Nefroptoz – the pathological mobility of a kidney which is shown the shift of body out of limits of the anatomic bed. Insignificant and moderate proceeds asymptomatically; at violations of an urodinamika and haemo dynamics there are waist pains, a gematuriya, arterial hypertension, pyelonephritis, , . Recognition of a nefroptoz is carried out by means of ultrasonography of kidneys, excretory urography, an angiography, MSKT, a nefrostsintigrafiya. Surgical treatment of a nefroptoz is required at secondary changes and consists in fixing of a kidney in it anatomic the correct situation – a nefropeksiya.
Normal kidneys have a certain physiological mobility: so at physical effort or the act of breath there is a shift of kidneys within the admissible border which is not exceeding height of a body of one lumbar vertebra. In case the kidney smeshchayemost down at vertical position of a body exceeds 2 cm, and at the forced breath – 3-5 cm, it is possible to speak about pathological mobility of a kidney or a nefroptoza.
The right kidney usually is 2 cm below than left; at children of a kidney settle down below normal border and hold physiological position to 8-10-year age. In the anatomic bed kidneys are fixed by the sheaves surrounding with fastion and paranefralny fatty cellulose. Nefroptoz is more often observed at women (1,5%), than at men (0,1%) and, as a rule, is right-hand.
Reasons of a nefroptoz
Unlike a congenital allotopia of a kidney, is the acquired state. Lead pathological changes in the device holding a kidney to development of a nefroptoz – bryushinny sheaves, a kidney bed (fastion, a diaphragm, muscles of a waist and a belly wall), own fatty and fastsialny structures. Hyper mobility of a kidney can be also caused by reduction of its fatty capsule or the wrong provision of vessels of a renal leg.
The low muscular tone of a belly wall, sharp loss of body weight, hard physical activity, strength sports, injuries of lumbar area contribute to development of a nefroptoz. Nefroptoz often occurs at people with system weakness of connecting fabric and the copular device – hyper mobility of joints, vistseroptozy, short-sightedness etc. people of certain professions are most subject to Nefroptoz: drivers (in connection with constantly experienced vibration at jolty driving), loaders (in connection with physical tension), surgeons and hairdressers (in view of long stay in vertical position), etc.
Nefroptoz can be combined with various congenital anomalies of a skeleton – an underdevelopment or lack of edges, violation of position of lumbar vertebras. In the puberty period can arise at teenagers of asthenic constitutional type, and also as a result of bystry change of proportions of a body at rapid growth.
At women it can be caused by numerous pregnancy and childbirth, especially large fruit.
Classification of degrees of a nefroptoz
On kidney shift degree below limits of physiological norm the urology allocates 3 degrees of a nefroptoz.
At the I degree of a nefroptoz the lower pole of a kidney falls more than by 1,5 lumbar vertebras. At a nefroptoza of the II degree the lower pole of a kidney is displaced lower than 2 lumbar vertebras. Nefroptoz III of degree is characterized by omission of the lower pole of a kidney on 3 and more vertebras.
Extent of omission of a kidney influences clinical manifestations of a nefroptoz.
Symptoms of a nefroptoz
In an initial stage of a nefroptoz during a breath the kidney is palpated through a forward belly wall, and at an exhalation disappears in a podreberye. In vertical position of patients the pulling unilateral waist pains, discomfort and weight in a stomach which disappear in a prone position can disturb.
At a moderate nefroptoz in vertical position all kidney falls below the line of a podreberye, however can be without serious consequences set by a hand. Waist pains are more expressed, sometimes extend to all stomach, amplify at loading and disappear when the kidney takes the place.
At a nefroptoza of heavy, III degree the kidney is in any position of a body below a costal arch. Abdominal and lumbar pains become constants and do not disappear in a prone position. In this stage renal gripes can develop, appear disorders of the GIT function, nevrastenopodobny states, renovaskulyarny arterial hypertension.
Development of a pain kidney syndrome at a nefroptoza contacts a possible excess of a mochetochnik and violation of a passage of urine, stretching of nerves, and also the excess of kidney vessels leading to kidney ischemia.
From a GIT at a nefroptoza appetite loss, nausea, weight in subspoon area, locks or, on the contrary, ponosa are defined. In urine the gematuriya, a proteinuria is defined; in case of accession of pyelonephritis – a piuriya.
