moderate intensity;
• Stage 3 characterized by displacement of the kidney by more than 3 lumbar vertebrae, it completely extends from the hypochondrium, regardless of the location of the body, it may descend into the pelvis, nephroptosis at this stage is characterized by severe pain.

The staged nature of the disease can occur sequentially, but the definition of the onset of the disease from the later stages is not excluded, especially with a traumatic component.

Right-sided nephroptosis has classic manifestations, in the vast majority of cases there are the following signs:

• lumbar pain with a focus of growth in the abdominal area;
• emergence pain signs when changing body position from vertical to horizontal direction;
• irradiation of pain in the groin area;
• pain decreases when the body is positioned on the right side; on the left, the pain intensifies.

The listed signs are characteristic of the onset and course of the second stage of the disease. At the first stage, many symptoms are either vague or completely absent. It is reliably known that during the initial stage, a discomfort often occurs in the patient lying on the side opposite to the diseased kidney. At the same time, with a sharp transfer of body position from sitting to lying, short-term and mild pain also appears.

If we consider the symptoms from the patient himself, it is recommended that systemic manifestations, even minor pain, contact a specialist to take timely measures.

Diagnosis of right-sided nephroptosis

Diagnostic methods used to identify the true disease include the following areas:

• visual observation and palpation manipulations;
• laboratory testing of blood and urine;
• X-ray examination;
• ultrasound interpretation.

Most meaningful method for 100% diagnosis of nephroptosis is an x-ray examination. In all cases where there is no exact certainty in making a diagnosis or to differentiate the disease, the excretory urography method is used to determine the displacement of the kidney relative to the vertebrae. X-rays are taken in horizontal and vertical positions of the body, then visible displacements are analyzed.

The information content of ultrasound examination comes in second place. This manipulation is relatively simple, while at the same time it is guaranteed to exclude other diseases that give similar symptoms.

In some cases, renal angiography is prescribed, with its help it is possible to ascertain venous stasis in the kidneys, which indicates the truth of the disease.

A visual examination of a patient, especially with an asthenic body constitution, is carried out in a vertical and horizontal position. The main purpose of the manipulation is to identify the mobility of the kidney through palpation. A clear patient history allows for a better examination, one at a time, excluding the causes of similar symptoms.

The picture of any examination for suspected nephroptosis is usually supplemented with a general blood and urine test. If, as a result of observation, true suspicions of kidney prolapse arise, then a control ultrasound or radiography is prescribed.

Diagnosis must differentiate diseases such as: pyelonephritis, the presence of kidney stones, some manifestations of lumbar osteochondrosis.

Treatment of nephroptosis of the right kidney

There are two ways to treat this disease: conservative therapy and surgery.

At an early stage of the disease, it is customary to carry out conservative therapy. The point is to prescribe a set of measures and restrictions. They are prescribed to wear a special bandage that prevents the kidney from leaving the hypochondrium. At the same time, it is recommended to conduct a course special exercises aimed at strengthening the weak abdominal wall. Patients with asthenic physique are prescribed special food to restore the fatty capsule of the kidney. At the same time, strict restrictions are introduced on lifting heavy objects and making sudden movements. The presented method is effective only when early stages.

In the second stage of the disease or in cases where conservative therapy is ineffective, surgical intervention is performed - nephropexy. The essence of the operation is to fix the kidney at its proper level. In this case, fixation is created with a certain degree of freedom. Rivoire nephropexy involves fixation of the kidney using a psoas muscle flap. Depending on the advanced stage of the disease, a laparoscopic fixation method can be used, which is a low-traumatic operation.

The postoperative period is long. With the classical method it is 21 days. Laparoscopic surgery has a shortened postoperative period from 3 to 7 days. Subsequently, strict restrictions on physical activity are introduced. The limitation period is from 6 to 8 months.

The prognosis of the disease depends on the timing of the disease, the individual data of the patient and the stage of the disease. at the moment. When right-sided nephroptosis is detected at the first stage, in most cases it can be cured using a conservative method. However, if you are undernourished or excessive loads relapses of the disease are possible.

The surgical method, as a rule, allows us to achieve the most complete solution to this problem. Fixation carried out, after passing rehabilitation period will allow you to lead a full life.

Lack of treatment and advanced conditions of the disease can lead to complications in the form of pyelonephritis and hydronephrosis, which will require longer and more expensive treatment.

Current media often suggest treating nephroptosis using herbal medicine, homeopathy, and various folk methods. These procedures usually lead to prolongation of the disease and transition to later stages. The prognosis of the disease with such approaches remains questionable.

