Symptoms of prolapse of the kidneys (nephroptosis) or their increased mobility. Stages of development of right-sided nephroptosis and treatment of pathology by conservative and surgical methods

Women are at risk for the development of nephroptosis - the prevalence of this condition is 1.5%. In men, it is diagnosed only in 0.1% of cases.

More often develops right-sided omission. Nephroptosis of the left kidney, as well as bilateral anomalous position, is very rare.

Kidney nephroptosis - what is it?

IN normal condition almost all organs human body may be displaced relative to the typical anatomical location. But if such changes exceed the permissible limits (norms) and begin to interfere with the functioning of the organ, the displacement is considered pathological.

Similarly, the kidneys can move within the normal range, with the movement and movement of the body. Such mobility favorably affects the urinary process.

But in some cases, this movement can become abnormal (in medicine it is called nephroptosis).

Among all kidney diseases, nephroptosis is a fairly common but poorly diagnosed condition. Translated from Latin, "ptosis" means omission, "sliding down." In reality, any pathological change the position of the kidneys, and not just the true prolapse is called nephroptosis.

The kidney can "wander", that is, move every time in different place, can go down, reaching the small pelvis, can change position around its axis.

The most common is nephroptosis right kidney- this is due to the initially lower location of the kidney due to the fact that the liver is located above it. In addition, on the right side, the ligaments that hold the organ are weaker than on the left.

Causes of kidney nephroptosis

The structures that affect the retention of the kidney in a typical anatomical location are ligaments, adipose tissue and muscles abdominal wall.

Therefore, the causes leading to the appearance of nephroptosis of the right kidney will be all those factors that contribute to the weakening and change of the retaining structures, as well as some anatomical features. The latter include:

• Underdevelopment or absence of the lower ribs;
• Congenital pathology of the location of the kidneys associated with impaired embryonic development;
• Asthenic (thin with long stature) body type;
• A change in the proportions of the body, observed during the period of intensive growth of the body (as a rule, this is puberty with intense hormonal changes characteristic of it).

A decrease in the amount of adipose tissue is another important cause of acquired nephroptosis. This may happen when intensive decline weight as part of an improper weight loss program or after a debilitating infectious disease.

Injuries ligamentous apparatus are a direct weakening factor of the restraint system. They appear due to a sharp change in intra-abdominal pressure or a change in body position. Sports such as basketball, football, volleyball and bodybuilding predispose to this.

Therefore, people at risk for nephroptosis, as well as those with a congenital form of this disease, these physical exercises are contraindicated. They will further aggravate wrong position kidneys. Injury to the ligaments can also be observed during falls from a height, blows to the lower back or stomach. In this case, there is a rupture of the ligaments with the formation of extensive hemorrhages.

Many women may develop nephroptosis on the right during pregnancy. This is facilitated by several predisposing factors, the dominant role of which changes in different trimesters:

• A sharp drop in intra-abdominal pressure after childbirth;
• Big belly during pregnancy;
• A large number of pregnancies and childbirth in history;
• Hormonal changes (among them, an increase in estrogen levels is especially significant).

Representatives of some professions have an increased risk of developing kidney prolapse throughout life. These are the specialties that are associated with:

• Vibration and shaking (drivers);
• Excessive physical stress (loaders);
• Prolonged standing (hairdressers, surgeons).

Stages of nephroptosis

The stages of the disease reflect the distance of the kidney displacement relative to its normal position, the presence of changes in its structure, functional state and severity of existing complications.

For the first stage a slight displacement of the kidney in the vertical position of a person is characteristic. It is not possible to visually determine nephroptosis of the 1st degree of the right kidney. At thin people you can feel the displaced kidney through the anterior abdominal wall in a standing position during the period of maximum inspiration. There are no functional renal disorders in the first stage.

In the second stage the kidney is visually determined on the right under the ribs in a standing position. However, when changing the position of the body from vertical to horizontal, it leaves the field of view, hiding in the hypochondrium. With palpation, the doctor can easily set it there.

Due to the greater displacement of the kidney in the second stage, its rotation relative to the longitudinal axis is possible. This leads to kinking of the vessels and the ureter.

As a result, the flow is interrupted arterial blood with the development of oxygen starvation (kidney ischemia). Along with these suffers and venous return leading to increased pressure in the renal vein. Violation of the outflow of urine, due to the kink of the ureter, contributes to the development of infection. Therefore, quite often at this stage chronic pyelonephritis joins.

In the third stage the kidney, regardless of the position of the body and the inhalation-exhalation phase, is located in the right hypochondrium. With the progression of the disease, it descends into the small pelvis. Almost all patients with stage III nephroptosis develop. Also aggravated vascular and metabolic disorders in the renal parenchyma.

At the first stage of kidney nephroptosis, symptoms may be absent or episodic, and their severity is minimal. Pain that appears in the lower back does not have specific features. She is dull or aching, nothing special stands out.

Therefore, the first stage is often ignored by the patient, or its symptoms are attributed to manifestations of osteochondrosis, myalgia, or chronic (ovarian inflammation).

