Wandering kidney treatment. What is a wandering kidney and what is the danger of the disease? Wearing special corsets for nephroptosis

Kidney prolapse is an acquired increased mobility of one or both organs. Normally, the kidneys can move slightly when changing body position and during breathing movements, but do not leave the limits of their anatomical bed formed by ligaments and fatty tissue. When prolapsed, the organ may move from lumbar region down, sometimes reaching the pelvic cavity. Prolapse of the right kidney develops much more often, which is due to its lower anatomical location.

Factors causing the occurrence of pathology

The causes of kidney prolapse can be a variety of external and internal factors, which lead to weakening of its ligamentous apparatus. Most often they are:

significant and rapid loss of body weight, which reduces the kidney capsule formed by fatty tissue;
tissue damage to the lumbar region caused by direct or indirect trauma (bruises, falls from a height, surgical interventions);
weakening of the lower back and abdominal muscles caused by old age;
Kidney prolapse is often observed during pregnancy (especially with repeated and multiple pregnancies);
inadequate load (hard work, strength sports);
genetically determined underdevelopment of connective tissue, leading to weakness of all ligamentous apparatus of the body.

In addition, there are predisposing factors - prolonged stay in vertical position, constant vibration. This explains why the kidney prolapses more often in people of certain professions - sellers, dentists, drivers, etc.

Symptoms

When the kidney prolapses, the symptoms depend on the stage of the disease and severity pathological changes in the organ.
The disease in the initial, stage I, manifests itself with minor pain. With prolapse of the right kidney, the symptoms will be localized in the right half of the lumbar region, with left-sided nephroptosis (prolapse of the kidneys) - on the left. Pain occurs in an upright position, sometimes spreads to the abdominal wall and disappears in a lying position.

When the kidney is lowered below the hypochondrium line (II degree of the disease), the pain is more pronounced and can become permanent. At this stage there is an inflection renal vessels and ureter, which leads to both disruption of the blood supply to the organ and the outflow of urine. Changes occur in the urine (protein and red blood cells appear).

In the third degree of the disease, the symptoms of a prolapsed kidney are constant pain, no longer disappearing into horizontal position, attacks of renal colic may occur. In this case, a serious circulatory disorder in the kidney and a violation of the outflow of urine occurs due to severe bending or twisting of the vascular bundle and ureter. Ischemia of the organ increases, the kidney begins to secrete increased amount the hormone renin, which increases arterial pressure.

With any prolapse of the kidney, the consequence in an advanced stage can be the development of severe arterial hypertension with very high pressure numbers.

A pronounced delay in the outflow of urine leads to the addition of an infection - the development of pyelonephritis and cystitis, in which urination occurs frequently and painfully, chills and a constant increase in temperature are possible.

Constant pressure on the kidney tissue from retained urine can lead to salt precipitation, stone formation and the development of hydronephrosis. The latter can lead to almost complete death of the active kidney parenchyma and cessation of its functioning.

Kidney prolapse - what does this mean for the patient? In the absence of adequate treatment, this pathology is fraught with the development of renal failure. This life-threatening condition requires constant blood purification through hemodialysis or donor organ transplantation.

Diagnostics

Studying the patient's complaints, examination data, palpation of the drooping right or left kidney in a vertical and horizontal position is usually sufficient to make a diagnosis.
Additionally, ultrasound, excretory urography, CT and MRI of the kidneys may be prescribed.

Treatment

Treatment for kidney prolapse depends on the stage, existing complications, concomitant pathologies, age and is selected individually in each case. The main directions are conservative and surgical methods.

Conservative treatment

This type of therapy cannot completely cure the disease, but can prevent the development of complications and serves to prepare for surgery in severe forms of the disease.

For minor symptoms of kidney prolapse, treatment may be limited to:

diet;
gymnastics;
wearing an orthosis (bandage).

Bandage

A bandage for kidney prolapse will be effective only at stage I of the disease, when there are no gross changes in the blood circulation of the organ and complications.

The device is made of dense and rigid material and is put on in the morning while lying down until you assume a vertical position. The bandage is wrapped around the waist and fastened after a deep exhalation. The action of the device is based on an increase in intra-abdominal pressure, which forces the kidney to return to its normal anatomical location.

The bandage is contraindicated in cases of severe pain and the presence cavitary adhesions. It should be remembered that he can both raise a lowered kidney and fix it in the desired position only for a while. But this method does not replace surgical methods of therapy when complications develop. In addition, prolonged wearing of the device leads to atrophy and weakening of the lumbar and abdominal muscles, further worsening the problem of kidney fixation. Therefore, the selection and use of a bandage must be carried out under the supervision of a doctor.

Diet

A special diet is indicated if kidney prolapse is the result of rapid and massive loss of fatty tissue. This condition can be observed during starvation (forced or voluntary, for example, with anorexia in girls) or severe debilitating diseases.