Owing to a tension and an excess of the vessels feeding a kidney permanent increase HELL with hypertensive crises develops. Renalny hypertensia at a nefroptoza is characterized by extremely high figures HELL which sometimes reaches 280/160 mm of mercury. Pereknut a vascular leg of a kidney leads to a local veno-and a limfostaz.
Periodic or constant , caused by an excess of a mochetochnik, creates conditions for development of an infection in a kidney and accessions of pyelonephritis, cystitis. In these cases the urination becomes painful and speeded up, the fever, fever, release of muddy urine with an unusual smell is noted. Further against the background of an urostaz the probability of development of a gidronefroz, stones in a kidney increases.
At a bilateral nefroptoz symptoms of a renal failure – hypostases of extremities, fatigue, nausea, ascites, a headache early accrue. Carrying out a hemodialysis or transplantation of a kidney can be required by such patients.
Diagnostics of a nefroptoz
Recognition of a nefroptoz is based on complaints of the patient, data of his survey, a kidney palpation, results of laboratory and tool diagnostics. At suspicion on all researches are carried out in position of the patient not only lying, but also standing.
Carrying out a polyposition palpation of a stomach allows to reveal mobility and a smeshchayemost of a kidney. Measurement and monitoring HELL at patients with nefroptozy also shows increase in values of blood pressure by 15-30 mm of mercury. when changing horizontal position of a body with vertical. In analyses of urine at a nefroptoza the eritrotsituriya, a proteinuria, a leykotsituriya, a bakteriuriya is defined.
Costing the ultrasonography of kidneys at a nefroptoza which is carried out and lying, reflects localization of a kidney, change of its arrangement depending on position of a body. By means of ultrasonography it is possible to reveal an inflammation in renal fabric, concrements, hydronephrotic dilatation cup a complex. Carrying out UZDG of vessels of kidneys is necessary for visualization of the vascular course of a kidney, definition of indicators of a blood-groove and extent of violation of kidney haemo dynamics.
The excretory urography at a nefroptoza allows to estimate extent of pathological omission of a kidney in relation to lumbar vertebras, rotation of a kidney. The survey urography at a nefroptoza is, as a rule, not informative.
Carrying out a kidney angiography and venografiya is required for assessment of a condition of a renal artery and venous outflow. The dynamic radio isotope nefrostsintigrafiya is shown for identification of violation of a passage of urine and functioning of a kidney in general. As a high-precision and informative alternative to X-ray contrast methods serve KT, MCKT, MPT of kidneys.
Various researches of bodies of a GIT (stomach roentgenoscopy, irrigoskopiya, kolonoskopiya, EGDS) are necessary for identification of shift of internals – a splankhnoptoz, especially at a bilateral nefroptoz.
Treatment of a nefroptoz
At a nefroptoza of the I degree conservative therapy is carried out. To the patient carrying individual orthopedic devices (bandages, corsets, belts), remedial gymnastics for strengthening of muscles of a back and an abdominal tension, massage of muscles of a stomach, sanatorium treatment, restriction of physical activities is appointed, with an insufficient weight – the strengthened food.
At the nefroptoz of the II-III degree complicated by violation of haemo dynamics, an urodinamika, a chronic pain syndrome, pyelonephritis nefrolitiazy, hypertensia, gidronefrozy, surgical tactics – carrying out a nefropeksiya is required. The intervention essence at a nefroptoza consists in return of a kidney to its anatomic bed with fixing to the next structures. In the post-operational period the long bed rest, stay in a bed with the raised foot end for reliable strengthening of a kidney in the bed is required.
Carrying out a nefropeksiya is not shown at a splankhnoptoza, a heavy interkurrentny background, advanced age of the patient.
Forecast and prevention of a nefroptoz
After a timely nefropeksiya indicators HELL are, as a rule, normalized, pains disappear. However at overdue treatment of a nefroptoz chronic states – pyelonephritis, can develop. At persons with nefroptozy professional activity should not be connected with long stay in vertical position or heavy physical activities.
Prevention of a nefroptoz includes formation of a correct posture at children, strengthening of muscles of an abdominal tension, prevention of injuries, an exception of continuous influence of adverse factors (heavy physical activity, vibration, the compelled vertical position of a body, sharp weight loss). Carrying a prenatal bandage is recommended to pregnant women.