People at risk of developing nephroptosis need to pay attention to one important sign. It lies in the fact that pain occurs when you change the position of the body - while standing, it appears and intensifies, and when lying down, it stops on its own without the use of medicines.

A similar situation is observed during physical activity - there is pain during exercise, but not at rest. The further the kidney begins to “walk”, the lower and pain. So, over time, the pain moves to the sacrum, the lower abdomen. At the same time, it becomes more intense, and its episodes are repeated more and more often.

At the second stage Painful sensations appear already with slight physical exertion, for example, when climbing stairs. Violation of the blood supply and stagnation of urine, characteristic of the second stage of nephroptosis, lead to the development of complications, as well as the appearance of protein and red blood cells in the urine.

The addition of pyelonephritis contributes to the aggravation of pain, the appearance of weakness, fatigue, apathy and fever.

Third stage nephroptosis has all the signs of an advanced disease with complications. The pain becomes constant, poorly controlled by analgesics. This leads to psychological depression of the patient. Against this background, depression and neurasthenia may occur.

Join problems with digestive system manifested by vomiting and diarrhea, decreased appetite. Physical activity becomes dangerous, because. it threatens the occurrence of renal colic associated with a significant inflection of the ureter. At this stage, the clinical manifestations of chronic pyelonephritis (pain, changes in urinalysis) remain, which become even more pronounced.

The constant increase in pressure in the renal vein, caused by its compression, leads to rupture of small vessels and the appearance of blood in the urine.

The kink and narrowing of the renal artery activates the juxtaglomerular complex, which produces angiotensin. This leads to an increase in total blood pressure and related complications. At this stage, it sometimes develops.

Final diagnosis nephroptosis of the right kidney is based on a thorough survey, identifying the nature of pain, the time and conditions of their occurrence. Palpation (palpation) of the right hypochondrium and the definition of a displaced kidney indicates the stage of the process.

Laboratory methods include:

• General analysis of blood and urine
• Biochemical study of blood with the determination of the concentration of urea, creatinine and total protein. These indicators help to judge the safety of kidney function. In some cases, a Rehberg test is required - an assessment of the speed with which the kidneys filter blood per unit of time.

Instrumental studies are also indicated for patients with nephroptosis:

• Ultrasound of the kidneys in a vertical position allows a preliminary visual assessment of the displacement;
• Carrying out an X-ray examination with the introduction of contrast (urography) is the main method for diagnosing nephroptosis, because. allows you to directly see the omission and determine its degree;
• Angiography of the renal veins and arteries allows you to clarify the state of the vessels and the position of the kidney;
• Radioisotope research helps to conduct functional assessment kidneys.

Treatment of kidney nephroptosis

Once the diagnosis of renal nephroptosis is confirmed, treatment depends on whether there are complications or not. If they are absent, then conservative therapy is indicated. It is aimed at strengthening the supporting apparatus of the kidney. For this purpose, it is recommended:

1. Wearing a medical bandage (put on in the supine position before getting out of bed
2. Strengthening the muscles of the anterior abdominal wall with specially selected physical exercises
3. High-calorie diet food to increase the percentage of adipose tissue in case of severe malnutrition or severe asthenia.

With the development of complications, the question arises of the need for surgical intervention. It is carried out according to the following indications:

• The constant nature of pain that cannot be stopped by painkillers, except for narcotic analgesics;
• Changes in quality of life associated with having pain syndrome;
• Chronic pyelonephritis, threatening development kidney failure;
• Significant deterioration in the functioning of the displaced kidney;
• Persistent increase in blood pressure, requiring the use of antihypertensive drugs;
• The persistent nature of hematuria (the presence of blood in the urine), indicating an increase in pressure in the renal veins;
• Hydronephrosis is an enlargement of the kidney associated with stagnation of urine.

Surgical treatment consists in performing nephropexy - fixing the kidney in its typical place maintaining physiological mobility. This operation is currently in progress laparoscopic method, which is the least traumatic and cosmetically more beneficial for the patient.

Conducting conservative treatment is aimed at changing lifestyle in order to stop the progression of the disease. Therapeutic measures should be carried out constantly along with preventive examinations by a urologist. Every year, patients with nephroptosis are shown an ultrasound examination, even after surgical correction, since there is always a risk of re-omission.

Disease danger

The displacement of the kidney is dangerous due to possible development disorders of the renal vessels or ureter. Twisting and squeezing of arteries and veins leads to oxygen starvation renal tissue, increased venous pressure. And this, in turn, provokes injury to small vessels inside the kidney, further aggravating the existing disorders.

Inflection of the ureter threatens dangerous delay urine and the development of inflammation of the renal tissue. Prolonged and permanent disturbance of microcirculation leads to metabolic disorders renal parenchyma. Thus the vicious circle closes.

Forecast

The prognosis for patients with right-sided nephroptosis depends on the presence of complications and the degree of prolapse. The occurrence of renal failure is considered a poor prognostic sign, because. requires the transfer of the patient to hemodialysis (artificial hardware purification of blood).