• What are the causes of nephroptosis?
• Symptoms of nephroptosis
• Treatment, prevention and consequences of nephroptosis

Before talking directly about the disease of the right kidney, you need to understand what nephroptosis is. Nephroptosis is a disease in which pathological mobility of one or both kidneys is observed. In this case, the kidney is displaced downwards (usually to the abdominal area, in more rare cases to the pelvic area). There is nephroptosis of the right kidney and left kidney. Interestingly, this disease is typical in 4 out of 5 cases specifically for the kidney located on the right.

There are not many reasons for the appearance of this disease, but they are conditional. That is, this disease can occur in a person “for no reason” (the meaning of this word in this case comes down to the fact that medicine cannot find the cause of this disease).

In this case, the reason given is: genetic predisposition a certain organism to this disease. The causes of the disease are:

1. Low intra-abdominal pressure. This is usually associated with decreased tone of the abdominal muscles.
2. Pathology ligamentous apparatus kidneys Often occurs due to injury.
3. A sharp reduction in the thickness of the fatty capsule of the kidney. Usually observed due to previous infectious disease or after rapid decline body weight.

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Symptoms of nephroptosis

Interestingly, there are no symptoms of nephroptosis as such. Does your lower back hurt, especially when walking for a long time? These are symptoms of spinal osteochondrosis, especially since the pain goes away when you take a lying position. Has your blood pressure increased? This is either a change in weather conditions, or stress, or heredity. Pyelonephritis or kidney inflammation? This is a cold of these organs. A person in such a situation is afraid of long walks, mild hypothermia, and does not even think about playing sports.

In addition, nephroptosis on the right has several other signs. For example, you should think about it if you experience nagging and aching pain in your right side, which disappears over time. When this disease starts, such sensations appear in the lower region of the ribs and become more intense and permanent.

Very often, with nephroptosis, symptoms include diarrhea or constipation. Worrying about an increase in temperature with a lack of appetite, as well as apathy, insomnia, and rapid heartbeat. All these signs of nephroptosis can be inherent in other diseases, so it is necessary to pay attention to your body in order to identify this disease at an early stage.

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Identifying kidney nephroptosis is also not entirely easy. For example, during an ultrasound they ask a person to lie down so that wandering kidney came back to normal. In this regard, an incorrect diagnosis is made, and the person does not treat the problem, but simply gets rid of the painful sensations. So to detect nephroptosis or ultrasound should be performed while the patient is standing. In addition, the diagnosis of this disease includes several blood tests (general and biochemical) and general analysis urine.

But the final diagnosis of this disease consists of the so-called survey and excretory urography (this is a special x-ray). It involves the introduction of a substance that is excreted from the body by the kidneys. This study allows us to identify functional feature kidneys and obtain their image in different positions.

Nephroptosis is classified depending on the degree of neglect:

1. In the 1st degree of this disease, the mobile kidney can be felt with the fingers only when the patient inhales, since upon exiting it hides under the ribs. At this stage it is extremely rare to make a diagnosis of this disease.
2. At stage 2, the wandering kidney is felt by the fingers only when the person takes a vertical position. If a person stands up, the affected organ hides under the ribs. Usually the diagnosis is made at this stage of the disease.
3. Stage 3 nephroptosis is the most severe, with the kidney protruding from under the ribs in any position.

is a pathological mobility of the kidney, manifested by a displacement of the organ beyond its anatomical bed. Minor and moderate nephroptosis is asymptomatic; when urodynamics and hemodynamics are impaired, low back pain, hematuria occur, arterial hypertension, pyelonephritis, hydronephrosis, nephrolithiasis. Recognition of pathology is carried out using ultrasound of the kidneys, excretory urography, angiography, MSCT, nephroscintigraphy. Surgical treatment is required for secondary changes and consists of fixing the kidney in its anatomically correct position - nephropexy.

General information

Normally, the kidneys have a certain physiological mobility: thus, with physical effort or the act of breathing, the kidneys are displaced within the permissible limit, not exceeding the height of the body of one lumbar vertebra. If the downward displacement of the kidney with a vertical body position exceeds 2 cm, and with forced breathing - 3-5 cm, we can talk about pathological mobility of the kidney or nephroptosis.

The right kidney is usually 2 cm lower than the left; in children, the kidneys are located below the normal limit and occupy a physiological position by 8-10 years of age. In their anatomical bed, the kidneys are fixed by ligaments, surrounding fascia and perinephric fatty tissue. Nephroptosis is more often observed in women (1.5%) than in men (0.1%) and, as a rule, is right-sided.

