Pathological mobility of the right kidney causes. Pathological mobility of the right kidney

basic information

Left-sided nephroptosis is the pathological mobility of the left kidney. The anomaly is expressed in the organ leaving its natural boundaries and changing its location.

The more severe the disease, the further the kidney goes. It may move into the abdominal cavity or descend to the pelvis.

At the initial stage, the pathology does not create any discomfort. A person begins to feel a significant displacement only with the appearance of painful symptoms.

The mobility of the organ is especially noticeable when the patient stands or walks. Nephroptosis predominantly affects women. The reason for this is the physiological characteristics of the body. In female representatives, the anatomical bed is not as deep as in men.

In addition, it is wider. The fat capsule is characterized by increased looseness, the abdominal muscles are somewhat weaker. It is difficult for patients with this disease to bear and give birth to a child. The body is under serious stress.

Kidney anatomy

The kidneys are a paired, bean-shaped organ. The main function of the kidneys is to eliminate harmful and toxic chemicals from the body through urine formation. Normally, they are located in the lumbar region on both sides. When projected onto the spine, the kidneys begin from the last thoracic vertebrae (Th 11-Th 12) and extend to the first lumbar vertebrae (L 1-L 2). The right organ is slightly lower due to its location under the liver.

The kidneys are fixed in place due to several factors:

intra-abdominal pressure;

the presence of renal fascia;

support by the renal bed, which consists of the psoas major and quadratus lumbar muscles;

the renal vascular system, which provides interaction with the aorta and inferior vena cava.

With pathological weakness of the fixing apparatus of one or both kidneys, prolapse occurs, which is called a wandering kidney, or nephroptosis.

Reasons for the development of the vagus organ

In normal condition, the right kidney is located slightly lower than the left. This is how nature took care of the slope of the ureters and the complete outflow of urine.

When changing body position, as well as during breathing, both kidneys move up and down from their bed by two centimeters. But with nephroptosis, this distance increases to 10 cm.

The organ is held at its natural level thanks to ligaments, fascia, intra-abdominal pressure and fatty tissue. When this retaining mechanism is disrupted, a healthy organ turns into a vagus organ.

The left organ is much less likely to move from its bed, since its ligamentous apparatus is much stronger than that of the right kidney, which is also located somewhat lower.

Left-sided and right-sided nephroptosis develops for the same reasons:

uncontrolled and rapid weight loss, which entails thinning of the fat capsule - one of the links of the ligamentous apparatus;
genetic predisposition to abnormal extensibility of connective tissues;
injury to the lower back, which caused damage to the ligamentous node and the development of a hematoma in the kidney tissue;
excessive physical labor and carrying heavy objects;
infection of the structure of the excretory organs;
severe stretching of the abdominal muscles during pregnancy.

Nephroptosis often occurs in patients with an asthenic physique, weak abdominal muscle tone and insufficient development of the fat layer.

Treatment of this disease

It is recommended to treat a mobile kidney in the first stages of the disease using a conservative method. Surgery may also be performed in case of prolonged intense pain. Patients with nephroptosis are recommended to wear a bandage that will support the position of the kidney, preventing it from descending or rotating. It should be put on in the morning while exhaling deeply while lying down, and taken off in the evening. However, you can only wear a bandage if you receive recommendations from a doctor.

If stage 1 nephroptosis is diagnosed, treatment consists of abdominal massage. Spa treatment is also recommended, where patients undergo rehabilitation aimed at strengthening the abdominal and back muscles to ensure the normal position of the kidneys in the pelvic area and limit downward displacement of the kidney. The doctor selects exercises taking into account concomitant diseases.

There are many different belts, ties, and braces, but they must be made individually for each patient. There are many contraindications to the use of auxiliary instruments, so their use must be approved by a doctor. It is forbidden to use them simply at random, so as not to harm yourself. Also, for nephroptosis, exercise therapy is not always prescribed, especially if the patient has a significant decrease in weight, then he is prescribed a therapeutic diet to gain weight.

Manifestation of the clinical picture

Nephroptosis of the left kidney has several stages of development and they are distinguished by characteristic symptoms.