Therefore, the main task of the urologist is to diagnose the progression of the disease in time and take all measures to prevent it. This means that indications for surgical treatment nephroptosis.

• 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 there is pathological mobility of one or both kidneys. In this case, the kidney is displaced downward (usually to the abdomen, in more rare cases to the pelvic region). There is nephroptosis of the right kidney and the left kidney. Interestingly, this disease is typical in 4 out of 5 cases for the kidney located on the right.

Reasons for the appearance this disease not so much, but they are conditional. That is, this disease can occur in a person and “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, put a reason such as genetic predisposition specific organism for a given disease. The causes of the disease are:

1. Low intra-abdominal pressure. This is usually associated with decreased muscle tone. abdominals.
2. Pathology of the ligamentous apparatus of the kidney. It often happens due to injury.
3. A sharp reduction in the thickness of the fatty capsule of the kidney. Usually observed due to an infectious disease or after rapid decline body weight.

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Symptoms of nephroptosis

Interestingly, there are no symptoms of nephroptosis as such. Lower back pain, especially when walking for a long time? These are symptoms of osteochondrosis of the spine, especially since the pain disappears when taking a supine position. Has the pressure increased? This is either a change in weather conditions, or stress, or heredity. Pyelonephritis or inflammation of the kidneys? This is a cold of these organs. A person in such a situation is afraid of long walks, easy hypothermia, and does not even think about playing sports.

In addition, nephroptosis on the right has several more signs. For example, you should think about if there are pulling and aching pain in the right side, which disappear over time. When this disease is started, such sensations appear in the lower region of the ribs and take on a more intense and permanent character.

Very often, with nephroptosis, symptoms include diarrhea or constipation. Worried about fever with lack of appetite, as well as apathy, insomnia, palpitations. All these signs of nephroptosis may be inherent in other diseases, so you need to pay attention to your body in order to identify this disease on early stage.

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Revealing kidney nephroptosis is also not entirely easy. For example, during an ultrasound, they ask a person to lie down in order to 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 it. pain. So to detect nephroptosis or ultrasound should be performed when the patient is standing. In addition, the diagnosis of this disease includes several blood tests (general and biochemical) and a general urine test.

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

Nephroptosis is classified according to the degree of neglect:

1. With the 1st degree of this disease, the mobile kidney is palpated with the fingers only when the patient inhales, since when it exits, it hides under the ribs. At this stage, it is extremely rare to make a diagnosis of this disease.
2. At stage 2, the vagus kidney is felt with the fingers only when the person is in an upright position. If a person gets up, then the affected organ hides under the ribs. Usually the diagnosis is made at this stage of the course of the disease.
3. Grade 3 nephroptosis is the most severe, with it the kidney comes out from under the ribs in any position.

Nephroptosis (mobile or wandering kidney) is a condition in which the kidney is displaced downward from the lumbar region, sometimes the kidney can even descend into the small pelvis. This condition is often referred to as "prolapsed kidney", and the organ can return to its usual place on its own. Nephroptosis occurs in women 15 times more often than in men. This is due to the fact that women have a wider pelvis, the ligaments that support the kidney are more elastic, and the tone of the muscles of the abdominal wall can be reduced, especially after childbirth. Omission of the right kidney occurs several times more often than the left.

There are a number of factors that can be one of the reasons for the prolapse of the kidney:

• a sharp loss of body weight, as a result of which a decrease in the volume of the fat capsule supporting the kidney can occur;
• hereditary predisposition (for example, diseases associated with increased elasticity connective tissue);
• injuries of the lumbar region and abdomen, hematomas in the perirenal tissue, leading to damage to the ligamentous apparatus of the organ;
• , as a result of which there is a constant stretching of the ligamentous apparatus of the kidney;
• pregnancy (when the abdominal muscles are stretched, intra-abdominal pressure decreases, due to which the kidney is also held in place).

Symptoms of nephroptosis

How pronounced the symptoms of kidney prolapse will be depends on the degree of nephroptosis.

I degree - the doctor can palpate (feel) the lower pole of the kidney, and then only on inspiration;
II degree - in the vertical position of the patient, almost the entire kidney is probed;
III degree - the kidney is completely palpable in any position of the body, it is even possible to lower it into the small pelvis.

Recall that normally the kidneys are not palpable.

The mobile kidney can long years cause no symptoms in the patient, function normally, and become an incidental finding during examination for another disease.

The first signs of the disease may be pulling or aching pain in the lumbar region that occurs after exercise or heavy lifting, decreasing in the supine position. The pain syndrome often occurs on the side where the kidney is lowered, but sometimes it can be bilateral. Over time, the pain intensifies, can become permanent and radiate to the inguinal region.

With grade III nephroptosis, an inflection of the ureter can form, and then the pain syndrome can intensify so much that it resembles, especially if the pain attack is accompanied by nausea, vomiting and fever.