A high-calorie diet is prescribed rich in carbohydrates and fats, the purpose of which is to restore the integrity of the fatty capsule of the kidney and the turgor of adjacent tissues. The extent of the disease and the presence of complications should be taken into account. If already available renal failure and the ability to remove decay products is reduced, the diet should contain easy-to-digest components that form a minimum of toxins.

Physiotherapy

Gymnastic exercises for kidney prolapse are prescribed in the initial stage of the disease. Their goal is to strengthen the natural muscular corset of the body - the muscles of the lower back and abdominal muscles. These muscles maintain intra-abdominal pressure normal level, which fixes the kidney in its normal position.

Before starting a set of exercises, it is necessary to evaluate the excretory function of the kidneys. Physical activity should be limited or canceled in the presence of renal failure, other concomitant severe diseases and the presence of severe pain syndrome.

Gymnastics for kidney prolapse is a set simple exercises which the patient is able to perform independently at home. They are usually performed once or twice a day with a total duration of the complex of up to half an hour.

An approximate set of exercises for nephroptosis (all exercises are performed in a supine position):

arms are moved from a position along the body to the sides as you inhale and return back as you exhale (up to 6 repetitions);
arms are raised above the head, straightened legs are raised alternately (up to 5 lifts);
“walking” in a lying position (up to 2 minutes);
knees pulled to the chest are held with your hands for a few seconds (up to 6 repetitions);
hands under the head, with legs bent, the pelvis rises as you inhale and falls as you exhale (up to 5 repetitions);
hands under the head, simultaneous bending of the legs in all three joints (up to 5 repetitions);
circular movements with maximum amplitude with raised straight legs (up to 5 times);
slow transition to a sitting position and back (up to 5 times);
pendulum-like movements of the raised pelvis (up to 5 times).

Treatment of kidney prolapse with folk remedies, which include yoga, Pilates and other exercises, usually only complements the main methods of treatment, is not independent and requires mandatory medical supervision.

Surgical intervention

What to do if the kidney is prolapsed and this condition does not respond to conservative treatment? In such cases, surgical intervention is indicated, which is performed if the disease has reached stage II or III and the following phenomena are present:

severe symptomatic arterial hypertension;
prolapse of the kidney to the fourth lumbar vertebra and below;
persistent pain syndrome;
the disease is bilateral and complicated by pyelonephritis;
the threat of developing hydronephrosis due to persistent obstruction of urine outflow;
Kidney function is impaired, renal failure develops.

The operation allows you to return the kidney to its anatomical bed and prevent its re-displacement by suturing it to adjacent tissues. To do this, a muscle flap is cut out, which will later play the role of a “pocket” for the kidney, or a special implant made from a special surgical mesh is used. The operation can be performed using the usual method through an incision in the lumbar region or with more modern low-traumatic approaches (laparoscopic surgery).

When choosing how to treat renal prolapse and what volume of surgery and type of access to prefer, the surgeon is guided by an assessment of the patient’s condition. Minimally invasive methods are usually used when there is no severe complications and pronounced adhesions in abdominal cavity, for a better cosmetic effect (especially in young patients).

In the presence of kidney stones or hydronephrosis, surgery can be supplemented by removing stones from the renal pelvis and restoring normal urine flow.

Contraindications to surgical treatment:

extreme severity of the patient's condition,
presence of serious concomitant diseases(oncopathology, severe heart failure, severe mental disorders);
deep old age patient;
the presence of total splanchnoptosis (general prolapse of all internal organs).

To know what to do when a kidney prolapses, you need to understand the symptoms of nephroptosis. The occurrence of lower back pain on one or both sides, disappearing in a horizontal position, is a sign initial stage pathology. If you or your loved ones have these symptoms, contact your doctor. A specialist will help prevent the disease from entering an advanced phase and avoid serious complications.

A wandering kidney is a pathology of the urinary system, which is characterized by excessive movement of the renal organ outside the anatomical bed.

Due to high mobility, the kidney can drop significantly downwards, reaching the pelvic area.

A mobile kidney is more characteristic of women due to the characteristics anatomical structure body. Elderly people are also susceptible to this pathology.

Causes

Both renal organs are naturally mobile, but their normal deviation from their usual place is no more than 1-2 cm.

If the displacement of the kidney exceeds this indicator, doctors diagnose a pathology such as nephroptosis, a type of which is wandering kidney.

Because the left kidney is located above the right one, then the mobility of the latter is slightly higher, so it is the right kidney that is more often diagnosed as wandering.

Doctors in currently cannot say with absolute certainty what causes specifically provoke such a pathology.

However, along with this, certain factors are identified that favor the occurrence of pathological movements of the organ.

