All human organs are in close interconnection with each other. This provides homeostasis (constancy of the internal environment) of the body, so necessary for the normal functioning of all cells. First of all, systems that support the most important constants (acidity, temperature, concentration of various ions) include cardiovascular and urinary. Since the first one provides blood circulation, the main nutrient medium, and the second - the release of unnecessary metabolites, fluids and toxins.
The role of the kidneys in the body
At first glance, the urinary system seems much less significant than, say, the respiratory or cardiovascular system. After all, enough people live quietly with a single kidney, while the absence of one lung or a heart transplant clearly affects the patient's condition. However, this is only a fallacy, since a person dies from hepatic-renal failure as quickly as he does from respiratory or cardiac. And this happens because of the rapidly developing toxinemia, because these two organs are the main "filters" of our body, and every day they pump tens of liters of blood through themselves, neutralizing dangerous substances and releasing them into the environment.
Metabolic function
In addition , the kidneys maintain a constant blood pressure in normal conditions and with blood loss, and it is in them that the main regulator of this indicator is the renin-angiotensin-aldosterone system (RAAS). Also, due to the selective permeability of capillaries in the parenchyma of this excretory organ, a balance of various electrolytes and osmotic components in the blood and tissues is ensured: sodium, potassium, calcium, magnesium, glucose, proteins, acids and many others. They also participate in erythropoiesis, since it is in them that a special substance erythropoietin is produced - a stimulator of the synthesis of red blood cells in the bone marrow.
Kidney anatomy
These organs are paired and are located in the lumbar region on the sides of the spinal column. They have a bean-like shape and face each other in concave parts, and these indentations are called “gates”, they include the artery and nerves, the vein, ureter and lymph vessels exit. These formations not only metabolize the kidney, but also serve as part of the fixing apparatus. Inside, these organs have a complex structure: everything starts with a nephron, a capillary glomerulus, through which, in fact, the blood is filtered. There are up to a million of them in the kidney, and then they pass into the tubule, in which there is a further concentration of blood, reabsorption of water, amino acids, glucose and salts, as a result of which secondary urine is ready for excretion.
Urinary tract
Then it goes a long way, gathering in small and then large cups and the renal pelvis, and ultimately flows down the ureters into the bladder and, finally, is released through the urethra. Thus, each department of the urinary system has its own function, and in any of them specific disorders can occur, leading to a malfunction. This, for example, renal nephroptosis or hydronephrosis, pyelonephritis, glomerulonephritis, urolithiasis, congenital strictures, urethritis, cystitis and others. In this article, we will dwell in more detail on the first disease, however, before proceeding with its consideration, you need to find out some more structural features of this organ.
Kidney fixation
They are located in the
retroperitoneal space, and therefore have a special fixing apparatus to maintain themselves at the same level (from the 12th thoracic to the 2nd lumbar vertebrae). It includes the peritoneal folds (the right kidney - due to the duodenum-hepatic and renal-hepatic ligaments, and the left - due to the diaphragmatic-colon), their special anatomical muscle bed, blood vessels (mentioned earlier), fascial-fat apparatus (represents many fascial bundles and three shells, creating together a “soft pillow” and a strong support) and intra-abdominal pressure, which is provided by the tension of the muscles of the walls of the abdomen. Thus, these organs are quite tightly fixed in the lumbar region. In this case, the right kidney is located slightly lower than the left, and they still remain quite mobile: during respiratory acts, they can go down and rise 1-2 cm, however, with certain pathological effects, this amplitude goes beyond 2 cm, and then they drop below the normal border, this condition is called renal nephroptosis.
Etiology and risk factors
Pathological mobility is more common in women, since they are characterized by a greater extensibility of the ligamentous apparatus in comparison with men, and can arise from a number of reasons that somehow cause a weak fixing apparatus. First of all, kidney nephroptosis can cause:
- a sharp loss of body weight, due to which the fat capsule of the organ becomes thinner, and it becomes more mobile;
- injuries of the lumbar region or abdomen that violate the integrity of the fascia or destructive of the muscle bed of the kidneys, for example, renal nephroptosis often accompanies retroperitoneal post-traumatic hematomas;
- a sharp increase in weight or professional exercise in which there is a strong muscle tension and an increase in intra-abdominal pressure, however, the constant influence of this factor stretches the ligamentous apparatus, under the influence of which the kidney can slide to a lower position;
- the weakness of the muscle apparatus, on the contrary, reduces pressure, and its fixing function also decreases, which is why nephroptosis and pregnancy or a hypodynamic lifestyle so often go side by side;
- in addition to the aforementioned acquired causes, increased tissue extensibility may also be a consequence of a hereditary predisposition, for example, in connective tissue diseases.