In addition to the pain syndrome, patients may be disturbed by stool disorders in the form of diarrhea or constipation, nausea, loss of appetite. With the progression of the process in patients, disturbances in work may be detected. of cardio-vascular system, dizziness, insomnia, increased nervous excitability, orthostatic arterial hypotension.

Complications of nephroptosis

In many cases, nephroptosis is diagnosed only when its complications have come.

When the kidney is lowered, a significant displacement or kink of the ureter can occur, resulting in a violation of the outflow of urine, or vesicoureteral reflux, in which urine is thrown from Bladder into the kidney. All complications in nephroptosis are associated with a violation of the outflow of urine.

When urine is stagnant, favorable conditions for bacterial growth, resulting in infectious diseases kidneys and bladder. Therefore, if, against the background of apparent well-being, symptoms such as pain in the lumbar region, pain when urinating, fever, and also appear, you should consult a doctor.

With stagnation of urine in urinary tract increased risk of development. The presence of kidney or bladder stones may also be an incidental finding during examination for another reason. Often urolithiasis disease manifests in the form of renal colic, in which there are sharp, very intense pains in the lumbar region or in the side, radiating to the perineum, pain during urination, fever, and an admixture of blood may appear in the urine.

The most formidable complication of nephroptosis is hydronephrosis - a disease in which there is an expansion pelvicalyceal system kidney, atrophy of its tissues and dysfunction of the organ occur. The kidneys cease to fully filter excess fluid, toxins and other harmful substances from the blood, the most severe complication in this situation can be.

Diagnosis and treatment of nephroptosis

Usually, ultrasound is sufficient to confirm nephroptosis, but if necessary, the doctor may prescribe a contrast radiography of the kidneys, a radionuclide study, computed tomography, or magnetic resonance imaging.

Treatment of this disease can be conservative or surgical, the choice of treatment tactics depends on the stage of the process, the presence of abnormalities in the work of the descending kidney and complications.

Conservative treatment

If the prolapse of the kidney is insignificant and the function of the organ is not impaired, then special treatment not required. The doctor may recommend wearing a special bandage, as well as therapeutic gymnastics aimed at strengthening the muscles of the anterior abdominal wall and back. It should be noted that wearing a bandage is contraindicated in patients in whom the descending kidney is fixed with adhesions. People diagnosed with nephroptosis are advised to avoid heavy lifting and heavy physical activity, some sports may also be contraindicated. In addition, patients need to periodically undergo examination in order to monitor the function of the kidney, as well as the degree of its prolapse.

If the cause of nephroptosis was a sharp weight loss, then it is necessary to restore sufficient nutrition, sometimes this is enough to return the kidney to its bed.

It should be understood that the application medicines will not help to put the lowered kidney in place. Medical treatment prescribed by a doctor only with the development of complications. Usually used antibacterial, anti-inflammatory, antispasmodic and painkillers. With the development of renal hypertension, the appointment of antihypertensive drugs is ineffective.

Surgical treatment

In the absence of the effect of conservative therapy, increasing hypertension and the development of complications, health threatening patient, it is recommended surgical treatment. During the operation, nephropexy is performed (the kidney is fixed in the renal bed). Currently, most patients are operated on laparoscopically. This is the method surgical intervention is the most sparing for the patient, since access to operating field performed through several small incisions in the anterior abdominal wall. This reduces the risk of postoperative complications and shortened recovery period. If necessary, the surgeon can also perform abdominal surgery.

Usually, after the operation, the outflow of urine is restored and blood pressure normalizes.

Which doctor to contact

If you experience lower back pain, you need to contact a nephrologist or therapist. Additionally, you may need to consult a urologist, gastroenterologist, cardiologist, neurologist with appropriate symptoms. Important role in the recognition of the disease, the doctor of ultrasound diagnostics plays.

Patent. Method of laparoscopic nephropexy

Nephroptosis (prolapsed kidney)- this is excessive mobility and rotation of the kidney, which occurs in the vertical position of the body. Normally, during breathing and when the body moves, both kidneys are displaced within the allowable physiological norm, which should not exceed the height of the body. lumbar vertebra(2–4 cm). Normally, the right kidney is located slightly lower than the left kidney. Nephroptosis is considered to be a displacement of the kidney in the vertical position of the body down more than 2 cm, and with a deep breath - more than 3–5 cm, in addition, nephroptosis also includes a condition in which the kidney rotates around the vascular pedicle.

The following degrees of nephroptosis are distinguished

• I degree of nephroptosis - lowering of the lower pole of the kidney more than 1.5 lumbar vertebrae
• II degree of nephroptosis - prolapse of the lower pole of the kidney for more than 2 vertebrae
• III degree of nephroptosis - omission of the lower pole of the kidney for more than 3 vertebrae

When the kidney is lowered, it can, as it were, be stably low, compared with physiological norm, and return to its place when the position of the body changes - the so-called "migrating kidney".