Causes of nephroptosis

Classification

Based on the degree of displacement of the kidney below the physiological norm, modern urology distinguishes 3 degrees of nephroptosis. In grade I, the lower pole of the kidney descends by more than 1.5 lumbar vertebrae. In grade II, the lower pole of the kidney is displaced below the 2 lumbar vertebrae. Nephroptosis III degree characterized by prolapse of the lower pole of the kidney by 3 or more vertebrae. The degree of kidney prolapse affects clinical manifestations diseases.

Symptoms of nephroptosis

In the initial stage, during inhalation, the kidney is palpated through the anterior abdominal wall, and when exhaling, it disappears in the hypochondrium. In an upright position, patients may be bothered by nagging unilateral pain in the lower back, discomfort and heaviness in the abdomen, which disappear in the lying position. With moderate prolapse in a vertical position, the entire kidney is displaced below the hypochondrium line, but can be painlessly adjusted by hand. Pain in the lower back is more pronounced, sometimes spreading to the entire abdomen, intensifying with exercise and disappearing when the kidney takes its place.

With grade III nephroptosis, in any position of the body, the kidney is located below the costal arch. Abdominal and lumbar pain become constant and do not disappear when lying down. May develop renal colic, gastrointestinal function disorders, neurasthenia-like conditions, renovascular arterial hypertension appear.

Development of pain renal syndrome associated with possible kinking of the ureter and disruption of urine passage, stretching of the nerves, as well as kinking of the renal vessels, leading to renal ischemia. Neurasthenic symptoms(headache, fatigue, irritability, dizziness, tachycardia, insomnia) are probably due to chronic pelvic pain. From the gastrointestinal tract, loss of appetite, nausea, heaviness in epigastric region, constipation or, conversely, diarrhea. Hematuria and proteinuria are detected in the urine; in the case of pyelonephritis - pyuria.

Complications

Periodic or constant urostasis caused by kinking of the ureter creates conditions for the development of infection in the kidney and the development of pyelonephritis and cystitis. In these cases, urination becomes painful and frequent, chills, fever, and the release of cloudy urine with an unusual odor are noted. In the future, against the background of urostasis, the likelihood of developing hydronephrosis and kidney stones increases.

Due to the tension and bending of the vessels supplying the kidney, a persistent increase in blood pressure develops with hypertensive crises. Renal hypertension is characterized by extreme high numbers Blood pressure, which sometimes reaches 280/160 mm Hg. Art. Torsion of the vascular pedicle of the kidney leads to local veno- and lymphostasis. With bilateral nephroptosis, signs of renal failure increase early - swelling of the extremities, fatigue, nausea, ascites, headache. Patients may require hemodialysis or kidney transplantation.

Diagnostics

Recognition of nephroptosis is based on patient complaints, examination data, palpation of the kidney, laboratory and instrumental diagnostics. The examination is performed with the patient not only lying down, but also standing. Carrying out polypositional palpation of the abdomen allows us to identify the mobility and displacement of the kidney. Blood pressure measurement and monitoring shows an increase in values blood pressure by 15-30 mm Hg. Art. when changing the horizontal position of the body to a vertical one. Urine tests determine erythrocyturia, proteinuria, leukocyturia, bacteriuria.

Ultrasound of the kidneys, performed standing and lying down, reflects the localization of the kidney and changes in its location depending on the position of the body. Sonography can detect inflammation in renal tissue, stones, hydronephrotic dilatation of the pyelocaliceal complex. Doing an ultrasound scan of the renal vessels is necessary to visualize the vascular bed of the kidney, determine blood flow indicators and the degree of renal hemodynamic impairment.

Excretory urography allows you to assess the degree of pathological prolapse of the kidney in relation to the lumbar vertebrae, and rotation of the kidney. Survey urography with nephroptosis, as a rule, it is not informative. Renal angiography and venography are required to evaluate the condition renal artery and venous outflow. Dynamic radioisotope nephroscintigraphy is indicated to identify disturbances in urinary passage and the functioning of the kidney as a whole. Highly accurate and informative alternatives to radiocontrast methods are CT, MSCT, and MRI of the kidneys.

Various studies of the gastrointestinal tract (fluoroscopy of the stomach, irrigoscopy, colonoscopy, endoscopy) are necessary to identify displacement internal organs– splanchnoptosis, especially with bilateral nephroptosis.

Treatment of nephroptosis

For pathology of the first degree, conservative therapy is carried out. The patient is prescribed to wear individual orthopedic devices (bandages, corsets, belts), therapeutic exercises to strengthen the back and abdominal muscles, massage the abdominal muscles, sanatorium treatment, limitation physical activity, with insufficient weight - enhanced nutrition.