First degree

Determined by palpation: in a standing position, the left kidney moves one vertebra to the lumbar region. When a person lies down, the organ returns to its place without creating any discomfort.

Symptoms of the first stage are nagging pain on the left and in the lower back. During exercise, the pain intensifies.

Second phase

It is expressed by the prolapse of the organ by two vertebrae. Painful sensations become much more intense and last longer. Sometimes the patient complains of colic attacks, nausea, malaise, and pale skin.

Impaired urine outflow contributes to its stagnation, which can subsequently lead to cystitis, pyelonephritis and other pathological phenomena.

Third stage

The most severe course of the disease. Chronic inflammation occurs in the organs of the genitourinary system, hydronephrosis and hypertension develop. Often the third stage requires treatment with hemodialysis, and sometimes there is an urgent need for transplantation.

Diagnostic measures

Even the most minimal manifestations of symptoms of the disease are a signal to immediately seek medical help. Nephroptosis is diagnosed in the following ways:

entering data on past injuries and illnesses;
examination of the patient by palpation of the abdomen;
general radiograph, excretory urography;
Ultrasound examination of the kidneys in different positions;
clarification of the location of the affected organ using radioisotope scanning;
renography to determine kidney functionality;
urine and blood tests to identify existing complications.

Diagnostics

Treatment of a prolapsed kidney in children and adolescents must begin with a diagnostic examination. To make an accurate diagnosis, a specialized specialist requires blood and urine test results. The doctor collects information about symptoms, genetic predisposition, and palpates the child while lying and standing. To confirm the diagnosis, an excretory urogram should be performed. When all the necessary data is received, the doctor prescribes individual treatment for the little patient.

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Methods of therapy

For abnormal nephroptosis of the left kidney, surgical and conservative treatment is recommended.

Conservative treatment

Used in the absence of complications. This type of treatment includes:

orthopedic therapy;
abdominal massage;
gymnastic exercises;
diet;
treatment in health resorts.

Orthopedic treatment involves wearing a bandage individually designed for the patient. You need to put on a medical corset or belt in the morning, without getting out of bed.

He puts it on while exhaling, otherwise the bandage will not bring any benefit. Remove the bandage before going to bed at the end of the day. With fixed nephroptosis, wearing a bandage is prohibited.

Abdominal massage and therapeutic exercises are most effective in the first stage of left-sided nephroptosis. The movements are performed every morning for 30 minutes while lying on your back. For convenience, a cushion is placed under the lower back.

With nephroptosis, you can play sedentary games, as well as walk on sloping terrain. You cannot jump, run, stretch, or hang on the bar.

Use of medications

Medicines for nephroptosis are used only as complex therapy. Medicines do not provide any therapeutic effect, so they can be prescribed for symptomatic treatment and to relieve the consequences.

The patient is prescribed:

antispasmodics to eliminate muscle spasms in the kidney;
antibacterial drugs to block inflammatory processes;
antihypertensive drugs to stabilize renal pressure;
analgesics for pain relief.

Surgery

Surgery for nephroptosis is prescribed only when conservative therapy has had no effect, or the patient’s condition is so complex that nothing can be done other than surgery.

Indications for surgical treatment:

displacement of an organ by more than 4 vertebrae;
sharp unbearable pain;
arterial and venous renal pressure;
chronic pyelonephritis;
enlarged pelvis;
stone formation;
impaired outflow of urine;
pathological hemodynamics of the kidney.

The essence of the operation is to strengthen the prolapsed kidney to the abdominal muscles, straighten the ureters, blood vessels, and cleanse the organ of adhesions. This procedure is called nephropexy.

Nephropexy is done in two ways:

The laparoscopic method is performed using a laparoscope. All manipulations are carried out through four small holes, which then tighten themselves.
Abdominal surgery - the tissue is cut, and after the operation it is sutured with surgical sutures.

The surgeon chooses the method of surgery independently, based on the patient’s condition and existing complications.