To determine the degree of nephroptosis and the severity of kidney dysfunction, as well as to choose the right tactics for surgical treatment, you need to send me a personal e-mail [email protected] [email protected] copy a complete description of ultrasound of the kidneys standing and lying down, ultrasound of the vessels of the kidneys standing and lying down, data from intravenous urography and radioisotope scintigraphy kidneys, indicate age and main complaints. Then I can give a more accurate answer for your situation.

The prevalence of the disease.

Nephroptosis is a fairly common disease (from 0.07 to 10.6%) that occurs in people in their prime vitality(20–40 years old) (Baran E.E., 1990; Lopatkin N.A., 1998; Lopatkin N.A. et al., 1985). The most common is right-sided nephroptosis. In women, prolapse of the kidneys occurs almost 15 times more often (1.5% of people over 18 years old) than in men (0.1%). This fact is explained by the structural features female body- a wider pelvis, reduced tone of the abdominal wall, greater elasticity of the ligaments. Bilateral nephroptosis is observed relatively rarely.

Reasons for the development of nephroptosis.

Normally, the kidney is fixed in its typical place thanks to the ligaments, fascia surrounding it, and fatty tissue. The most common factors that can lead to the development of nephroptosis (omission of the kidney) include a sharp weight loss, a decrease in muscle tone abdominal wall, trauma to the lumbar region, constant carrying of weights, complicated pregnancy, congenital structural features of the vascular pedicle of the kidney and the so-called renal bed.

A complete list of factors in the development of nephroptosis (descent of the kidney) includes congenital inferiority of the ligamentous apparatus of the kidney; previous infectious diseases that reduce the activity of the mesenchyme and lead to severe changes in the connective tissue formations; damage to the ligamentous apparatus of the kidney as a result of trauma with complete or partial break or detachment of ligaments (fall from a height, a sharp blow, a strong concussion of the body); significant and rather sharp weight loss with a decrease in the volume of perinephric tissue; weakening of the tone or sagging of the anterior abdominal wall with a decrease in intra-abdominal pressure after rapid emaciation, as a result of multiple pregnancies or prolonged childbirth.

As a rule, nephroptosis (prolapse of the kidney) develops gradually over the course of life, it is more common in young women, mainly with a slender physique.

Symptoms, signs and clinical picture of nephroptosis (prolapse of the kidney).

When the kidney is lowered, it does not just shift down, followed by a series pathological processes- rotation (rotation) of it along the axis, tension of the renal vessels; the blood supply to the kidney worsens, the ureter is bent, contributing to the development of inflammation in the pelvis and the formation of stones.
Kidney prolapse (nephroptosis) is manifested by various signs, depending on the stage of nephroptosis. There are 3 stages of nephroptosis:

• at the 1st stage omission of the kidney clinical manifestations are absent, or there are complaints about general changes well-being and decreased performance, while, as a rule, pain is practically absent.
• at the 2nd stage prolapse of the kidney appear pain in the lumbar region, aggravated in the standing position, sometimes paroxysmal, protein and erythrocytes are often detected in the urine.
• at the 3rd stage nephroptosis, the pain syndrome intensifies, sharp changes in kidney function join, and performance deteriorates significantly.

Very common nephroptosis (prolapsed kidney) long time not diagnosed and hidden under masks incorrectly established diagnoses - chronic cholecystitis, chronic colitis, chronic adnexitis, acute appendicitis, etc. At the same time, the patient is treated for these ailments for a long time and unsuccessfully, which leads to asthenia and neuroticism of the patient, sharply worsening the quality of life. But the average patient with nephroptosis is a young, slender, thin girl. It must also be remembered that the presence of kidney problems affects the course of pregnancy, and the manifestations of nephroptosis during this period only intensify.

"Manual suture in endoscopic surgery", K. V. Puchkov, D. S. Rodichenko

Typically, patients present for the first time medical care at the 2nd stage of nephroptosis. It is characterized by a downward displacement of the kidney by more than 5 cm when moving the patient from a supine to a standing position and is accompanied by pain in the abdomen or in the side. In addition, pain in nephroptosis can radiate to lower divisions abdomen, accompanied by nausea and chills. Less often, pathological mobility of the kidney is manifested by paroxysmal pain of the type of renal colic (intense arching cramping pain), micro- and macrohematuria (admixture of blood in the urine visible to the eye or under microscopy), albuminuria (excess protein in the urine), increased blood pressure.

In many cases, patients in whom nephroptosis is accompanied by clinical manifestations, these are young women of a slender physique who have chronic pain in the lumbar region in an upright position manifests itself as the primary and often the only symptom of nephroptosis. Chronic periodic pain in the side (lower back), a feeling of heaviness, discomfort in the abdomen are most often observed in a complex manner. The most common complications of nephroptosis are arterial hypertension, kidney infection, urolithiasis, and renal colic.

Hypertension develops as a result of kinking of the vessels that feed the kidney, and, as a rule, can lead to the development of arterial crises and a persistent increase in blood pressure.