First of all, the kidney may become wandering due to weakening of the abdominal muscles, loss of elasticity of the fascia, or excessive depletion of the fat capsule.

Abdominal muscles can lose strength due to various circumstances. In particular, even difficult labor and multiple pregnancies favor relaxation of the abdominal wall.

The kidney capsule becomes depleted if the body loses too much excess weight. This situation happens when a person subjects himself to a strict diet or suffers a serious illness in the near future.

The kidney can also become wandering if the fascia has been torn; accordingly, nothing can hold the organ in one anatomical position.

Most often this happens when a person gets into dangerous situations resulting in serious injury.

Favors increased organ mobility difficult conditions labor when you have to move or lift heavy objects.

Even coughing, intestinal constipation can trigger the appearance of a wandering kidney.

In rare cases, doctors consider such a pathology as pathological heredity, when the structure of the connective tissue undergoes serious changes.

Symptoms

If the kidney has become wandering, and its deviation from the natural bed is great, the patient will definitely notice this, since the pathology in this case is accompanied by certain symptoms.

Unfortunately, stage 1 nephroptosis is quite difficult to recognize and visually diagnose, since there are no obvious symptoms, the person simply does not worry about anything.

It is most often possible to identify a vagus organ of the 1st degree only by chance, when a person goes to ultrasound diagnostics for other reasons.

However, each person is unique, so the body can perceive individual internal pathological processes differently.

As a result, a wandering kidney can be suspected based on the individual symptoms that appear. In particular, pain in the lumbar region indicates renal pathologies.

If painful sensations eliminated after a change in body position, it is quite possible that the organ has become excessively mobile and wandering. It is no secret that a wandering kidney can be returned to the renal bed, indeed occupying a horizontal position.

Symptoms of a wandering kidney can also include increased heartbeat, as well as an excessive increase in blood pressure.

In some cases, the vagus organ manages to affect the nerve endings, squeezing them, resulting in neuralgia, excessive irritability and hot temper.

Nephroptosis is also characterized by loss of appetite and intestinal disorders.

In addition, the patient feels a clear loss of strength, dizziness, and often experiences insomnia.

Complications

If you notice signs of a wandering kidney, it is important to immediately seek medical help.

Ignoring the symptoms of a wandering kidney can lead to disastrous results, since excessive mobility of the kidney can provoke some pathologies that are accompanied by serious danger.

In particular, the kidney in the process of movement can affect the ureter, causing its compression. In such cases, natural urination is disrupted.

Urine begins to accumulate in the kidney, negatively affecting its condition. Urine favors the development of pathogenic bacteria, so its increased concentration provokes infectious and inflammatory processes.

Also, a high concentration of urine provokes urolithiasis, which occurs due to the combination of grains of sand into stones, and subsequently into large conglomerates.

Urinary dysfunction contributes to the occurrence of such the most dangerous disease like hydronephrosis.

Pyelonephritis may occur, followed by frequent attacks renal colic.

When reducing diameter renal artery, which happens when it is compressed or twisted, the patient begins to suffer from increased blood pressure, which is, of course, followed by headaches.

The dangerous thing is that due to oxygen deficiency, hypertensive crises can occur.

The most serious and dangerous not only for health, but also for life, is kidney failure, which can also act as complications if there is inaction and complete ignorance of the signs of a wandering kidney.

Diagnostics

Identifying a wandering kidney helps not only the symptoms that the patient is ready to list at a doctor’s appointment, but also a visual examination with simultaneous palpation.

An experienced doctor can immediately identify a wandering kidney, but to clarify the diagnosis, he will still refer the patient for laboratory and instrumental diagnostics.

Measuring blood pressure in different positions can also identify the wandering kidney. In particular, blood pressure readings in horizontal and vertical positions may differ by 15–30 mm. Hg

When conducting laboratory research urine is determined by the presence of red blood cells, leukocytes, and protein in it.

Doctors do not stop at the results of laboratory diagnostics; they necessarily refer the patient for an instrumental examination.

Ultrasound examination can identify the wandering kidney. During the diagnostic process, the location to which the renal organ is moved is determined.

Ultrasound diagnostics for this purpose are carried out only after the patient has been in an upright position for some time, and accompanied his actions with additional activity.

The wandering bud makes it possible to detect and X-ray examination, excretory urography, for which a special contrast agent is injected into a vein.

Angiography allows not only to detect kidney prolapse, but also to pay attention to the condition of the veins.

Radioisotope scanning and scintigraphy are also used as instrumental diagnostics.

Treatment

If the symptoms confirm a pathology such as nephroptosis, the doctor considers several treatment options.

Conservative techniques and surgical intervention can be used. The technique is selected depending on the degree of pathology detected in the patient.

At the initial stage of development of the wandering kidney, the doctor establishes only medical control, which provides for constant monitoring of the condition of not only the patient, but also the dynamics of the pathology.