In case of nephroptosis of II-III degree, complicated by impaired hemodynamics, urodynamics, chronic pain syndrome, pyelonephritis, nephrolithiasis, hypertension, hydronephrosis, surgical tactics are required - nephropexy. The essence of the intervention is to return the kidney to its anatomical bed with fixation to neighboring structures. The postoperative period requires a long bed rest, being in bed with the leg end raised to reliably strengthen the kidney in its bed. Nephropexy is not indicated for splanchnoptosis, severe intercurrent background, or elderly patient.

Prognosis and prevention

After timely nephropexy, as a rule, blood pressure levels normalize and pain disappears. With delayed treatment, chronic conditions may develop - pyelonephritis, hydronephrosis. In persons with nephroptosis, professional activities should not be associated with long periods of standing in an upright position or heavy physical exertion.

Prevention of nephroptosis includes the formation of correct posture in children, strengthening the abdominal muscles, avoiding injuries, eliminating constant exposure to adverse factors (heavy physical activity, vibration, forced vertical body position, sudden weight loss). Pregnant women are recommended to wear a prenatal bandage. If you experience nagging pain in the lower back while standing, you should immediately contact

Nephroptosis (prolapse of the kidney): causes, consequences, symptoms and treatment

Kidney prolapse is an excess of mobility of this paired organ compared to acceptable norm. The kidneys move in accordance with changes in the person’s position, since, being only in a certain position or tension, they are more susceptible to injury. If nephroptosis occurs, the patient will feel changes in well-being and should consult a doctor.

A special pathological condition is nephroptosis, also defined as kidney prolapse, which is an excess of the mobility of this paired organ compared to the permissible norm. According to the principles of physiology, the kidneys move in accordance with changes in the person’s position, since, being only in a certain position or tension, they are more susceptible to injury. Also, the raising and lowering of the kidney to a slight height occurs during breathing: at the moment of opening and coagulation of the lungs. If nephroptosis occurs, the patient will feel changes in well-being and should consult a doctor.

Reasons for the development of nephroptosis

The disease is classified into unilateral and bilateral nephroptosis. Simultaneous displacement of both kidneys occurs in urological practice very rarely.

With pathological prolapse, the paired bean-shaped organ can move up to 11 cm, sometimes descending into the pelvic cavity. Given this mobility, the kidney is defined as “wandering”. The age category of patients suffering from nephroptosis is from 25 to 40 years. The disease has a code according to ICD 10 – N28.8.

There are several factors predisposing to the development of nephroptosis:

Fast and sharp decline weight, which entails a massive reduction in the fatty part in the kidney capsule;
lifting large loads, hard physical work (more often this factor causes prolapse of the kidneys in men);
previous kidney diseases of infectious origin (especially if the disease is chronic and the ligament supporting the kidney undergoes degenerative changes);
previous closed injuries to the lumbar back or abdominal cavity (due to injury, the ligaments holding the kidney in the retroperitoneal space may be damaged);
for women, this is the period of bearing a child and childbirth, when constitutional changes occur in the body, which are characterized by a weakening of the muscular part of the abdominal wall;
obesity and rapid weight gain.

Most often, nephroptosis has a right-sided location, and the majority of patients are women. The so-called risk group includes people with an asthenic body constitution (they have a weak subcutaneous tissue). One of the reasons for kidney prolapse in women is if the muscles of the anterior abdominal wall are stretched to a critical state during pregnancy.

Symptoms of nephroptosis

The clinical manifestations of the pathology directly depend on the stage of its development. Urologists have identified three degrees of severity of kidney prolapse:

Nephroptosis 1st degree. This initial stage development of the disease, in which there are no complaints or other clinical symptoms. By palpating the patient's abdomen, the doctor feels the kidney. Pain may not bother you at all, or may be present, but only mildly. Often, taking a position on your side or back can reduce sensitivity.

Nephroptosis 2nd degree. The patient experiences pain in the lumbar region - unpleasant feeling has a pulling and aching character. Sometimes an attack develops, which intensifies when changing body position. An examination by a specialist allows you to palpate the kidney in the hypochondrium. Getting worse digestive function body, nausea occurs. Clinical analysis urine helps identify protein and increased concentration red blood cells, the urine itself is cloudy in color.