Read about nephroptosis (prolapse of the kidney), symptoms, diagnosis and treatment methods in the material by K. Puchkov

Rice. 1. Ultrasound of the vessels of the right kidney with nephroptosis 3 tbsp. lying down (left) and standing (right). There is a pronounced change in the diameter of the artery from 7.5 mm to 3.5 mm.

In connection with the violation of the free outflow of urine from the renal pelvis and ureters, with a disturbed position of the kidney and an inflection of the ureters, a local infection of the urinary tract develops. Urine that is retained in the urinary tract provides an opportunity for bacteria to grow and spread. Symptoms of a urinary tract infection (pyelonephritis and cystitis) include frequent and painful urination, abdominal or lower back pain, fever, and chills. The urine may be cloudy or have an unusual odor.

Urinary stones are formed from substances found in the urine, such as calcium and oxalates. Stagnation of urine in the urinary tract, a decrease in the rate of its free flow into the bladder are predisposing factors for the development urinary stones. The presence of disorders of urate or purine metabolism dramatically increases the likelihood of developing stones in the kidneys or urinary tract. In this case, there is severe pain in the side, back or pelvic pain, blood in the urine, chills and fever, vomiting, burning when urinating.

The presence of a lowered kidney sharply increases the risk of injury when blunt trauma abdomen and pelvis. If the kidney displaced in nephroptosis is low in the abdomen or in the pelvis, then it is more susceptible to injury or blunt trauma.

One of the most common complications of nephroptosis is renal colic. Renal colic when the kidney is lowered, it is characterized pain attack in the side (lumbar region), nausea, chills, tachycardia, oliguria (reduced amount of urine), intermittent hematuria (blood in the urine), or proteinuria (protein in the urine).

Diagnosis of nephroptosis (omission of the kidney).

A kidney prolapse can be suspected if there is an appropriate clinical picture, as well as when signs of nephroptosis are detected according to ultrasound examination of the kidneys in the supine and standing position. key method diagnosis, on the basis of which the diagnosis of "pathological mobility of the kidney (nephroptosis)" is established is intravenous excretory urography from obligatory fulfillment one of the x-rays in a standing position, in which a radiopaque agent is injected intravenously and a series of x-rays of the lumbar region is taken. Only on the basis of ultrasound data, the diagnosis of nephroptosis cannot be established; X-ray confirmation of the diagnosis is necessary.

Rice. 2. Ultrasound showed a decrease in the maximum renal blood flow in the right renal artery in the standing position up to 70 cm/sec (Fig. on the right) in comparison with these indicators lying down - 111 cm/sec (Fig. on the left).

Differential diagnosis of pathological mobility of the kidney and its dystopia (congenital disorder of the position of the kidney) is carried out on the basis of an ultrasound color Doppler study with the possibility of visualizing blood vessels. In this case, an important criterion is the level of origin of the renal artery from the aorta. Also color Doppler ultrasound procedure allows you to measure the decrease in blood flow in the lowered kidney in a vertical position.

Also additional methods examinations of the kidneys with nephroptosis are isotope renography and kidney scintigraphy.

Treatment of nephroptosis (prolapse of the kidney).

Rice. 3. Places of punctures on the abdominal wall during laparoscopic nephropexy.

Rice. 4. Fixation of the mesh implant to the kidney during laparoscopic surgery.

Rice. 5. Results of laparoscopic nephropexy - data in-in excretory urogram in a standing position (10 minutes after the introduction contrast medium). Left before surgery, right 1 month after surgery.

Currently, among the conservative methods of treating a pathologically mobile kidney, the following are used: limiting heavy physical exertion of a static nature, wearing a bandage, a complex of physiotherapy exercises, high-calorie diets (in order to increase body weight), hydrotherapy (cold compresses, showers, bathing), drug therapy ( antibiotic therapy with exacerbation of chronic secondary pyelonephritis, antihypertensive therapy with arterial hypertension). But, unfortunately, these measures help only 10% of patients.

Patients with an incidentally detected kidney prolapse should be observed by a urologist and regularly examined: once every six months, take urine tests, biochemical analysis blood (creatinine, urea, residual nitrogen), perform ultrasound of the kidneys and bladder, ultrasound of the kidney vessels in a standing and lying position, once a year, conduct radioisotope renography and, if indicated, intravenous excretory urography. In the absence of negative dynamics, long-term observation is possible.

Indications for surgery for the treatment of nephroptosis occur when the kidney is lowered by more than 3 vertebral bodies in the vertical position of the patient or the presence of a pronounced clinical picture of kidney prolapse. The operation is indicated in the presence of signs of a decrease in blood flow in the renal vessels and a violation of the excretory function of the kidney, as well as in the case of a recurrent urinary infection.

In the last 10–15 years, depending on the chosen surgical access, most commonly used the following ways surgical treatment of nephroptosis:

• lumbotomy access - traditional way"open" surgery;
• minimally invasive methods of nephropexy (percutaneous, laparoscopic, retroperitoneoscopic, mini-accesses).