If you put on a bandage in a vertical position, you can fix the organ in the wrong position, adhesive processes will increase Negative consequences incorrect fixation.

High performance is accompanied Spa treatment.

Modern medicine successfully performs nephropexy, which makes it possible to artificially create conditions that support the kidney in the right place.

Nephropexy is performed laparoscopically, accompanied by minimal trauma.

Abdominal surgery has recently been performed extremely rarely, when there is no other option for surgical intervention.

So, nephroptosis poses some threat to the health of every person, but timely treatment can prevent any complications.

Movement of the kidneys within the ligamentous fat bed is normal. An anomaly is considered to be the exit of organs beyond the lumbar region, that is, their displacement by more than 5 centimeters. The phenomenon in medicine is called nephroptosis.

Prolapse of the kidneys leads to disruption of their functioning and carries with it many complications. The disease rarely causes pain. It is often diagnosed during an ultrasound examination. Pathology develops more often in women than in men.

When the kidneys prolapse, the causes are factors that provoke the inability of the ligamentous apparatus to hold the organs in the desired area of the body. These include:

hematomas, injuries, bruises that cause the kidney to descend. When damaged, the ligaments lengthen due to the formation of tears. The organ is not fixed securely. Hematomas can disturb the kidney;
strong physical activity. Under pressure in the abdominal cavity, the ligaments are stretched, resulting in prolapse of the organ;
losing weight for a short time leads to depletion of the fat capsule;
a sharp drop in pressure in the abdominal cavity after childbirth leads to weakening of the muscles, resulting in prolapse;
when hereditary predisposition to diseases of connective tissue weakness, ligaments stretch easily. This causes prolapse of the right or left kidney;
constant vibrations lead to stretching of the fascia and ligaments;
a sedentary lifestyle leads to a decrease in tone in the abdominal muscles. Intra-abdominal pressure drops and the organ descends;
It happens that the kidney is prolapsed as a result of long-term illnesses (cirrhosis of the liver, tumors and other infections). When a cough does not go away for a long time due to tuberculosis, whooping cough, or bronchitis, it provokes an anomaly due to the lowering of the diaphragm.

The causes of kidney prolapse are varied and can be confused with other diseases. Therefore, you should not make a diagnosis yourself.

Contact a doctor who will draw up a complete picture of the disease and help you get rid of the pathology without consequences.

How to recognize nephroptosis?

When the kidneys descend, symptoms appear gradually, depending on the stage of progression of the pathology. The lower the organ goes, the more signs appear. TO general symptoms include:

1. The back aches, the lumen of the blood vessels narrows, the outflow of urine and blood becomes less, swelling appears. By stretching, the organ increases fibrous capsule. It gives pain thanks to receptors.

Stage 1 is characterized by the occurrence of pain when standing or when changing position.

Stage 2 of the disease is expressed by attacks after exercise, lasting up to half an hour.

Stage 3 is represented by constant pain due to persistent swelling.

2. Blood in the urine. The phenomenon occurs due to the twisting of blood vessels and depletion of their walls. Urine acquires a burgundy hue as a result of mixing it with blood.

3. Symptoms of kidney prolapse are manifested by pain in the groin, abdomen, thighs, and genitals. Do not confuse this with an attack of appendicitis. The pain is sometimes unbearable, the person is unable to pronounce words or move.

4. Diarrhea, constipation, vomiting and other gastrointestinal disorders express irritation of the nerve endings located near the affected organ.

5. Impaired kidney function leads to poisoning of the entire body. In addition to pain, a person feels weakness, irritability, and often develops a fever.

When the right kidney prolapses, the symptoms are the same as in the case of an anomaly of the left organ. After one of the above signs of the disease manifests itself, you should visit the clinic and be examined by a specialist.

What are the degrees of the disease?

In medicine, there are three stages of development of nephroptosis. Let's look at each of them in detail:

first. The kidney is in its place, but when you inhale it shrinks up to 9 centimeters, part of it can be felt in the area of the lower ribs. Manifests dull ache in the lower back when rising from a lying position;
second. When a person stands, the kidney descends 2/3 below the hips. As soon as the patient lies down, the organ returns to its place. At physical activity the patient experiences pain that resembles colic in nature. When a person lies down, the pain subsides. The analysis shows the presence of red blood cells and protein in urine;
third. The kidney descends below the rib line or into the pelvis. The pain is severe and constant. As a result of stagnation of urine, blood and mucus are found in it.

How is nephroptosis diagnosed?

Kidney prolapse is recognized through diagnosis. It includes the following steps:

Patient interview. It is important for the doctor to know how long ago the symptoms began to appear and how severe they are.
Feeling. A drooping kidney can be felt as a painful roundness in the area below the ribs.
X-ray. Signs of a prolapsed kidney are visible when performing urography with a contrast agent while standing and lying down. Doctors find out the condition of the kidney vessels and its location.
Analysis of urine for the presence of red blood cells, protein and leukocytes.
Ultrasound of organs. Research rarely accurately makes such a diagnosis. After all, the procedure is carried out in a lying position, and the kidneys in this state return to their original place.

