Kidney prolapse

When examining X-ray images of the lumbar region or anatomical illustrations of the location of internal organs, one can notice that one kidney, the right one, is always slightly lower, approximately 1.5-2 cm, in relation to the other, the left one. This position of the kidneys is considered normal. Pathology develops if the prolapse of the kidney clearly exceeds the specified indicators. In this case, we are talking about nephroptosis, a pathology in which one, or both renal structures at once, “leaves” its usual location and is located in the lower part of the abdominal cavity.

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Causes renal prolapse

Norm and deviation from the norm in the location of the kidneys

In its natural state, the kidney is not a strictly fixed organ. It has a certain movement, "free play", which contributes to a better process of filtration and urine formation. In a lying position, the kidney is almost at the same level, in relation to each other, when the body takes a horizontal position, one kidney goes slightly lower. In the process of active movements that we make during the day, the kidney can alternately rise and fall within the limits of the permissible physiological norm.

Such movements are possible due to constant intra-abdominal pressure, which is created by the interaction of the diaphragm and abdominal muscles. Each kidney is surrounded by three capsules or membranes. The innermost is fibrous, then fatty and the outer one is connective tissue membrane. They owe their constancy of position to each of these membranes and the help of intra-abdominal pressure.

The muscular framework of the lumbar region and the density of the muscle mass of the whole body play an important role. In the case when a person has pronounced muscle weakness, frequent colds, multiple chronic diseases, especially in the urinary system, there comes a favorable moment for the development of renal pathologies and prolapse of the kidney is just one of them. General exhaustion of the body leads to a decrease in the fat layer, including thinning of the fat capsule around the kidneys, which leads to a weakening of the ligamentous apparatus as a whole.

Several reasons have already been partially named due to which kidney prolapse may develop - this is insufficient muscle mass, constant and general exhaustion of the body. Among other reasons, we can name:

• low intra-abdominal pressure due to poor abdominal muscle tone, which is often observed in women who have given birth many times;
• abdominal and lumbar injuries accompanied by internal hematomas. Perinephric hemangioma leads to significant displacement of the kidneys. As a result of a strong deviation from the physiological bed, stretching of the ligamentous apparatus occurs;
• weakness of the kidney's own ligamentous apparatus;
• a sharp, uncontrolled decrease in body weight, as a result of an improper diet or a severe infectious process.

When listing the reasons that can cause kidney prolapse, it is worth mentioning the risk group, which includes people predisposed to the development of this type of pathology. This includes, first of all, women:

• frequently giving birth;
• with multiple pregnancies;
• asthenic physique;
• suffering from acute or chronic pyelonephritis;
• gravitating towards various experimental diets aimed at rapid weight loss.

In men, kidney prolapse occurs much less frequently, mainly only due to injuries, the consequences of heavy physical labor or exhaustion after an illness. Therefore, if they are included in the risk group, then only according to some indicators, such as asthenic body type, chronic renal and genitourinary pathologies.

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Symptoms renal prolapse

Kidney prolapse occurs in three stages or phases of development. At the first stage, no significant external manifestations are observed. The organ displacement can only be seen during a diagnostic examination. The kidney shifts relative to the vertical axis, as a rule, after heavy physical labor. The kidney returns to its original, normal position after the person lies down on a flat surface and is at rest. The only hint of kidney prolapse may be a slight nagging pain in the lumbar region, becoming more pronounced with physical exertion.

But such "little things" rarely attract close attention from a person. Minor pain sensations are associated with simple physical fatigue. Therefore, the manifestation of nephroptosis at the first stage is detected completely by chance, through a routine medical examination, or the prolapse of the kidney is not detected at all, moving to another stage of development.

At the second stage, deeper and more serious changes occur in the perirenal space. During the "unauthorized" movement of the kidneys, the vascular bundle, the ureter, is stretched and twisted. Large main vessels, the renal vein and artery, undergo a decrease in lumen in half, which leads to a disruption of blood flow, both in the kidney itself and in general. Disturbances in urination and urine formation begin to appear. Painful sensations are more pronounced, localized not only in the lumbar region, but also in the lower abdomen. In the urine analysis of such patients, protein and red blood cell levels are increased.

The third stage of nephroptosis is characterized by a pronounced clinical picture. The changes that occurred in the second stage begin to progress. Blood (venous) pressure in the kidney increases (hypertension), the renal tissue suffers from a lack of oxygen due to poor arterial blood supply, leading to the development of renal tissue ischemia. Congestive processes lead to the formation of edema around the kidneys and inflammation inside them. The ureter, broken by a kink, impedes the outflow of urine, due to which it constantly accumulates, expanding the renal pelvis. The pain becomes constant, intense, and does not go away even after taking a horizontal position and being at rest. Blood appears in the urine, the analysis shows greatly increased protein and leukocyte levels. Along with all the internal changes, emotional instability is observed, irritability increases, and a feeling of fear.