The disadvantage of lumbotomy access is its invasiveness - the muscles are widely intersected, the innervation, blood and lymph circulation of the muscles of the lateral abdomen are disturbed. The period of rehabilitation of a patient with open lumbotomy is long, postoperative complications (hernia, atony of the abdominal wall, etc.) may develop. The cosmetic effect of the operation is minimal.

Laparoscopic approach for nephroptosis has obvious advantages over open operations: less trauma, no blood loss during surgery, good cosmetic results, more easy flow the postoperative period, reducing the length of stay in the hospital, as well as the ability to correct concomitant diseases of the organs abdominal cavity and small pelvis requiring surgical treatment.

After laparoscopic nephropexy, 96% of patients note positive results treatment - the disappearance or a significant decrease in pain, normalization of blood pressure figures, improvement in urine passage. When using mesh implants in the treatment of nephroptosis, leading foreign and domestic authors note a recurrence of the disease in only 0.3% of patients.

The "gold standard" of surgical treatment of nephroptosis is a laparoscopic operation, during which modern, safe mesh implants are used that will securely hold the kidney in a physiological position. The use of own tissues during nephropexy often leads to the development of a recurrence of nephroptosis and therefore has ceased to be used by leading urologists. The optimal way to use polypropylene meshes is nephropexy with a polypropylene implant for the upper pole.

Watch the video of operations performed by Professor Puchkov K.V. You can visit the site "Video operations of the best surgeons in the world".

Features of rehabilitation in the postoperative period.

Within 1.5 months, it is necessary to comply with the regime - limiting physical activity and wearing a bandage for 2-3 weeks. Dynamic supervision of a urologist is necessary - examination, delivery clinical analyzes urine and blood, ultrasound after 3 months. If necessary (after 3-6 months), if there were pronounced changes in these indicators, then intravenous excretory urography, ultrasound dopplerography kidney vessels, radioisotope renography. Pregnancy is possible after six months.

Every day I answer your letters for several hours.

By sending me a letter with a question, you can be sure that I will carefully study your situation and, if necessary, request additional medical documents.

Huge clinical experience and tens of thousands of successful operations will help me understand your problem even at a distance. Many patients do not require surgical care, but correctly selected conservative treatment while others need urgent operation. In both cases, I outline the tactics of action and, if necessary, recommend the passage additional surveys or emergency hospitalization. It is important to remember that some patients for successful operation Preliminary treatment of concomitant diseases and proper preoperative preparation are required.

In the letter, be sure (!) to indicate the age, main complaints, place of residence, contact number and address Email for direct communication.

So that I can answer all your questions in detail, please send along with your request scanned conclusions of ultrasound, CT, MRI and consultations of other specialists. After studying your case, I will send you either a detailed answer or a letter with additional questions. In any case, I will try to help you and justify your trust, which is the highest value for me.

Yours sincerely,

surgeon Konstantin Puchkov

Nephroptosis- urological pathology, which is characterized by a pronounced, excessive activity of the kidney, manifested by its downward displacement.

In other words, with such a disease, the kidney descends - it is not for nothing that it is called wandering. With nephroptosis, material violations undergoes blood flow.

In addition, when moving through the ureter, urine experiences significant difficulties.

Causes of nephroptosis

Here is a list of circumstances that can provoke the occurrence of such a pathology

• jumping too fast
• heavy lifting
• decreased muscle tone in the anterior abdominal wall
• significant loss of adipose tissue
• rapid loss
• injuries, especially in the lumbar region
• a large amount of extremely hard physical work
• power sports

Symptoms of nephroptosis

The obvious presence of pathology is evidenced by diverse pain sensations that can appear as “stabbing” and “aching”. They increase their activity after excessive physical exertion, lifting weights.

A temporary lull occurs when the position changes, for example, when the patient is on his side or back.

In the future, the intensity of pain attacks will increase rapidly, they become permanent - they strongly “exhaust” the body.

In most cases, the attack of pain itself starts unexpectedly, and its duration can be diametrically opposed. In addition, the nature of its flow is undulating, the phase of growth is replaced by a period of weakening.

At the same time, the patient turns very pale, cold sweat appears, the temperature increases sharply.

It is worth noting that aggressive pain is not the only sign. There is a fairly extensive list of symptoms characteristic of such a pathological condition:

• the appearance of a feeling of heaviness in the epigastric region
• chronic constipation, or vice versa, persistent diarrhea
• loss of appetite
• aggressiveness, irritability, irritability
• fast fatiguability

Treatment of nephroptosis

In addition to direct examination, palpation "palpation" - for setting accurate diagnosis required diagnostic tests. The following diagnostic methods can provide the most accurate informative picture:

• urography
• panoramic x-ray of the urinary system

In most cases, therapy for nephroptosis is conservative, without surgical intervention. A very common orthopedic form of treatment, which is characterized by putting on a special bandage on the stomach. Similar procedure carried out with a deep exhalation, in the morning, until getting out of bed. In the evening, the corset is removed.

Currently, there is a wide variety of models, but I note that for each individual patient, similar means should be selected in a strictly individually. Contraindication to the use of this therapeutic method, is the situation when the kidney is fixed in a new place.