What to fear if there is no treatment?

What are the consequences of kidney prolapse and ignoring treatment of the disease? The doctor tells the patient about this when diagnosing nephroptosis. Lack of therapy leads to irreversible changes. Let's get acquainted with the consequences that an advanced disease leads to:
pyelonephritis and cystitis. Diseases occur due to stagnation of urine, which provokes the active growth of bacteria;
urolithiasis disease. Increased content salts in urine, their further crystallization leads to the formation of stones;
hydronephrosis. Develops due to the accumulation of fluid in the pelvis
death of parenchyma. The cause of the pathology is the bending of blood vessels, their rupture.

This is why kidney prolapse is dangerous. All diseases can result in organ dysfunction or its complete removal. If the third stage of nephroptosis occurs, the patient becomes disabled and requires a transplant.

How is the disease treated?

What to do if a kidney prolapses? First, contact a specialist and undergo an examination. After analyzing the studies, the doctor prescribes the only correct treatment. Conservative therapy is able to cope only with the initial stage of nephroptosis. For the third and fourth degrees of the disease, surgical intervention is indicated.

Surgical treatment

Treatment of kidney prolapse is performed surgically for the following indications:

unbearable pain;
complication of infection when the left kidney and the right kidney prolapse at the same time;
possible development of hydronephrosis;
last stage of hypertension;
signs of dysfunction;
if the organ has descended below the 4th vertebra of the lumbar spine.

When the kidney prolapses, surgery is performed in two ways: laparoscopy or open intervention. The operating method is selected by the surgeon and depends on age, concomitant pathologies, severity of symptoms, and treatment is carried out accordingly. Surgical intervention includes several stages:

Return to Right place organ localization.
Fixation of organs and bed to avoid recurrence of confusion.
Using absorbable sutures, doctors attach the kidney to muscle tissue.

Before starting the manipulation, specialists eliminate infections in the patient, improve the flow of urine, and normalize blood pressure.

Conservative medicine

How to treat kidney prolapse at the first stage? Therapy includes a number of procedures:

medicinal, symptomatic treatment;
hydrotherapy;
putting on a special support device.;
therapeutic gymnastic exercises;
diet.

When the kidneys prolapse, treatment must be comprehensive. Restoration is possible only in this case. Let's consider all the points of successful therapy in more detail.

Proper nutrition

The causes and consequences of nephroptosis can be eliminated through diet, especially if the disease occurs due to sudden weight loss. Foods rich in fats and carbohydrates are included in the diet. This is necessary to increase the volume of the anatomical bed of the organ. When drawing up a menu, doctors rely on the patient’s condition. In case of already acquired deficiency, it is recommended to consume only those foods that are easily digestible and contain a minimum amount of toxins.

Wearing bandages

How to raise a drooping kidney? The bandage plays an important role here, but only at the first stage of the disease. The adaptation is effective before complications or strong changes in blood flow occur.

A special bandage made of hard material is worn in a horizontal position. Exhaling, wrap it around your waist and fasten it. The essence of his therapy is to artificially increase the pressure in the abdominal cavity, due to which it is possible to return the organ to its place. Wearing the device does not cure, it is only a temporary procedure. It is selected by a specialist individually for each patient. Long-term use of bandages leads to weakening of the muscles of the lower back and peritoneum.

Physical exercise

If omitted right kidney or left, is at the first stage of development of the pathology, a course of gymnastic exercises is prescribed. Their action is aimed at maintaining the tone of the abdominal muscles and lower back. At the same time, the pressure returns to normal, which allows you to keep the organ in the desired area of the body. Therapy is contraindicated for severe pain, insufficiency or other concomitant diseases. The classes are simple, last about half an hour, and can be done independently at home. The complex should be performed once or twice a day.

It is important to remember that such treatment is only additional to the main treatment with medications or surgery. Coordinate all actions with your doctor.

Surgical treatment

If the kidney is prolapsed and the pain is unbearable, seek help from a specialist. May be required surgical intervention. The procedure is performed in rare cases and has a number of indications:

urolithiasis disease;
severe pain syndrome;
complications such as pyelonephritis, hydronephrosis;
hemorrhage from the vessels of the organ.

There are also contraindications to the manipulation:

lowering of all organs of the peritoneal area;
a person over 60 years old;
concomitant serious illnesses.