In case of an inflammatory process, a course of anti-inflammatory treatment is initially carried out, then surgery is started.

ethnoscience

Folk remedies are used as a complement to traditional methods of treatment. Popular traditional medicine recipes are:

Dry horsetail is steamed with boiling water and infused. Take in small portions.
Equal volumes of lemon balm, sage, catnip, St. John's wort, and cloves are poured with boiling water, left for two hours and drunk three times.
Brew a kilogram of oat straw in 20 liters of water and boil for one hour. The decoction is used for bathing.

Therapeutic diet

If you have nephroptosis, you need to eat a varied diet. It is necessary to remove extractive substances from the diet that can irritate the diseased kidney.

It is recommended to divide the daily meal into 6 times. The menu must include fruits and vegetables. The minimum daily amount of liquid should be 1.5 liters.

Carbonated drinks, rich broths, cakes, salty, smoked and canned foods, legumes are not necessary. Seafood salads will be healthy.

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Causes of nephroptosis

The renal bed is formed from the following anatomical formations:

perinephric tissue surrounded by a fascial capsule;
ligamentous apparatus inside the abdomen in combination with the fascial base of the peritoneum;
the diaphragm above and the muscles of the abdominal wall.

Most often, initial problems arise at the level of the abdominal ligaments. The amount of adipose tissue in the perinephric tissue plays an important role. The main reasons leading to gradual renal prolapse are the following factors:

rapid and pronounced decrease in body weight, when perinephric fat reserves sharply decrease (strict diet or fasting, leading to very rapid weight loss);
weakness of the abdominal wall muscles due to a sedentary lifestyle;
any traumatic injury in the lumbar region or lower abdomen (impact, concussion), especially if ligaments are torn or local accumulation of blood (hematoma);
very strong and sudden muscular effort or extreme physical activity;
an infectious process in the abdomen or lumbar region with damage to the retroperitoneal tissue.

For women, the main condition may be during pregnancy when, due to the rapid enlargement of the abdomen due to the growing uterus, the abdominal wall muscles are overstretched and internal organs are compressed. Immediately after childbirth, there will be a displacement of the kidney against the background of severe muscle weakness and overstretched ligaments. Symptoms of renal prolapse appear especially often in multiparous women.

Stages of pathological mobility

Depending on the ability to detect the kidney by palpation and the severity of symptoms, the pathological change in the location of the urinary organ is divided into 3 degrees.

Nephroptosis 1st degree.

At this stage there are very few or no symptoms. During palpation, the doctor will not immediately be able to detect the wandering kidney: when you inhale, the edge of the kidney will appear in the hypochondrium, but when you exhale, it is no longer possible to find the organ.

Nephroptosis 2nd degree.

The doctor can easily detect the kidney by palpation, but only in an upright patient. If a person is in a horizontal position, the organ moves back and cannot be found with hands.

Nephroptosis 3rd degree.

Pathological prolapse of the kidney at the last stage leads to multiple symptoms, and the doctor will easily find the organ in the wrong place in any position of the human body. Nephroptosis of the 3rd degree is manifested primarily by vascular symptoms, which is due to a pronounced narrowing of the lumen and a decrease in the diameter of the renal arteries and veins. In addition, there may be problems with urinary excretion that arise from a kink in the ureter and require treatment to prevent complications.

Symptoms of nephroptosis

Typical manifestations of progressive renal prolapse will include the following:

dull and pressing pain in the lower back that appears during physical activity and quickly disappears with rest;
as the degree of displacement of the vagus organ increases, the severity and intensity of pain will increase regardless of work or rest;
gastrointestinal disorders such as lack of appetite, belching, nausea, increased gas formation and constipation;
psycho-emotional symptoms (depression, neurasthenic conditions) are explained by the constant nature of the pain.

It is much worse when excessive mobility of the kidney leads to complications, which include the following conditions and pathologies:

acute pyelonephritis, almost always leading to a chronic form of the disease;
venous hypertension of the kidney, the outcome of which can be rupture and bleeding with the appearance of blood in the urine;
arterial hypertension with a high risk of cardiovascular complications;
hydronephrosis due to a fixed bend of the ureter.