On the initial stages diseases, it is permissible to use massage, a specialized complex gymnastic exercises whose main tasks are:

• significant strengthening of the muscles of the back, the press
• stabilization of intra-abdominal pressure indicators
• limitation of renal displacement

When conservative treatment does not bring proper effectiveness, then fixing kidneys performed through surgery. Nephropexy is an operation during which the doctor “returns” the prodigal kidney back, “fixing” it in an anatomically correct place for it.

Complications of nephroptosis

If the displacement of the kidney is significant, then the ureter is impressively twisted, while the passage of urine experiences serious difficulties, its stagnation in the renal pelvis is observed.

The most “popular” complication is pyelonephritis, which is characterized by inflammatory processes in the structures of the kidney.

In addition, nephroptosis can provoke the occurrence of urolithiasis, hematuria.

Catastrophic lack of blood, oxygen, nutrients, leads to an increase in blood pressure, a hypertensive crisis is possible.

Of course, drugs are not able to “put” the kidney in place, however, with their help, it becomes possible to very successfully counteract possible complications nephroptosis.

Prescribing a particular medication is the prerogative of the attending physician only. It is strongly not recommended to independently take the initiative in such a matter.

With nephroptosis - you should absolutely not get carried away with any diets, losing weight in this situation is contraindicated. On the contrary, the presence of such a pathology recommends the patient moderate weight gain. This will strengthen the fat layer that holds the kidney.

I think it's worth explaining the above a little. The kidney rests on the fatty capsule, and when, as a result of weight loss, the size of the fat layer decreases, then all the prerequisites are created for the kidney to inevitably fall. As a result, the outflow of urine is disturbed, conditions arise for the occurrence of kidney stones, chronic pyelonephritis.

Gymnastics with nephroptosis

Such exercises are a high degree effectiveness especially in the initial stages of excessive kidney mobility. Below is a set of exercises recommended for people suffering from nephroptosis.

These exercises should be performed systematically, giving them at least a third of an hour a day. The number of repetitions varies from 5-10.

1. Lie on your back, knees bent. Inhale, inflate your stomach, holding your breath for a few seconds. As you exhale, draw in your stomach.
2. The starting position is similar to the previous exercise. In the inhalation phase, gently raise your legs, preferably to a vertical position. As you exhale, lower your legs.
3. Lying on your back, raise your legs, while keeping your knees together. As you inhale, slowly spread your legs, and as you exhale, cross them back.
4. Place a pillow under your back. Breathing in, bend right leg and as you exhale, return to the starting position. On the next breath, repeat the same procedure with the left leg.

High blood pressure - check the kidneys

It was mentioned above that nephroptosis is a weighty argument for increasing. Unfortunately, many people suffering from renal hypertension may not be aware of their high blood pressure for a long time, while living quite calmly and measuredly, practically not feeling it.

The renal form of hypertension poses a much more significant danger than the usual one, more often provoking the occurrence of strokes and heart attacks.

With that said, total control over your pressure is a vital necessity. If you regularly high pressure, moreover, the diastolic indicator constantly “tends up”, and you do not feel much discomfort, then the current situation is a weighty argument for an immediate visit to a nephrologist.

What worsens the condition of the kidneys?

1. During the cleansing of the kidneys, doctors often prescribe various diuretic drugs. Some, completely ignoring medical appointments, in order to speed up the purification, are overly fond of them. Such actions carry with them unequivocally - only negative consequences.

The fact is that an extremely aggressive diuretic effect can cause large-scale thickening of the blood, while the normal nutrition of cells is under threat.

Do not forget that drugs with a diuretic effect, in the course of their work, remove a number of important trace elements from the body, for example, calcium, which should be replenished immediately.

Of course, diuretic herbs act much softer, having a minimal set side effects, however, nevertheless, their prolonged use, can also cause significant trouble to the body.

Therefore, the daily intake of any diuretic decoctions, drinks, juices is recommended no more than 100 ml.

2. Excessive consumption of animal protein, which is widely represented in meat, fish, affects the loss of calcium by the body, which is excreted by the kidneys. Its high content in the urine creates “favorable” conditions for the birth. negative effect to some extent can be mitigated - by increasing in nutritious diet potassium, vitamins B6, C.

3. Excessive consumption of sodium does not bode well for the body - it contributes to large losses of calcium along with urine.

4. You should limit as much as possible in the diet the use of foods that are rich in oxalates. The list is quite large, here are a few:

• parsley, spinach
• coffee, chocolate, beans
• cabbage, sweet potatoes, peanuts

5. Sugar consumption - should be taken under the strictest control, because its high content in the diet contributes to high level calcium in the urine. In addition, sugar greatly stimulates the increase in oxalate, as well as the level of uric acid.

pathological condition caused by nephroptosis(excessive mobility of the kidney) is a completely solvable problem, subject to timely diagnosis, timely started qualified treatment.

Take an interest in your health in time, goodbye.