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February 6, 2013
The nephroptosis (nephroptosis) is morbid condition of which the displacement of the kidney from a bed is characteristic. Its arrangement does not answer norm: the kidney is below. Besides in the course of movement of a body mobility of a kidney becomes bigger, than it is supposed physiological norms. Mobility of a kidney when the body stays in vertical position is especially expressed. As a result, the second name of this illness — pathological mobility of a kidney. At a normality of internals of a kidney in the course of breath, and also are displaced only on 2–4 cm that is admissible norm.
The disease is diagnosed rather often (according to the statistics, from 0,07 to 10,6%), and, the illness affects people of working-age. The bilateral nephroptosis meets less than unilateral.
The kidney normal is kept in a waist by a belly linking, muscles of an abdominal wall, fastion, and also the supporting sheaf. The adipose capsule of a kidney has the defining value in maintenance of its correct position. The movements of a kidney are limited also thanks to availability of pararenal cellulose which is located around it. But on condition of sharp reduction of amount of cellulose the kidney can fall and even to turn around an axis.
The copular device of a kidney can change under the influence of several factors. The most considerable impact is exerted in this case by development in the person of infectious diseases, sharp loss of excess weight and lowering of a tone of muscles of an abdominal wall. The nephroptosis also often develops as an effect of an injury owing to which the kidney can be displaced from a bed.
As causes of illness it is also necessary to note inborn pathology of the copular device of a kidney, numerous pregnancies owing to which muscles stretch.
Much more often the nephroptosis of a kidney is diagnosed for women, and, it is shown in most cases on the right. At slender women the illness develops more often than at those who have a dense constitution. More frequent display of an illness at women is explained by some features of a female organism. It is wider basin in comparison with man's, and also the fact that the tone of an abdominal wall is often broken at incubation of the child and childbirth. The right nephroptosis develops more often as on the right the kidney is normal located below, than at the left. Besides the copular device of a left kidney is stronger.
Before treating a disease, in the course of diagnosis its degree is defined. Depending on weight of an illness treatment of a nephroptosis is appointed. It can be both operation in hard cases, and special exercises at a nephroptosis. The patient recommends not only to carry out LFK at this disease, but also to carry a special bandage.
Specialists allocate three stages of a disease. The nephroptosis of 1 degree is diagnosed if omission of the lower pole on distance more than 1,5 lumbar vertebrae takes place. The specialist probes a kidney on a breath through a front abdominal wall, and on an exhalation it goes to hypochondrium. At the same time at normal position of a kidney it is probed only at especially thin people, at the others its palpation is impossible.
2 degrees define a nephroptosis if there is an omission on distance more than two vertebrae. The kidney completely a kidney leaves hypochondrium if the person stays in a standing position. In lying situation it independently enters hypochondrium, or it can be set easily a hand.
The diagnosis "a nephroptosis 3 degrees" is made to the patient at omission of the lower pole of a kidney more than on distance of 3 vertebrae. In any position of a body of the patient the kidney leaves hypochondrium completely. Sometimes it is displaced in a small pelvis.
If the unilateral or bilateral nephroptosis is diagnosed for the patient, then the kidney can low reside and return to the place. In the latter case it is about "the migrating kidney".
Symptoms of an illness are shown depending on its degree. Falling, the kidney not only is displaced from the location, but in it also there are pathological changes. In it vessels stretch, the kidney turns around an axis. As a result, the blood flow in a kidney worsens, the ureter is bent that leads to formation of stones.
At a nephroptosis depending on what stage of an illness developed, at the patient various symptoms can be shown. At the first stage of display of a disease or are absent completely, or the person complains only of small decrease in working capacity and deterioration in health. But there is no pain at the same time. At the second stage of an illness periodically there is a back pain which becomes more intensive when the person costs. Sometimes pain develops attacks. At laboratory research of urine erythrocytes and protein are found. At the third stage of a course of a disease pain becomes more severe, at the same time there are sharp changes in functioning of kidneys. The person notes noticeable decrease in working capacity. If a disease proceed for several years, then over time pain becomes more severe, disturbs the patient constantly, exhausting him.
At a nephroptosis pain can sometimes give to generative organs. The person loses appetite, suffers from constant ponos or locks. Later also the frustration of a nervous system which are shown high excitability, irritability, a neurasthenia can be shown. Most often the nephroptosis is shown at young women of a brittle constitution, and, during pregnancy the condition of the patient sharply worsens.
At a nephroptosis rather often the illness is not revealed throughout a long time, or the diagnosis is established incorrectly. Often at a nephroptosis suspect development of an acute appendicitis, chronic colitis, chronic cholecystitis, a chronic adnexitis, etc. Because the patient begins the wrong treatment, over time its state worsens.
In most cases patients address specialists at development of the second stage of a disease when they are disturbed by an abdominal pain or in a side. Sometimes pain gives to the lower part of a stomach, can often feel sick the person, it periodically has a fever. In more exceptional cases patients complain of the pain similar to renal colic, and in urine blood impurity appears.
