February 6th, 2013
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Nephroptosis ( nephroptosis ) Is a pathological condition which is characterized by the displacement of the kidney bed. Its location does not meet the norm: the kidney is below. In addition, in the process of moving the body mobility kidney becomes larger than it is supposed to physiological norms. Especially pronounced kidney mobility when the body is in upright . As a consequence, the second name of the disease - abnormal mobility of the kidney. In the normal condition of the internal organs of kidney during respiration, but also shifted only 2-4 cm That is permissible norm.
The disease is diagnosed relatively frequently (according to statistics from the 0 07 before 10, 6% ), And, illness affects people of working age. Bilateral nephroptosis rarer than unilateral.
Reasons Nephroptosis
The kidney normally held in the area of the lumbar pelvic ligaments, muscles of the abdominal wall, fascia, as well as supporting ligament. Adipose capsule kidney is crucial in maintaining its proper position. Movement is also limited to the kidney due to the presence of perinephric fat that is around her. But provided a sharp decrease in the number of kidney tissue may fall and even turn around its axis.
Ligamentous apparatus kidney may change under the influence of several factors. The most significant impact in this case is the development of a human infectious diseases, sudden loss of overweight and a decrease in muscle tone of the abdominal wall. Nephroptosis often develops as a consequence of injury, due to which the kidney can be displaced from the bed.
As the causes of the disease should also be noted congenital pathology ligamentous apparatus kidneys, multiple pregnancy, as a result of which the muscles are stretched.
More often nephroptosis kidney diagnosed in women, and it appears in most cases the right. Do slender women develop the disease more frequently than those who have a tight physique. More frequent manifestation of the disease in women is due to some peculiarities of the female body. This wider pelvis compared with the male as well as the fact that the tone of the abdominal wall is often violated during child-bearing and childbirth . Right nephroptosis develops most often as the right kidney is normally lower than the left. Besides ligaments of the left kidney stronger.
Before treating the disease in the diagnostic process is determined by its degree. Depending on the severity of the disease treatment is prescribed Nephroptosis. This can be the operation in severe cases, and special exercises at nephroptosis. Patients are advised not only to perform physical therapy in this disease, but also to wear a special bandage.
Experts identify three stages of the disease. Nephroptosis 1 degree It is diagnosed if there is the omission of the lower pole by a distance greater than 1, 5 lumbar vertebrae. Probes kidney specialist at inspiration through the abdominal wall, and on the exhale, she goes to the upper quadrant. At the same time, it is normal position kidney detectable only in very thin people, the rest of its palpation is impossible.
Nephroptosis 2 degrees determining if there is a distance omission more than two vertebrae. Kidney Kidney completely out of hypochondria, if a person is in a standing position. In the supine position, it automatically enters the upper quadrant, or it can be easy to straighten his hand.
Diagnosis " nephroptosis 3 degrees "Put the patient at the omission of the lower pole of the kidney more than a distance of 3 vertebrae. In any position of the body kidney patient leaves the hypochondrium completely. Sometimes it shifts in a small basin.
If the patient is diagnosed with unilateral or bilateral nephroptosis, the kidney may be constantly low, and return to the scene. In the latter case we are talking about " migrating kidney ".
Symptoms
Symptoms occur depending on its extent. Omitting the kidney is not only displaced from the location, but it also occurs pathological changes. It stretched vessels, kidney rotated around the axis. As a result, blood flow is deteriorated in the kidney, ureter bends, which leads to the formation of stones.
When nephroptosis depending on what stage of the disease has developed, the patient can manifest a variety of symptoms. With first stage manifestations of the disease are either absent completely or person complains only a small reduction in disability and deterioration of health. However, pain during this. In second stage disease appears periodically pain that becomes more intense when the person is standing. Sometimes pain develops seizures. In a laboratory study of urine found erythrocytes and protein . In third step the disease progresses pain becomes stronger, with abrupt changes in the functioning of the kidneys. Man marks a significant decrease in efficiency. If the disease will continue for several years, then eventually the pain becomes stronger, it worries the patient constantly harrying him.
Sometimes nephroptosis pain can give to sexual organs. A man loses his appetite, suffer from persistent diarrhea or constipation. Later it may occur, and disorders of the nervous system, manifesting high excitability, irritability, neurasthenia. Most often nephroptosis manifested in young women slightly built, and, during pregnancy the patient's condition deteriorates.
When nephroptosis often the disease is not detected for a long time, or the diagnosis is wrong. Often nephroptosis suspected of acute Appendicitis . chronic colitis . chronic cholecystitis . chronic adnexitis et al. Due to the fact that the patient begins to incorrect treatment, it will eventually condition worsens.