Unconventional ways to get rid of illness

Treatment with folk remedies can relieve pain and remove complications. Herbs cannot fight nephroptosis, so treatment with them is only auxiliary. Let's look at a few effective recipes:

Onion peel. Grind in your hands and separate three tablespoons. Pour boiling water over it and leave to steep for 30 minutes. Afterwards, take one spoonful orally 4 times a day.
Jerusalem artichoke. Sitz baths can help relieve the pain of kidney prolapse. Pour a liter of freshly boiled water into 3 tablespoons of a mixture of flowers and leaves of the plant. After insisting for half an hour, add it to the container and stay there for a quarter of an hour.
Seeds. Take flaxseed or pumpkin seeds, fry them in a frying pan, after dipping them in powdered sugar. Eat three times every day.
Oat straw. Kidney prolapse in a child is also not a rare occurrence. This product can help your baby. Grind a kilogram of the plant and, adding water, cook for an hour. Once cooled, add to bath tub.
Kochia coronata. Take the stem of the plant and hot water in a ratio of 1:3. Infuse the decoction for 12 hours. Then strain and take 1 spoon per day.

Preventive measures to avoid the development of pathology

With a prolapsed kidney, the consequences are very varied and dangerous to health. Disease prevention consists of the principles of a healthy lifestyle:

balanced diet and diet;
regular sports activities;
excessive weights and heavy physical loads are excluded;
the back is always straight;
We don’t go hungry;
We wear a bandage during pregnancy;
protect yourself from injury and damage;
We lose weight gradually.

Simple rules will help anyone protect themselves from nephroptosis

In the case of kidney prolapse, symptoms and treatment are interrelated. Signs influence the degree of development of the pathology, and it helps to choose a specific type of therapy. Don't study. It will lead to worsening of the disease and the development of concomitant pathologies.

When the kidney is prolapsed and it is not clear what to do, you need to go to the doctor. Only a specialist can make an accurate diagnosis and prescribe the only correct treatment.

Nephroptosis (wandering or mobile kidney) is a condition in which the kidney from its usual position (in the lumbar region) is strongly shifted to the bottom (to the abdomen and even pelvis). At the same time, she may either return to her usual place or not return there.

Prevalence of nephroptosis

Nephroptosis occurs predominantly in women (0.1% in men and 1.5% in women). This fact is explained by the structural features female body– wider pelvis, decreased tone of the abdominal wall, greater elasticity of the ligaments.

The kidneys, like most organs of the human body, are in relative mobility, although they have their own clear place in the body. At the moment of inhalation, the kidney moves downwards by 2-4 cm, with deep breath goes away by 4-6 cm. It reacts to movements and movements of the body. Such physiological fluctuations help normal excretion urine.

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

Symptoms of nephroptosis

At first, the disease does not manifest itself at all, and the wandering kidney begins to make itself known. unpleasant sensations in the lumbar region on the side of the descent: more often on the right - in 75% of cases, in 10% - on the left and in 15% - on both sides. The most common consequence of kidney displacement is a pulling, aching pain, less often stabbing. At the beginning of the disease, the pain is not pronounced and quickly disappears. But over the years they become more intense, constant, and exhausting.

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

Pain when nephroptosis They can also be very intense - like renal colic. They can appear suddenly after severe stress or a change in body position from lying to vertical and last from several minutes to several hours - either weakening or increasing. The pain often radiates to groin area, into the genitals. Sometimes such an attack is accompanied by nausea and vomiting. The patient may be pale, covered in cold sweat, and the temperature may rise.

Pain - no the only symptom nephroptosis. For many, a mobile kidney is manifested by loss of appetite, nausea, a feeling of heaviness in the epigastric region, constipation or, conversely, diarrhea.

In the future it is possible functional disorders nervous system in the form of increased excitability, neurasthenia. Such patients are overly irritable, distrustful of the doctor’s conclusions and advice, and suspicious. They get tired easily, suffer from dizziness, palpitations, and insomnia.

There are three stages in the development of nephroptosis, depending on the level of kidney prolapse:

Stage 1. At this stage, the drooping kidney can be palpated through the anterior abdominal wall on inhalation; on exhalation, the kidney goes into the hypochondrium (normally, the kidney can only be palpated in very skinny people, in all others it is not palpable).
Stage 2. In the upright position of the patient, the entire kidney comes out of the hypochondrium, but in the supine position it returns to the hypochondrium, or it can be painlessly set by hand.
Stage 3. The kidney completely emerges from the hypochondrium in any position of the body and can move into the pelvis.

Causes of nephroptosis

The causes of nephroptosis are factors leading to changes in the ligamentous apparatus of the kidney (infectious diseases, sudden weight loss) and a decrease in the tone of the muscles of the anterior abdominal wall (for example, during pregnancy), as well as injuries accompanied by overstretching or rupture of the ligamentous apparatus of the kidney (sudden lifting of weights, falling from a height, etc.).