Symptoms of the disease
The clinical manifestations of nephroptosis can be divided into stages. So, at the first, the affected kidney drops to 4-6 cm in the vertical position of the patient and independently returns when it goes into horizontal. At this stage, the patient can only be bothered by pulling pains from the affected side of the lower back when lifting weights, with severe physical exertion. Nephroptosis of the left kidney is less common than the right, because it is physiologically higher, so most symptoms appear in the right-sided localization. If at this stage the disease is missed, then it progresses, and the affected organ can go down to the level of the navel. This is how nephroptosis of the right kidney manifests itself in the second stage, its symptoms are as follows: the body itself no longer sets itself, its manual movement into its bed is necessary. Pain at this stage intensifies and spreads to almost the entire abdomen and disappears only when the kidney is repositioned and horizontal.
Running process
Nephroptosis of both kidneys is much more formidable, which can develop already at this stage, as a rule, due to a hereditary predisposition. The extreme degree is the lowering of the organ to the pelvis, then the pains become regular, even occur at rest and do not weaken in a horizontal position, since with such a neglected disease, the kidney is not able to return to normal position by conservative methods. This threatens the development of serious complications, such as hydronephrosis, arterial hypertension, renal colic due to urolithiasis, as well as the affected organ is much more easily exposed to an ascending infection, resulting in pyelonephritis.
Diagnosis of the disease
If the patient has a thin physique, then the doctor may suspect a prolapse of the kidney on the basis of complaints, a collected history and palpation of the kidneys through the anterior abdominal wall.
However, this becomes practically impossible in patients with obesity or with developed abdominal muscles. Then, on the basis of the symptoms of nephroptosis, the patient is sent to the first stage of the examination - survey radiography or fluoroscopy, so that the pathological mobility of the affected kidney can be determined. If, already at this stage, the doctor suspects any disease (urolithiasis, congenital malformations, hydronephrosis, a second wrinkled kidney on the background of atherosclerosis or arterial hypertension), then excretory urography with intravenous administration of a contrast agent is possible. This method has several advantages, for example, it is easy to visualize the patency of the urinary tract and their borders, kidney stones or nephroptosis. Treatment at this stage is early to begin, first you still need to perform an ultrasound examination of the abdominal organs, blood and urine tests, as well as their bacteriological culture to confirm or reject the version of the infectious disease.
Distant complications
So, we figured out in detail what renal nephroptosis is and how to diagnose this disease. We should also mention the fact that the complications of this disease are reflected not only in the urinary system. So, in the absence of adequate treatment, or, for example, if the patient does not follow a diet for renal nephroptosis, disorders in the gastrointestinal tract (constipation / diarrhea, anorexia, nausea) increase, renal colic worries more often, due to which neurasthenia develops and the normal passage of urine is disrupted, it squeezes the surrounding tissues, nerves and blood vessels. This exacerbates the risk of arterial hypertension with crises or infection of the kidneys, renal failure develops to an extreme degree, which often causes the patient to die.
Therapy
How to treat kidney nephroptosis in the first stage? This is a solvable issue. To do this, it is extremely important to avoid physical exertion, wear special bandages, especially during pregnancy. Individual therapeutic exercises are also prescribed, which is aimed at strengthening the muscles of the lower back. The patient is advised to strengthen his diet, gain weight, of course, within reasonable limits. A therapeutic diet for kidney nephroptosis No. 7 is also important, with a limited amount of salt (it can be replaced with caraway seeds or lemon juice), broths, snacks, smoked meats, fatty foods, sweets, and legumes. If the disease goes into stages 2 and 3 and acquires concomitant complications, then the only option remains nephropexy - the surgical method by which the kidney is returned to its bed and fixed. And with the development of renal failure, the patient is placed on hemodialysis to periodically
cleanse the blood of those toxins and metabolites that normally once diligently removed a healthy kidney normally.