Nephroptosis 3rd degree. Painful sensations strongly expressed, an unpleasant sensation is observed almost continuously. Against the background of attacks, a dyspeptic disorder develops - the patient feels nauseous, the attack ends with vomiting, salivation increases, and digestion and defecation disorders occur. The patient develops neurological disorders– irritability, increased fatigue, anxiety. The kidney is able to descend into the pelvic cavity. Clinical urine analysis allows you to find out about significant deviations from the norm. Urine is cloudy in color and has a distinct unpleasant odor.

In the severe stage of development (when the kidney drops by 6 cm or more), the patient first develops an inflammatory process, and then an adhesive process. The localization of the lesion is the space around the kidney (pathology is defined as “perinephritis”). The formed adhesions limit and then fix the kidney in the pathological position, preventing its movement as the patient changes body position. Hemodynamics are disrupted, it becomes difficult, and then the full outflow of urine stops altogether. Symptoms of kidney prolapse depend, among other things, on concomitant pathologies.

Often, simultaneously with the prolapse of the kidney, the patient experiences an attack of renal colic. Provoking reflex muscle contraction, it causes vomiting, involuntary urination and defecation. The condition is characterized by pallor skin, decreasing level blood pressure, increased heart rate. If renal colic develops against the background of nephroptosis on the left, it is possible that the patient will also experience pain in the heart.

The pathology in question occurs in women during pregnancy, which jeopardizes the fact of pregnancy. If the patient had nephroptosis earlier without manifesting symptoms, then after the birth of the child the condition only worsens. Regardless of the degree of nephroptosis during pregnancy, an additional negative side of the disease is the high probability of miscarriage.

Level of danger to the body

The patient, having learned about his diagnosis, immediately wonders whether kidney prolapse is dangerous? Each kidney contains large blood vessels– artery and vein: anatomically they are wide and shortened. When the kidney is displaced from the physiological niche in which it is supposed to be, the blood vessels are forced to stretch, narrowing the width of their lumen. This causes circulatory problems within this paired organ.

Also, displacement of the kidney becomes a factor predisposing to bending of the ureter, which is fraught with the development of acute urinary retention. The specified deviations from normal condition, create favorable conditions for the emergence and progression inflammatory process kidney tissue. The pathology is defined as “pyelonephritis” and on an ongoing basis can cause serious complications as a chronic renal failure.

Complications of kidney displacement

The disease has a tendency to progress, so if qualified treatment is not provided in a timely manner medical care, it will develop further. An uncorrected condition provokes the following consequences kidney prolapse:

Pyelonephritis. Disease inflammatory in nature develops due to stagnation inside the kidneys - it is this pathological process that creates favorable environment, in which pathogenic microflora is able to multiply and develop, expanding the spectrum of damage within the pelvis system.

Secondary arterial hypertension - occurs due to disruption of the natural blood circulation inside the kidney. When develops this complication, a consistently elevated blood pressure level (to critical levels) responds poorly to attempts at correction with medications. More often this is typical clinical cases when the kidney prolapses by 5 cm or more.

Hydronephrosis. The disease is characterized by flooding and swelling of the renal membranes, as a result of which the paired organ increases significantly in size. The development of the disease is preceded by a disturbance in the process of urine outflow, which is accompanied by kinking or twisting of the ureter.

Considering what threatens the prolapse of the kidneys, it is important to note the development of stroke and heart attack, which is caused by a stable increased level blood pressure.

Diagnosis of nephroptosis

When visiting a doctor, it is important to talk about the events that preceded the onset of back pain. You should also list previous inflammatory and viral diseases, how often the pain occurs, and whether taking a horizontal position helps reduce it.
The specialist conducts a general examination, palpating the lumbar region and peritoneum. It is possible to preliminarily establish the pathology when the patient is examined first horizontally, then vertically.

Pain that occurs with nephroptosis on the right can be regarded as a manifestation of appendicitis. Therefore, in order to clarify the diagnosis, the specialist prescribes radiography, as well as instrumental diagnostic options. Elementary, but exact way determine nephroptosis - undergo an ultrasound. Additionally, the urologist prescribes such an informative method as excretory urography. After a comprehensive examination, the patient will be able to accurately find out the stage of his disease.

Treatment

A specialist will be able to determine reliably how to treat kidney prolapse only after receiving data from a comprehensive examination of the patient. The therapeutic approach is divided into application conservative methods And surgical intervention. The conservative option for eliminating nephroptosis will be effective only if initial stage its development. The approach involves performing physical exercise, compliance with diet therapy, the use of a special support device - a bandage, attending a massage course.

