Anomalies of the kidneys

Anomalies of the kidneys met infrequently. They create conditions for occurrence of various kidney diseases. A large part of the anomalies of the kidneys are anomalies of the number. Double kidney is one capsule and both parts can be separated; the top half to twice the kidneys usually smaller than the bottom. Each half is full of the ureter. The top half is more prone to disease than the bottom. The ureters from the double kidney may fall into the bladder separately, then the mouth of the ureter of the upper half is below the mouth of the ureter of the lower half of the kidney.
Congenital reducing the size of renal hypoplasia is often complicated by the inflammatory process and may lead to renal hypertension.
One-fourth of all the anomalies of the kidneys is a congenital false position of the kidney - dystopia. In rare cases, pelvic dystopia of kidneys it is located in the pelvis and during the operation can be mistaken for pelvic tumor. When the pelvic dystopia kidney, ureter its short and renal vessels coming to the front surface of the kidney.
Congenital violation of kidney parenchyma leads to bilateral kidney disease - free. In this disease felt enlarged, painful, with rough surface of both kidneys. Polycystic accompanied by pain in the lower back, renal hemorrhage, hypertension, renal failure.
Falling of kidney. If omitted, internal organs quite often defined and ptosis of kidney - nephroptosis, which causes pain in the lumbar region sometimes by type of renal colic, rarely - renal hematuria. The nephroptosis more often affects women aged 30-40 years. Diagnosed ptosis of kidney (in horizontal and vertical position of the patient) by palpation, and also by means of x-ray studies.
If the kidney is palpated outside renal bed and freely moves when palpation, it is called "wandering kidney".

Anomalies of the kidneys find almost 1% of autopsies.
Various defects that arise during embryonic development and promotion of the kidneys of the pelvic cavity in the lumbar region, divided into anomalies of the number, size, position, relationships P. and their structure. Various types of anomalies P. can be combined with each other and with defects of other organs of the urogenital system. Anomalies P. more common in women and is often asymptomatic. Some malformations P. disturb the function of the authority, other can create a predisposition for renal diseases.
Anomalies of the amount of make up almost half of all cases of malformations P. and are commonly found in the form of doubled kidneys (ren duplex). This Petrograd divided into two parts thin connective tissue layer. Each part has a separate full of yourself off the ureter and separate circulation. The upper part P. usually developed lower and less prone to diseases. Coming from it flows into the ureter into the bladder below the mouth of the ureter, the exhaust from the lower part P. Sometimes doubled kidney combined with split the ureter (see), ectopia of his mouth. Doubling P. in 94% of cases is one-sided. However, in the opposite P. often found more development of the upper half of the pelvis-plating system than lower. This should be considered when interpreting pyelogram. In the absence of secondary diseases doubled P. clinical symptomatology is not found in cases of combination with double the ureter during cystoscopy, and in patients with split through the ureter excretory urography or ascending panoretrograph (Fig. 22).
A very rare form of anomaly is the presence of a third, not spliced with other, P. - incremental kidney (ren accessorius).
Reducing the number of kidneys, congenital absence of one of them (aplasia renis) is rare. When aplasia kidney is usually absent and the corresponding ureter, which allows to recognize the flaw through a cystoscopy. In doubtful cases the diagnosis is established by means of retrograde pielografii, Pnevmostroimashina, renal angiography. Single, solitary, P. these patients few gipertrofirovannyj. Bilateral aplasia P. (e) is found only rarely and in combination with other incompatible with life of the fetus defects.
Congenital reducing the size of the kidney (hypoplasia renis) is 5% anomalies P. Parenchyma P. this is so significant development of fibrous tissue that even histological examination makes it difficult differentiation blemish from primary or secondary wrinkled P. Hypoplasia P. often complicated by secondary pyelonephritis. The diagnosis is made on the basis pielografii (detected reducing the size of the pelvis and cups), Pnevmostroimashina, functional tests.
Anomalies of the provisions of the kidneys (dystopia renis) is about 25% of vices. There are lumbar, iliac and pelvic dystopia. You can find P. in the chest cavity. Cross-dystopia - move one of the Isthmus to the opposite side, and therefore the corresponding ureter crosses the midline of the body (Fig. 23). Dystopia of the kidneys usually combined with anomaly vascular supply, forms and kidney pelvis-plating system. Dystopia P. detected by palpation, but finally established radiographically; however, it should be differentiated with nephroptosis (see below). From the omission of kidney lumbar a dystopia is distinguished by low mobility of the body, short ureter, abnormal structure of the pelvis and cups (Fig. 24), but mainly determined by angiography unusual level of discharge of the renal vessels.