Owing to a nephroptosis at the patient serious complications can develop. Often as complication of a nephroptosis arterial hypertension often develops. This phenomenon is connected with an excess of vessels which feed a kidney. Sometimes at the person arterial crises are shown.
Because of disturbance of normal outflow of urine from ureters and a renal pelvis the infection of uric ways can develop. Because urine in them is late, there is an active distribution of bacteria. It conducts to frequent and to an urodynia, and also an abdominal pain and manifestations of a fever, fever.
Stagnation of urine and the reduced speed of its outflow in a bladder promotes development of urinary stones. Stones in kidneys and urinary stones can be also formed as an effect of the broken uratny or purine exchange.
If at the person the nephroptosis or the wandering kidney takes place, then such morbid condition considerably raises injury risk at getting injured of a stomach and a basin. The kidney displaced down a stomach or in a basin is more susceptible to any injury or wound.
Renal colic – the most widespread complication at a nephroptosis. At a nephroptosis colic is shown by severe pain in a waist in a side. Besides, the patient is disturbed by a fever, nausea, an oliguria, in urine protein and blood appears.
The suspicion on a nephroptosis can arise in the presence of the symptoms described above. The doctor carries surely out a kidney palpation, at the same time the patient stays both in vertical, and in horizontal position.
It is possible to find pathology during ultrasonic research of kidneys. The patient needs to see off it both in a prone position, and in a standing position.
But data of ultrasonography need to be confirmed by carrying out X-ray inspection. In the course of diagnosis the intravenous excretory urography is carried out. At the same time it is necessary to execute one picture in a standing position.
For differential diagnosis of mobility of a kidney ultrasonic color Doppler research with a possibility of visualization of vessels is conducted. If necessary additional methods — the stsintigrafiya and an isotope renografiya of kidneys allowing to define more precisely a nephroptosis are applied if the specialist still has certain doubts.
In modern medicine treatment of a nephroptosis is carried out with use of both conservative, and operational methods. As conservative treatment the patient is recommended to limit heavy loadings which have static character, to carry a bandage, to carry out exercises from a complex of special physiotherapy exercises. The bandage needs to be carried constantly, putting on it in the morning on an exhalation in a prone position and removing in the evening. The special exercises directed to strengthening of a prelum abdominale practice. They need to be carried out in the morning, for 20-30 minutes.
To the people having too low body weight, doctors recommend to adhere to high-calorific diets. It is also desirable for patients at whom nephroptosis symptoms are observed to practice a hydrotherapy (a cold shower, a compress, bathings). Carrying out massage of a stomach is appointed.
How to treat a nephroptosis, applying medicamentous therapy, only the specialist defines. But in this case medicines are appointed by that at whom against a nephroptosis chronic diseases become aggravated. If the arterial hypertension accompanying a nephroptosis to it is diagnosed for the patient appoint reception of antihypertensives. What to do to patients with such diagnosis how to pick up the most effective methods of therapy, the specialist during reception which will analyze causes of illness, will prompt its current and features (omission of the right or left kidney, what stage of a disease, what its complications, etc. takes place)
Those patients at whom the nephroptosis was revealed have to pass regular inspections at the urologist, once in half a year conduct laboratory researches of urine, blood, and also ultrasonography of kidneys and a bladder. All other researches will be appointed by the doctor depending on a situation. If negative dynamics at the patient it is not fixed, long supervision without treatment is shown him.
Operational treatment (nephropexy) practices if at the patient the nephroptosis more than on 3 bodies of a vertebra takes place or there is an expressed clinical picture of a nephroptosis. At signs of reduction of a blood-groove in vessels of kidneys, disturbance of functions of kidneys, at continuous recurrence of an uric infection carrying out surgical intervention is also appointed.
Now both traditional operations, and low-invasive ways of carrying out nephropexies practice (laparoscopic, percutaneous, mini-access).
At traditional operation the main shortcoming is the high injury, the long period of rehabilitation after operation, and also higher risk of complications after its carrying out.
At laparoscopic operation the injury is much lower, there is no considerable loss of blood, the postoperative period proceeds rather easily, and the patient is quickly written out from a hospital. In the course of such operation most often establish to the patient special implants which will hold a kidney in its normal physiological situation. After carrying out such operation the palindromia occurs very seldom.
After an operative measure for three months the patient should observe strictly the special mode – to carry a bandage, to avoid physical tension, to visit the doctor for the purpose of control over a state of health. Women should consider that pregnancy is admissible only in half a year after operation.
Women who gave birth to the child recently have to pay attention to the health, practicing from first weeks after the delivery easy exercises. Later the complex should be complicated, adding new exercises for prelum abdominale muscles.
It is necessary to pay attention to a condition of an organism if there was a sharp weight loss, or there was a stomach injury. At suspicion on development of a disease it is worth passing all necessary researches.