Orthopedic treatment

This type of therapy is only useful when the therapeutic corset is put on and worn correctly. The bandage for prolapsed kidneys must be worn daily: put it on in the morning, without getting out of bed, in a lying position, and first take a deep breath. If you ignore this rule and wear it regardless of breathing, there will be no benefit from such treatment, since the corset will not be positioned correctly and will not correct the problem area.

For each patient, this device must be selected in accordance with individual characteristics physique. Currently, a network of pharmacies and specialized stores with medical products offer a wide range of bandages. But if you can’t find the most convenient one, it should be made specifically to order. Product normal size does not restrict the breathing process, does not hinder movement.

There are also contraindications to using the bandage: the presence of adhesions inside the abdominal cavity (in this case, the displaced kidney is fixed in only one place).

Therapeutic exercise

This type of treatment is not the case when kidney prolapse and sports are incompatible. Physical activity, intended for therapeutic purpose, involves a whole set of exercises, the purpose of which is to strengthen the muscles of the anterior wall of the peritoneum and lumbar back. The duration of physical therapy should not exceed 20 minutes.

Operation

If nephroptosis is complicated or has a high severity (prolapse of the kidney by 8 cm or less), surgical intervention is necessary. Main indications for surgical treatment:

Prolonged, persistent pain that does not respond well to analgesics;
chronic pyelonephritis;
dysfunction of the urinary system;
dropsy of the kidney;
persistently elevated blood pressure.

The patient is prepared for surgery within 10-14 days. During this period, the use of medicines anti-inflammatory group. This therapeutic measure necessary to exclude further development of the pathological process and the spread of pathogenic microflora through blood circulation throughout the body.

The purpose of the operation is to return the displaced kidney to its normal position. IN postoperative period, the patient is prescribed mild laxatives to prevent muscle tension during bowel movements.

As a rule, the outcome surgical treatment always favorable. It is possible that the doctor will recommend limiting physical activity.

This is a pathological condition of the kidney in which it leaves its assigned place and becomes more mobile. Normally, the mobility of the kidney when moving the body, during abdominal contractions, or even during breathing is no more than a few centimeters, although it should not be tightly fixed, which also belongs to the group of nephroptosis called fixed. If the kidney is so mobile that it easily moves into various directions even in manual mode, we're talking about about the "wandering kidney".

The main apparatus for holding the kidney in a normal position is represented by its fatty capsule, the ligamentous apparatus formed by the peritoneal folds and the fibrous capsule of the kidney. The weakening of one of the elements or the entire apparatus as a whole determines the mechanism of the pathology - the integrity of the ligamentous apparatus is disrupted, the amount of adipose tissue in the capsule decreases, or both occur simultaneously, the kidney begins to move freely in the perinephric space and, under the influence of weight, descends.

Studying the topic allows us to conclude that nephroptosis is more often diagnosed at the age of 25-40 years, and females are at greater risk. The latter is explained by anatomically determined expansion of the pelvis and/or impaired tone of the abdominal wall, often provoked by pregnancy and childbirth. In men, the renal bed is deep, conical and tapering downward. In women it is flat, cylindrical in shape, and widens downward. The left fornix of the diaphragm is more sharply rounded and higher than the right one, and therefore right-sided nephroptosis is more common than left-sided or bilateral.

Causes of nephroptosis rightly considered:

• rapid loss of body weight (in short terms, For example serious illness or strict diet);
• injuries in the lumbar or abdominal area (severe single or regularly repeated), as a result of which the ligaments holding the kidneys could be damaged or a perinephric hematoma may form;
• factors of chronic trauma - frequently repeated pushing, carrying and lifting heavy objects, etc.;
• pregnancy and labor activity, as a result of which the abdominal wall weakens and other constitutional features develop.

Nephroptosis is classified into three stages:

• first - when inhaling, the lower pole of the kidney leaves the hypochondrium and is clearly palpated; when exhaling, it returns back to the hypochondrium;
• second - in a vertical position of the body, the entire kidney comes out of the hypochondrium and is palpated, in a horizontal position it returns or is moved by hand to its usual place; at this stage, the kidney often rotates around its stem, its vessels become more and more elongated, their length increases, and their diameter decreases;
• third - the kidney completely emerges from the hypochondrium, sometimes moves below the iliac crest into the large or small pelvis.