It is advisable to conduct examination and treatment in the initial stages of prolapse, when the risk of complications is minimal and the possibilities for conservative and surgical treatment are optimal.

Diagnostic methods

In addition to a standard examination by a urologist and clarification of all symptoms, you will need to pass a typical set of tests and undergo an ultrasound examination of the kidneys. However, X-ray diagnostics will be the most accurate. With the help of excretory urography, performed in the vertical and horizontal position of the patient, the doctor will detect pathological movement of the kidney with a high degree of confidence.

A good examination option is tomography with arteriography and venography of the renal vessels. In addition to the typical complications of nephroptosis, problems with arteries and veins, congenital dystopia of the renal vessels can be identified.

In urine tests, the doctor will find:

leukocytes and bacteria in pyelonephritis;
hematuria and a large amount of protein with venous stagnation against the background of renal hypertension.

It is extremely important to accurately assess the severity of nephroptosis and the presence of complications in order to choose the right treatment tactics.

Therapy methods

Conservative therapy is used in the initial stages of the disease. The following measures are most effective:

wearing a special elastic bandage that prevents the kidney from moving downwards;
regular exercises from the complex of therapeutic exercises for nephroptosis;
diet to increase the amount of adipose tissue in the perinephric region.

Indications for surgical treatment are complications that arise with 2–3 degrees of nephroptosis:

severe pain that cannot be relieved by conventional methods;
pyelonephritis with frequent exacerbations and severe course;
arterial hypertension, in which it is very difficult to stabilize blood pressure;
progressive hydronephrotic transformation.

A typical operation is suturing and fixing the kidney in its usual place at a normal level (nephropexy). After successful surgical treatment, pain disappears, blood pressure normalizes, and a healthy kidney ensures urinary function.

A wandering kidney can create a lot of problems for human health. Timely detection and treatment of renal prolapse will be the best method of preventing dangerous and unpleasant complications.

Possible complications

With nephroptosis, significant kinking of the ureter can occur.

The result of this phenomenon is impaired urine flow or vesicoureteral reflux. In this case, urine from the bladder enters the kidney.

If urine stagnates, a huge number of bacteria will begin to multiply in it, which is fraught with the development of infectious diseases of the genitourinary system. The risk of developing kidney stones also increases.

The most dangerous complication of nephroptosis is hydronephrosis.

This is a pathological expansion of the calyces and pelvis of the kidney, which is accompanied by tissue atrophy and serious organ dysfunction. The kidneys begin to struggle to clear excess fluid and harmful elements from the blood, which will subsequently lead to kidney failure.

Stages

There are three stages of the pathological process:

The first stage is characterized by the presence of mild symptoms; the kidneys can be palpated while inhaling. In some cases, patients are bothered by pain in the abdomen and lower back, without clear localization.
The second stage is characterized by more pronounced mobility of the organ; the kidney can be palpated in the hypochondrium area. There is pain that appears in a standing position, accompanied by heaviness in the lower back and abdomen. The pain syndrome may in some cases resemble attacks of renal colic. Along with this, symptoms such as impaired urination, disturbances in the functioning of the nervous system, and arterial hypertension may occur. The patient's condition improves after physical labor or walking.
Third stage - at this stage of the development of the disease, kinks of the ureter may occur, since the mobility of the kidneys in this case is expressed to a significant extent. Such attacks are usually accompanied by a sharp deterioration in the patient’s condition, nausea, cold sweat, and consciousness may be depressed.

Prevention and prognosis

Complete treatment can completely rid a person of kidney problems. But if time is lost, the disease is not treated and kidney failure occurs, then the patient will depend on the hemodialysis procedure for life.

It is necessary to prevent the appearance of nephroptosis from childhood. This is especially true for people with a hereditary predisposition or congenital kidney diseases.

As a preventive measure it is necessary:

accustom your body to physical exercise;
monitor your own weight;
undergo an annual examination.

It is easier to prevent any disease than to treat it later. But if the first symptoms have already appeared, there is no need to waste time. You should immediately seek help from a therapist or nephrologist. For effective treatment, you will need not only the qualifications of the doctor, but also the participation of the patient himself.