Anomalies relationship kidney arise as a result of their Union bottom poles (horseshoe kidney), side surfaces (geleobraznye P.), poles (S - and L-shaped Isthmus). The most common P. u (ren arcuatus) is characterized by a ventral position renal gate that helps to recognize blemish when pielografii {Fig. 25). The pressure of the isthmus u P. the abdominal aorta and its nervous plexus can cause syndrome Martynov - Rusinga (pain in the navel with hyperextension of the trunk, dysfunction of gastrointestinal tract, neurotic, hysterical reaction). In such cases, perform the dissection of the neck and fixation disconnected P.
To anomalies in the structure of the kidney are changing the shape of the body: lobed P. (is similar to embryonic and P. bear), flattened, oval P.
More important vices vascular supply to the kidneys, which creates difficulties for surgical interventions. Observed in 25-30% of cases anomalies extension of the renal artery, approaching the lower pole, hybridizes with the initial division of the ureter and is often the cause of hydronephrosis (see).
To anomalies in the structure of the kidney are solitary cyst dermoid buildings or those with serous content. Of particular importance polycystic kidney disease (ren cysticus). Due to incorrect embryogenesis is an incomplete merge direct and convoluted tubule many of nephrons, the proximal departments which turn into cysts of different sizes (printing. Fig. 1). The pressure of cysts in the areas of healthy tissue, blood circulation disorders, secondary pyelonephritis usually at the age of 35-45 years lead patients to the effects of kidney failure. The disease often hereditary and bilateral always, often combined with cystic lesion of the liver, pancreas, ovary. Polycystic pastels can be accompanied by pain, arterial hypertension, hematuria, pyelonephritis. Palpation increased, thick, bumpy P., found a reduction of their functions. When retrograde pielografii visible stretched, compressed by the cysts pelvis and cups (Fig. 26). Angiographic symptoms distinguish in difficult cases, this Vice from neoplasms P. Therapy complications polycystic P. directed against pyelonephritis and kidney failure. The futility of her urges to conduct punctures, dissection, cysts, operations promenthoux.
Ptosis of kidney - nephroptosis (nephroptosis)is characterized by pathological mobility of the authority in connection with the weakening of its ligaments, depletion of fat capsules P. Significantly expressed omission was named wandering kidney.
Often nephroptosis is private manifestation of splashnotes (see). Ptosis of kidney more common in women aged 25-40. Usually asymptomatic. Sometimes caused tension vessels, inflection of the ureter, the pain in the long vertical position sick, hematuria, nephrogenic hypertension. Persistent pain complicated by the disorders of the bowel, mental depression. Palpation in horizontal and vertical position you can determine the degree of mobility P. May prosuvalisya only the lower pole (I degree of nephroptosis), the entire kidney (II degree) or P. freely brought from under a costal arch (II) the extent wandering kidney). A more accurate diagnosis is made on the basis pielografii (Fig. 27) and angiography, produced in the horizontal and vertical position of the patient. The main method of treatment nephroptosis and is wearing a bandage, a progressive pyeloectasia, pain, symptomatic hypertension shown operation nefropatii (see below).

Fig. 22. Double kidney split ureter.
Fig. 23. Cross-dystopia of the left kidney with calculous hydronephrosis.
Fig. 24. Lumbar dystopia of the right kidney.
Fig. 25. Horseshoe kidney.
Fig. 26. Polycystic kidney disease.
Fig. 27. The lowering of the right kidney.
Fig. 28. Subcapsular hematoma with rupture of the fibrous capsule kidney and bleeding in perinephral fatty tissue.
Fig. 29. Damage to the core substance of the kidney (prerenalnaya hematoma).
Fig. 30. Damage cortical and brain matter buds with a break lower cups (prerenalnaya hematoma).
Fig. 31. Multiple gaps renal parenchyma with damage to the kidney and ureter (prerenalnaya diffuse hematoma).
Fig. 32. The gap renal vascular legs and a separation of the ureter; great haemorrhage fibre in the region renal gate.