Nephroptosis – Elite Treatment in Europe
SURGICAL DIVISION CB 6 RZD – MOSCOW
Nephroptosis – the omission of kidney wandering kidney or abnormal mobility of the kidney. When the kidney is displaced nephroptosis from its normal position and is lower when the change of the patient's body moves the kidney more than the norm. The kidney is held in place in the lumbar region:
- pelvic ligaments
- muscles of the abdominal wall
- supporting a bunch of buds.
Of great importance in maintaining the correct position of the kidney plays its fatty capsule. Placed around the kidney Kidney tissue supports normal position the kidney, and restricts its movement. If the amount of fiber decreases sharply – down the kidney and can even be rotated about its axis. In fact, it rotates around the vascular bundle (renal artery and renal vein).
Weight loss, especially rapid, one of the factors contributing to the development Nephroptosis. Omission of the kidney occurs with a decrease in muscle tone of the abdominal wall. In this case falls not only kidney, but other abdominal organs. Infectious diseases of connective tissue lesions, which consist of the ligaments and fascia, also contribute, contributing Nephroptosis. Women Nephroptosis occurs much more frequently than men. Frequency Nephroptosis women 1.5% for men – 0.1%.
In the development of Nephroptosis distinguish three stages:
- Stage 1. At this stage, lowered the kidney can be felt through the abdominal wall on inspiration, on the exhale goes to the upper quadrant kidney (normal kidney can be felt only in very thin people, all the rest, it is not palpable).
- Stage 2. In the vertical position of the patient is out of the whole kidney hypochondrium, but lying back in the hypochondrium, or it can be safely straighten arm.
- Stage 3. The kidney is completely out of the hypochondrium in any position of the body and can shift in a small basin.
For the second stage of the kidney can be rotated around its axis, and the renal artery and Vienna bend, their clearance is reduced, except that the vessels are stretched. This leads to a decrease in delivery to the kidney arterial blood (ischemia) and the difficulty of outflow from the renal venous blood (venous hypertension). In the third stage may be resistant inflection ureter that causes a disturbance of the outflow of urine. Thus, Nephroptosis in 2-3 stages can lead to significant disruption of blood supply of kidneys, a blood and venous blood. All that facilitates the development of infection in the kidneys and the occurrence of pyelonephritis. Pyelonephritis in nephroptosis often becomes chronic.
Nephroptosis in the first stage can proceed quickly. Sometimes there are periodic dull, aching pain in the lumbar region. Most often they are aggravated by physical exertion and disappear at rest, or occur during the transition from horizontal to vertical. With increasing degree of renal ptosis, pain intensified. Now they can be given in the lower abdomen, the sacrum.
Starting from the second stage renal blood flow is disturbed, there is stagnation of urine, it is accompanied by the appearance of protein in urine and erythrocytes.
In the third stage of pain in the kidneys become permanent. Because of constant pain in a patient may experience depression, neurasthenia. Often accompanied by a breach Nephroptosis of the gastrointestinal tract reduced appetita.V third stage with a significant inflection ureter after exercise may be a renal colic. Very often complicated by the addition of Nephroptosis infection ( chronic pyelonephritis ). Because venous hypertension, renal vein filled with small, on the wall of the calyces and pelvis, such veins can rupture, whereas the blood in the urine appears. Most developing hypertension, especially if nephroptosis twisted and narrowed renal artery. It is much less developed hydronephrosis.
Diagnosis is based on a survey of Nephroptosis patient, palpation of mobile kidney. Produced blood and urine tests. Ultrasound examination with the patient supine and standing detect mobile kidney. The main method of diagnosis Nephroptosis X-ray . The most important excretory urography – a study using contrast agents. It allows you to see exactly the position of the lowered kidney. To clarify the state of renal function performed radioisotope study. Especially valuable method in the diagnosis of Nephroptosis arteriography and venography is considered to be kidneys. It allows you to not only determine the position of the kidneys, but also to clarify the status of the kidney blood vessels.
Conservative treatment of nephrosis conducted in the absence of complications:
- wearing a bandage that is worn in the morning, before the patient gets out of bed in the supine position, exhale
- special set of physical therapy to strengthen muscles of the anterior abdominal wall
- high-calorie diet to increase the amount of adipose tissue, if the patient has a low weight.
Surgical treatment Nephroptosis out if there are complications:
- prolonged, intense pain that violate the patient's vital functions
- chronic pyelonephritis
- a significant reduction in renal function lowered
- resistant hypertension
- blood in urine
- hydronephrosis .
By the operation the patient is prepared for about two weeks. Appointed by the anti-inflammatory treatment to eliminate the possibility of runaway infection during surgery. 2-3 days before surgery the patient accustomed to the supine position with elevated 20 cm foot end of bed. In the same situation, the patient should be placed and the first few days after surgery.
During the operation, which is called nephropexy, the kidney is fixed at a normal level, but it should retain normal physiological mobility. Ways operative fixation of the kidneys are many. Type of surgery depends on the patient and the surgeon's qualifications. After surgery the patient for 2 weeks prescribe anti-inflammatory treatment, if needed laxatives. Results of surgical treatment is usually good. Most patients recover. After surgery, patients should limit physical activity for 6 months.
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Urology, University Hospital Marburg
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