Nephroptosis manifests itself as follows: symptoms:

• pain in the lumbar region - this can be an acute pain (similar to renal colic), or dull, sometimes increasing, stopping in a horizontal position;
• the pain often radiates beyond the lower back - to the groin, genitals, thigh;
• an alternative to pain may be discomfort when moving the body from a horizontal to a vertical position, when walking;
• reduction of pain in the patient in the position on the “sick” side; on the “healthy” side, a feeling of heaviness or dull pain is felt in the opposite side of the lower back or abdomen;
• functional disorders of the nervous system - emotional lability, irritability, short temper, fatigue, etc.;
• disorders gastrointestinal tract- nausea, bloating, abdominal pain, constipation, loss of appetite, etc.;

The cause of pain during nephroptosis is the occurrence of tension and narrowing of the lumen of the renal vessels, which entails impaired blood circulation in the kidney, stagnation here venous blood, swelling of the parenchyma and stretching of the fibrous capsule in which pain receptors are located are formed. The occurrence of symptoms from the nervous system and gastrointestinal tract is caused by reflex irritation of the solar, mesenteric, para-aortic and other nerve plexuses when the kidney prolapses.

How to treat nephroptosis?

Treatment of nephroptosis It is performed by two methods - conservative and surgical. Traditionally, the early stages of the disease become the reason for conservative methods. First of all, the patient is prohibited from heavy physical activity; instead, special therapeutic exercises are prescribed and enhanced nutrition is prescribed. The exercises are designed to strengthen the anterior abdominal wall, and the effect can be enhanced by wearing a bandage, preferably made according to an individual design. You need to put on the corset in the morning, while in a horizontal position, while exhaling.

The reason for surgery for nephroptosis is severe pain that impairs the patient’s ability to work. in addition, surgery is indicated for chronic recurrent pyelonephritis, fornical bleeding, nephrogenic hypertension, hydronephrosis and similar complications.

During an operation called nephropexy, the kidney is fixed in its proper place at a normal level. The fixation must be both strong and reliable, but movable. After surgery, it is necessary to avoid dense scars around the kidney, vascular pedicle and ureteropelvic segment.

The most common operation is nephropexy using the Rivoire method, the essence of which is to fix the lower pole of the kidney with a flap from the psoas muscle, which is passed through the subcapsular tunnel. An alternative may be laparoscopic nephropexy: it is accompanied by less tissue trauma, which reduces the time spent in hospital and speeds up recovery.

What diseases can it be associated with?

Nephroptosis is easily combined with splanchnoptosis - prolapse of other internal organs - when the displacement is caused by a decrease in the tone of the abdominal wall muscles, intraperitoneal or retroperitoneal pressure.

Increasing narrowing of the renal artery and its twisting leads to ischemia of the kidney, the outflow of blood from the kidney is disrupted and or develops, which is predominantly renovascular in nature. In the early stages of nephroptosis, arterial hypertension is most often orthostatic in nature, and in last stage becomes permanent. Parenchymal arterial hypertension is often caused by pyelonephritis, which complicates nephroptosis, which means that nephrogenic arterial hypertension turns out to be renovascular, parenchymal or mixed.

It turns out to be the most common complication of nephroptosis; it is caused by a violation of renal hemodynamics and the outflow of urine from a prolapsed kidney and a disorder of the renal circulation. Pyelonephritis is often accompanied by the formation of stones and the development adhesive process around the kidney. Usually pyelonephritis becomes chronic, which leads to excessive development connective tissue in the kidney parenchyma and its wrinkling. This causes a sharp decrease in renal function and contributes to the development of nephrogenic hypertension.

With nephroptosis (most often at the third stage), it develops quite slowly and is caused by a fixed bend of the ureter due to a scar cord.

With nephroptosis, fornical bleeding can also occur - the basis is derived from venous hypertension, which impedes the outflow of blood from the kidney. in patients with nephroptosis, it often occurs due to physical stress and disappears at rest.

Treatment of nephroptosis at home

Treatment of nephroptosis at home is possible only if it is sufficiently supervised by a specialist. Without adequate treatment, the prognosis of the disease is unfavorable, because progression of the disease leads to the inevitable development of complications and loss of ability to work. At home, the patient can follow the nephrologist’s prescriptions as follows: dietary food(for kidney diseases, diet No. 7 is recommended) and a therapeutic and physical training complex of exercises.

Diet No. 7 is aimed at controlling the amount of protein consumed, phosphorus and sodium, which comes from table salt. Also, special attention is paid to the caloric content of food and maintaining adequate weight. Carbonated drinks, legumes, cream desserts, broths (meat, fish and mushroom, as they contain extractive substances), pickles, smoked meats, and canned food are contraindicated.