In most cases, patients are turning to specialists in the development of the second stage of the disease when they are worried about the pain in the abdomen or in the side. Sometimes the pain gives to the lower abdomen, the person can often feel sick, he periodically appears chills. In more rare cases, patients complain of pain, similar to renal colic And an admixture of urine blood.
Complications
Due Nephroptosis patient can develop serious complications. Often, as a complication of kidney ptosis often develops arterial hypertension . This phenomenon is due to an excess of blood vessels, which nourish the kidney. Sometimes a person has manifested arterial crises .
Because of the disruption of the normal outflow of urine from the ureter and renal pelvis can develop urinary infection . Because urine is delayed therein, there is an active proliferation of bacteria. This leads to frequent and painful urination, and abdominal pain and a fever manifestations, fever .
Stagnation of urine and reduced the rate of its outflow into the bladder promotes Urinary stones . Kidney stones and urinary stones can also be formed as a consequence of impaired uric acid or purine metabolism.
If a person holds nephroptosis a floating kidney, such a pathological condition significantly increases the risk of injury when receiving injuries of the abdomen and pelvis. Kidney shifted down in the abdomen or pelvis, is more susceptible to injury or any injury.
Renal colic - The most common complication of nephroptosis. With lowered kidney colic manifested by severe pain in the lower back in the side. In addition, the patient worried chills, nausea, oliguria, protein appears in the urine and blood.
Diagnostics
Suspected nephroptosis may occur in the presence of the above symptoms. The doctor must perform palpation of the kidneys, and the patient remains in both the vertical and horizontal position.
You can detect the pathology during the ultrasound examination of the kidneys. It must hold the patient in a prone position and in the standing position.
But the data must be confirmed by ultrasound examination of the X-ray examination. In the process of diagnostics performed intravenous urography. It is necessary to perform a one shot in the standing position.
For the differential diagnosis of mobility kidney color Doppler ultrasound performed a study with the ability to visualize vessels. If necessary, apply additional methods - scintigraphy and isotopic renography kidneys, allowing more precisely the omission of the kidneys, if the specialist has some doubts.
Treatment
In modern medicine, the treatment is performed with the omission of the kidneys and the use of conservative and operative methods. As a conservative treatment of the patient is recommended to limit the heavy loads that are static in nature, wearing a bandage, do the exercises from a set of special physiotherapy. The bandage should be worn all the time, putting it in the morning on an exhalation in the supine position and shooting night. Practice special exercises to strengthen the abdominal muscles. They must perform in the morning, for 20-30 minutes.
People with very low body weight, doctors recommend to stick high-calorie diets . Patients who have symptoms of renal ptosis, it is also desirable to practice hydrotherapy (cold showers, compresses, bathing). Appointed holding belly massage.
How to treat nephroptosis using drug therapy, only defines a specialist. But in this case the drugs are assigned to those who have a background in the omission of aggravated chronic kidney disease. If a patient is diagnosed arterial hypertension , Accompanying Nephroptosis he prescribed receiving antihypertensives. What do patients with this diagnosis, how to choose the most effective methods of treatment, tell the expert during the reception, which will analyze the causes of the disease, its course and features (there is omission of the right or of the left kidney, what stage of the disease, its complications and what the other.)
Those patients who have been found nephroptosis should undergo regular examinations by a urologist, once every six months to carry out laboratory tests of urine, blood and ultrasound of the kidneys and bladder. All other studies prescribed by a doctor depending on the situation. If the negative dynamics of the patient is not fixed, it shows the long-term observation without treatment.
Surgical treatment (nephropexy) practiced if the patient holds nephroptosis more than 3 vertebral body or have severe clinical picture of the omission of the kidney. If signs of reduced blood flow in the vessels of the kidney, impaired renal function, with constant recurrent urinary infection also assigned surgical intervention.
Currently practiced as traditional surgery and minimally invasive methods of nephropexy (laparoscopic, percutaneous, mini-access).
In conventional operation the main disadvantage is the high trauma, long recovery period after surgery, as well as a higher risk of complications after the conference.
When laparoscopic surgery trauma is much lower, no significant blood loss, postoperative period is relatively easy and fast patient discharged from the hospital. During this operation the patient often establish special implants that will keep the kidney in its normal physiological state. After carrying out such an operation recurrence of the disease is very rare.
After surgery for three months, the patient should strictly observe the special mode - to wear a bandage, avoid physical stress, visit a doctor for the purpose of health control. Women should be aware that pregnancy allowed only six months after surgery.
Prevention
Women who have recently given birth, should pay attention to their health, practicing from the first weeks after birth light exercise. Later, the complex should be complicated by adding new exercises for abdominal muscles.
It is necessary to pay attention to the condition of the body, if there has been a dramatic weight loss or abdominal trauma happened. If you suspect that the disease is to go through all the necessary research.
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