Complications of nephroptosis

At the moment of significant displacement of the kidney, often downward, the ureter bends, twists, and the passage of urine becomes difficult. Urinary retention occurs, its stagnation in the pyelocaliceal system of the kidney. Urine keeps flowing in, but outflow is difficult, the renal pelvis expands, which over time can lead to hydronephrotic transformation.

Most often, stagnation of urine leads to pyelonephritis - inflammation of the renal collecting system. This is the first, earliest and common complication nephroptosis. In some cases, pyelonephritis can occur acutely with the development of severe pain syndrome - renal colic, which requires emergency medical attention.

The renal artery is stretched, sometimes it doubles in length, naturally narrowing at the same time. As a result of torsion of the renal arteries during nephroptosis, arterial hypertension often develops, accompanied by pronounced increase blood pressure and difficult to treat with medication. Kidney doesn't have enough blood nutrients and oxygen, which even results in hypertensive crises. Renal blood pressure is the highest, especially due to diastolic numbers, and can reach up to 280/160 mmHg.

Diagnosis of nephroptosis

The diagnosis is made on the basis of complaints, examination of the patient and palpation (palpation) of the kidney, laboratory and instrumental examinations.

At nephroptosis there is a difference in blood pressure (BP) of 15-30 mmHg. in the same patient in a vertical and horizontal position - in a vertical position it increases.

When examining urine, a small amount of protein, white blood cells and even red blood cells may be detected.

The main method for diagnosing nephroptosis is x-ray and ultrasound examination. Most informative instrumental methods kidney examinations - a survey X-ray of the urinary system, as well as excretory urography - an X-ray research method combined with the introduction of a contrast agent into the patient’s vein. Pictures are taken in standing and lying positions. Radioisotope scanning and scintigraphy allow you to determine the position, and renography - functional state pathologically mobile kidney. Angiography allows us to judge the condition of the renal artery, venography - about venous outflow. Sometimes it is necessary to examine all organs gastrointestinal tract(X-ray of the stomach and intestines, FEGDS, colonoscopy) to exclude or confirm general prolapse of the abdominal organs.

Treatment of nephroptosis

Treatment nephroptosis can be either conservative or operative.

On early stages disease in the absence sharp pain if complications have not yet developed, nephroptosis can be cured conservative methods. These methods include orthopedic treatment: a special bandage in the morning, before getting out of bed, is put on the stomach while exhaling deeply, while in a horizontal position, and removed in the evening. There is a lot on offer various bandages, belts, corsets, but they must be made individually for each specific patient. A contraindication for orthopedic treatment is only a kidney fixed in a new place by adhesions. In all other cases it is indicated.

In the first stage of nephroptosis, sanatorium-resort treatment, abdominal massage, and therapeutic exercises aimed at strengthening the abdominal and back muscles, ensuring normal intra-abdominal pressure and limiting downward displacement of the kidneys are useful.

It is impossible to put the kidney back in place with medications. However, they treat complications nephroptosis, such as pyelonephritis, high blood pressure with renal arterial hypertension. Antispasmodic, analgesic, and anti-inflammatory drugs are usually prescribed. It is necessary to limit severe physical activity. If nephroptosis developed as a result of the patient losing weight, then sufficient nutrition is necessary in order to regain the lost weight.

For the treatment of nephroptosis, a complex is also used physical exercise aimed at strengthening the abdominal muscles.

If ineffective conservative treatment resort to surgical methods of fixing the kidney - nephropexy (fixation of the kidney to neighboring anatomical structures). In this operation, the urologist returns the kidney to its usual bed in the lumbar region and strengthens it there.

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

"Old" abdominal surgery using a muscle flap is quite traumatic and requires an extended lumbar incision of up to 20 cm. In addition, in postoperative period must be observed bed rest for 2 weeks so that the kidney is securely fixed in its bed.

A timely operation usually gives good results. Transient arterial hypertension, as a rule, goes away and blood pressure returns to normal.

Wandering kidney (nephroptosis) is a kidney disease characterized by its displacement relative to the normal physiological state. When the human body moves, even slightly, the kidney moves (up to 10 cm), in a vertical and horizontal position.

Causes

Wandering kidney, the disease is not congenital, but acquired. A healthy kidney is held in place by: intra-abdominal pressure, a complex of ligaments, in the form of a renal bed, adipose tissue. The development of pathologies in one of the organs that support the kidney leads to nephroptosis.

Reducing the size of the fatty capsule of the kidney.
Changed position of the vessels of the renal pedicle.
Low tone of the abdominal muscles (abs).
Sudden change in the patient's weight.
Engagement in work that involves lifting weights, standing for long periods of time, or strenuous exercise.
Receiving an injury to the lumbar region.
Heredity.

