Falling of kidney (nephroptosis)

Falling of kidney (Nephroptosis) is also called a movable kidney (ren mobilis) or wandering kidney (reri migrans). The kidney is not a static body: breathing, change of position of a body, physical stress it may move downwards, around its vertical, sagittal or front axle. The volume of these movements varies individually. So sometimes it is difficult to draw a clear line between physiological and pathological mobility of kidney.
Normal kidney't be felt. Only skinny people with loose abdominal wall (mainly in parous women) with a deep breath palpation of the lower pole of the kidney. In view of this, about nephroptosis as a pathological condition you can only talk in, if it causes pain, disorders of the functions of neighboring organs, in violation of the ability to work.
The mobility of kidney limited number of moments, of which the main role is played vascular leg of the kidney, renal fascia and intra-abdominal pressure.
The kidney is surrounded pre - and posudomoechnaja bands that are glued along the lateral edge and form narrowed from top to bottom case. Formed bands cavity made adipose tissue (fat capsule kidney) and penetrated thin connective tissue bridges between sheets fascia and fibrous capsule kidneys. The funnel shape fascial cavity, a normal tone fascial sheets and sufficient development perinephral fat also limit the mobility of the kidneys.
Insufficient elasticity fascial sheets, weak development of fatty capsules or heavy weight loss are important in the pathogenesis of movable kidney.
The weakness of the fascial records is often a manifestation of a General failure of the connective tissue. So along with nephroptosis often observed omission and other organs (stomach, uterus, the front wall of the vagina), i.e. total splashnotes.
More the role of intra-abdominal pressure, depending on the tone the abdominal muscles. This explains the fact that nephroptosis occurs mostly in women, especially given birth lot. Men nephroptosis occurs about 10 times less than in women.
Known value has the form of renal bed. Deep conically tapering down renal bed of the man largely restricts the mobility of kidney than cylindrical renal bed in women.
Nephroptosis is often a result of an injury - hit in the lumbar region, her injury if dropped, sharply shaking body in the fall, the strong contraction of the abdominal muscles when excessive physical strain. All these factors can cause acute offset the kidneys as a result of violations safe perinephral fascia and fibrous jumpers.
The lowering of the right kidney occurs in 5-6 times more than the left, because of lower its anatomical position (pressure liver, less deep dome of the diaphragm on the right). However, these x-rays indicate that the omission of both kidneys observed not less than 1/3 of cases, but on one side the falling of kidney asymptomatic.
Nephroptosis occurs most often in people between the ages of 20 to 40 years.
Omitted kidney apparently not changed, but the vascular pedicle it is usually extended. Frequent displacement kidney accompanied venous stagnation due break renal veins. Disorders of blood circulation cause kidney dystrophic changes in the form of the expansion of the interstitial tissue, cloudy swelling and fatty degeneration of the tubular epithelium. These changes are weak and on the function of the kidney is not recognised.
Disorders caused by nephroptosis, divided into pain, diarrhoea and nervous.
Pain omitted when the kidney are dull, persistent or severe, type of renal colic. In most cases they have typical for renal colic the irradiation. Dull pain depressing patients not so much intensity as stubborn persistence. Sometimes the pain no, but patients experience some foreign body in the quadrant, which prevents them to do certain movements, to take a deep breath, etc. For nephroptosis characteristically, painful manifestations, both acute and obtuse, usually seen when standing, during the work, walk and disappear quickly when lying down.
Dull pain when nephroptosis explained by vascular tension legs and injury to adjacent organs and tissues movable kidney.
Renal colic is called sudden sharp increase in the kidneys and raise vnutripuzarnogo pressure due to venous stagnation with acute tension fibrous capsules kidneys, and inflection of the ureter under the acute angle with the subsequent delay of the outflow of urine from the kidney and the rapid expansion of the pelvis.
Diarrhoeal phenomenon when nephroptosis have the reflex nature and are expressed most often in constant constipation. Sometimes there pain and heaviness in the stomach, bloating, belching, nausea, vomiting.
Breakdown of patients suffering from nephroptosis, there often. In simpler cases they are expressed in lability nervous system (rapid change of mood), sometimes witnessed a depressed state, in severe cases, hypochondria or hysteria.
Among the non-permanent symptoms include dysuria and hematuria. Dysuria is observed both during and outside attacks. During attacks it is called reflex on the part of the kidney; dysuria out attacks is not directly linked with nephroptosis, and depends on the omission of the front wall of the vagina (see Cystalgia) as manifestations of the General enterobioza.
Hematuria when nephroptosis (usually microscopic) can be explained by the disorders of blood circulation, mentioned above.
To probe descended the kidney is not always possible. When well-preserved toned abdominal muscles palpation difficult. Sometimes it is easier when you position on the opposite side or in a vertical position.
Diagnosis to be confirmed by homocysteinemia and especially pielografia. When nephroptosis the Indigo Carmine is excreted by the kidney normally. Before pielografia necessarily produced by x-ray review kidney and ureter to exclude the presence of stones. Pielografia is performed in the horizontal and in the vertical position, as usual picture in the supine position can not detect the omission buds (Fig. 126). Pyelogram shows not only falling of kidney, but also turns it around sagittal, transverse and vertical axis. When turning around transverse axis shadow pelvis shortened, rotating around the vertical axis, it becomes narrow paths cups lubricated, sometimes almost not visible.

the lowering of the right kidney
Fig. 126. The lowering of the right kidney. Retrograde pyelography, and - in the supine position; b - in a standing position of the patient.

Differential diagnosis with abnormalities and tumors of kidney problems is not because they both give the characteristic pyelogram.
Harder to differentiate omitted kidney tumors of abdominal cavity emanating from the intestines, liver, stomach, and with retroperitoneal tumors. In such cases becomes the value of pilosopiya. Having filled the buckets by contrast agent and moving apparently tumor in front of the screen, you are able to establish, whether it is a kidney. Sometimes you have to resort to pneumoina or Pnevmostroimashina.
Treatment. If omitted the kidney does not cause disorders, treatment is not required. When pain is shown wearing the brace and high-calorie diet.
Only if often repeated bouts of renal colic, particularly in patients who are engaged in physical labor, showing surgery: podselenie kidneys (propecia) to the XII edge or suturing fascial renal bed.