The physical therapy complex is represented by daily exercises, often familiar to us from school physical education lessons - these are “scissors”, “bicycle”, “cat”, etc. It is necessary to start the activity with a warm-up, which may include:

• slowly raising and lowering your legs from a lying position;
• longitudinal twisting alternately in both directions;
• parallel lifting of the legs and slowly lowering them from a lying position;
• relaxation - breathing freely, eyes closed, legs and arms extended to the sides.

Neither exercise, nor nutrition, much less medication should be determined and adjusted independently by the patient, but only by a doctor with the appropriate education. Non-compliance of this rule can only aggravate the course of the disease and make the patient feel worse.

What drugs are used to treat nephroptosis?

Taking medications for treatment of nephroptosis does not provide therapeutic action, since it does not in any way determine the mechanism for the kidney to restore its original natural position. Medicines can be prescribed by a specialist only for symptomatic treatment, namely to weaken pain syndrome, as well as as part of the treatment of complications of nephroptosis if they occur.

Treatment of nephroptosis with traditional methods

Treatment of nephroptosis exclusively folk remedies, just like taking medications, is not capable of producing a therapeutic effect. However, taking products made on the basis medicinal plants, can improve the condition of the patient, who, among other things, follows the prescriptions of a specialized specialist - follows a diet and nutrition, performs therapeutic exercises, avoids heavy physical activity and other factors that aggravate the disease. The following recipes are popular:

• 1 tsp pour dry horsetail with a glass of boiling water, leave for half an hour, strain; take small portions throughout the day;
• combine the herbs of sage, St. John's wort, agrimony, lemon balm, cloves, catnip in equal proportions, chop thoroughly; 1 tbsp. Place the resulting mixture in a thermos and pour a glass of boiling water, leave for 2 hours; drink in three doses during the day;
• combine the herbs of St. John's wort, centaury, and bracken in equal proportions, chop thoroughly; 3 tbsp. pour the mixture with 1 liter of olive oil, leave in a water bath for one hour, and then leave in a dark place for 2-3 days, strain after the allotted time; take 1 tbsp. three times a day 30 minutes before meals;
• Brew 1 kg of oat straw with 20 liters of water, boil for an hour (for convenience, you can separate both the straw and the water), and use the resulting decoction for repeated baths.

Treatment of nephroptosis during pregnancy

Nephroptosis of the kidney is not a contraindication to the possibility of becoming pregnant, however, a woman with such a diagnosis in the past or present requires special attention by medical personnel.

A pregnant patient needs regular blood and urine tests, and a comprehensive ultrasound examination is recommended. The slightest disturbances in urination, as well as a small amount of daily urine, should be a reason for an urgent consultation with a nephrologist. The addition of pyelonephritis and, even worse, the development of renal or liver failure is dangerous.

Back pain develops as pregnancy progresses. It is recommended to wear a special bandage, as well as unloading and strengthening exercises for the muscle corset. The basic advice from a doctor for back pain is to adopt an unlimited number of knee-elbow positions as the pain intensifies.

With nephroptosis, first diagnosed during pregnancy, the main efforts of the woman and her attending physician are usually aimed at preventing and relieving pain. More thorough treatment is undertaken after childbirth.

Which doctors should you contact if you have nephroptosis?

The diagnosis usually does not make it difficult for a specialized specialist and begins with an analysis of the patient’s complaints and a painstaking history taking. The latter is usually full of information about the characteristics of pain syndrome, sudden weight loss, previous diseases, injuries, constant physical activity.

The doctor pays attention to the patient’s physique, muscle tone, and volume of fatty tissue. The kidney is palpated in three positions of the patient: on the back with legs bent at the knees, on the side and standing. Detection of kidney prolapse by palpation, especially in the later stages, is usually not difficult.

To confirm the diagnosis, blood tests, urine tests, ultrasound examination of the abdominal organs and some special tests are performed. x-ray studies(for example, intravenous urography).

Urine examination reveals orthostatic proteinuria and microhematuria due to venous hypertension in the kidney, and when complicated by pyelonephritis, leukocyturia.

Particular importance in diagnosing nephroptosis is given to radiological and ultrasound examinations. Excretory urography is used in horizontal and vertical positions of the patient. Ultrasound is performed in three positions of the patient, as well as palpation - on the back, on the side and standing. Excessive mobility of the kidney during breathing and changing body position, as well as an abnormally low position of the kidney, becomes apparent.

Radioisotope renography and scintigraphy of the kidneys with the patient lying and standing make it possible to determine the location and functional ability of the pathologically mobile kidney.

Differential diagnosis of nephroptosis is carried out when it is complicated by dystopia, tumor or hydronephrosis of the kidney.

Treatment of other diseases starting with the letter - n

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