Degree of displacement

The kidney descends 1.5 vertebrae, below the normal position. Almost a third of it comes out of the hypochondrium, and can be felt with your hands (regardless of the patient’s weight) while inhaling. After exhalation, it returns to its original position.
When the lower part of the kidney is displaced by 2 vertebrae. The kidney completely leaves the hypochondrium area, deformation of the renal vessels occurs. Takes its original place only in a horizontal position of the body.
Change in distance from the initial position to the diagnosed one, more than 3 vertebrae. The kidney is dislocated in the pelvis, possibly squeezing the ureter.

Symptoms and complications

Nephroptosis is generally asymptomatic and is discovered by chance. The main problems for patients are painful sensations in the lumbar region, which is often diagnosed as poor posture and is associated with a modern sedentary lifestyle.

A wandering kidney most often accompanies skeletal pathologies acquired in utero - changes or absence of ribs, displacement of vertebrae. These pathologies, causing pain, hide kidney pathologies.

The most common symptoms:

Occurs more often strong pain in the hypochondrium and in the renal region. When the body position changes to horizontal, the pain goes away.
Heaviness in lumbar region. Manifestation of diseases such as urethritis, cystitis, renal colic. Laboratory analysis, in some cases, indicates the presence of protein in the urine.
Arrhythmia, hypotension.
Neurogia in the hip area, short temper and irritability.
Gastrointestinal disorders. Lack of appetite.

The danger of the pathology lies in the disruption of the standard function of the urinary system. Nephroptosis leads to impaired blood circulation in the kidney and increased intrarenal pressure. A disease such as pyelonephritis develops, an inflammatory process in connective tissues kidneys, and arterial hypertension.

Treatments of this disease Most often it goes away with a delay, this is due to the difficulty of diagnosing it and the absence of symptoms. In advanced cases, compression of the ureter is possible. The wandering kidney rotates around itself, strangulation develops, leading to an enlargement of the kidney and the manifestation of nausea, weakness and fever. Nephroptosis often leads to urolithiasis.

Diagnostics

Diagnosis of a wandering kidney is based on interviewing the patient, physical examination and palpating the patient in various positions (standing and lying down), laboratory diagnostics(analysis), and diagnostics using special equipment.

A routine examination will show the nature of the displacement of the diseased kidney. Renal changes will be indicated by blood pressure by 10-30 points when changing body position. Laboratory analysis will show the presence of leukocytes, red blood cells and bacteria in the urine.

An ultrasound examination will help to take a closer look at the pathology of the kidney and identify the presence of inflammatory processes. For full diagnostics Vascular ultrasound is used for a detailed examination of the state of the vascular system of the kidney and assessment of the degree of damage caused by the disease.

X-ray research method urinary tract, is used to determine the degree of disease, by the distance to the vertebrae, when the kidney prolapses.

To characterize the condition of the renal artery, angiography and venography are performed. Radioisotope diagnostics are prescribed to determine changes in the process of urine passage and the performance of standard kidney functions.

Numerous studies of the gastrointestinal tract (fluoroscopy of the stomach, irrigoscopy, colonoscopy, endoscopy) are carried out to determine changes in the position of the abdominal organs - splanchnoptosis, most often affected by nephroptosis on both sides.

Treatment methods

The choice of treatment method should be made by a specialist; do not self-medicate, this can lead to irreparable consequences.

Surgery. Fixation of the kidney with a segment of fibers of the lumbar muscles, with surgical intervention, called nephropexy.
Palliative therapy is used when the disease is at an incurable stage, the patient is prescribed procedures that help maximize comfort during the course of the disease. In case of nephroptosis, patients are recommended to wear an individually selected corsage or bandage that fits tightly to the body.
Symptomatic treatment is characterized by getting rid of specific symptoms. Prescribe analgesics and antispasmodics, anti-inflammatory drugs, vitamin complexes, antimicrobial agents.

The prescription of certain medications occurs after a detailed consultation with a specialist and a complete complex diagnostics patient.

Prevention of floating kidney

Surgical intervention and those prescribed by a specialist medicines not the only method of getting rid of a wandering kidney. Doctors have developed a whole set of exercises aimed at eliminating dystrophy of the muscular corset of the dorsal region and the press. Maximum effect achieved at integrated use gymnastics, therapeutic massage, diets and healthy image life.

To prevent nephroptosis, it is worth studying the following rules:

WITH early age, close attention pay attention to posture.
If you have a thin, sickly build, avoid heavy loads.
Take occupational diseases into account when choosing a job.
During pregnancy, do not neglect the bandage; wear it to help your spine. Perform a simple set of exercises daily to strengthen the muscle corset.
Exclude sharp jumps weight. If there is a significant drop in body weight, provide a nutritious diet that does not allow loss of calories and nutrients.
Try not to injure the lumbar and spinal regions.
It is important to remember that unlike a cat, which walks on its own, your easy-going kidney can bring a lot of problems and discomfort.