Complications and consequences

A prolapsed kidney is not as dangerous in itself as the complications that arise against its background. Due to stagnation in the area of the prolapsed organ, there is a disruption of the nutrition of the renal tissue, swelling of the perirenal region, difficulty in the outflow of urine, an increase in local and general venous pressure, which entails the rupture of small vessels and the opening of internal bleeding in the cavity of the kidneys themselves.

The consequence of all these disorders, in addition to bleeding, is an associated infection in the form of extensive pyelonephritis. This also includes hydronephrosis and the development of orthostatic hypertension, in which the upper limit of arterial pressure approaches 280, the lower limit is about 160.

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Diagnostics renal prolapse

Any diagnostics begins with examination of the patient, evaluation of external parametric data, palpation of the painful area. Palpation is always necessary and is carried out both with the patient in a horizontal position and in a vertical one. In case of diagnosis of kidney prolapse, with the body in a vertical position, the pathological kidney is easily palpated, which significantly facilitates further diagnosis of kidney prolapse.

In case of complaints of pain in the lumbar region, it is necessary to check the Pasternatsky symptom, which gives a positive result in case of development of renal pathologies. It is necessary to conduct a detailed survey of the patient in order to identify possible causes, the consequence of which was the development of the disease process.

A number of general tests are certainly prescribed, among which the most important will be the result of the urine test, which, as a rule, reveals high levels of leukocytes, protein and erythrocytes, the color of the urine has a reddish tint due to the admixture of blood. In the general blood test, in the presence of a concomitant inflammatory process in the kidney, the erythrocyte sedimentation rate (ESR) increases.

Among the instrumental research methods, the following methods help diagnose kidney prolapse:

• ultrasound examination;
• urography (X-ray using a contrast agent) in a lying, standing and lateral position. Images in different positions are necessary to clearly determine the degree of severity of the pathology;
• pyelography and angiography;
• MRI and CT scan.

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Treatment renal prolapse

At an early stage of nephroptosis development, when there are no signs of concomitant complications, supportive therapy is carried out, aimed not at eliminating nephroptosis itself, but at maintaining and strengthening the muscular frame and fat layer in the body. By achieving good results in muscle tightening, equalizing intra-abdominal pressure, increasing the fat layer, it is possible to "return the kidney to its place", although it takes a lot of time to achieve a positive result with this approach to treatment, but serious interventions in the body are not required.

To increase muscle tone, it is advisable to wear a bandage, at the initial stage it will play the role of the abdominal press, bringing intra-abdominal pressure to normal values. In order to increase muscle and fat mass, a special diet with a high content of carbohydrates, vitamins is prescribed, a set of physical exercises is selected aimed at raising muscle tone. Thus, trying to align the position of the kidneys, simultaneous prevention of possible complications of nephroptosis is carried out.

In the case where complications already exist, the treatment will depend on the type of disease that resulted from such a condition as kidney prolapse, with simultaneous strengthening of the muscular frame. In the most severe situations, a radical method is indicated, in which both kidney prolapse and all the consequences of this process are eliminated by surgical intervention. Such intervention is required in the case of pronounced pain syndrome, multiple complications, accompanied by acute impairment of the functional capacity of the kidneys.

In the preoperative period, a two-week course of antibacterial therapy should be carried out in order to eliminate the signs and manifestations of pyelonephritis or other types of inflammatory processes in the kidneys. The postoperative period requires strict adherence to long-term bed rest. In the first days, the foot end of the bed should be raised by ten to fifteen centimeters, this is necessary so that stagnation does not begin in the lower extremities, the kidneys and heart will be able to cope with pumping fluid more easily, thereby organizing a gentle regime for the organ being operated.

Prevention

Based on the list of main reasons that lead to the development of such a pathology as kidney prolapse, given above, we can assume the main preventive measures that allow you to avoid meeting with the discussed disease. Good nutrition, constant training aimed at strengthening all muscle groups, primarily the abdominal press, a competent approach to choosing a diet that leads to a gradual and controlled weight loss, in cases of urgent need for this.

The selection of the right diet should be discussed in more detail. In recent years, fashionable diets have become very common, which are popular among women who believe, sometimes completely unreasonably, that they are overweight. Most of the fashionable diets involve fasting, low-calorie food or excessive fluid removal from the body. As a result of such a "diet", the body, feeling a lack of energy that it received from breaking down fats coming from food, begins to break down those fats that are in its "emergency reserves". One of these fat depots are the perirenal fat capsules.

Depletion of fat reserves, constant dehydration, low levels of salts and vitamins in the body, protein starvation (during the diet, the body "extracted" protein from the muscles to balance the necessary protein) results in excellent indicators for reducing the main weight, delighting the woman, discovering the graceful curves of the body. And after some time, the exhausted internal organs begin to fail, one after another, including the development of kidney prolapse.

Women love to wear high heels, it is beautiful and makes the body visually slimmer. But with internal exhaustion of the body, as a result of the above-described experiments with diets, the likelihood of a slow but constant weakening of the ligamentous apparatus increases, as a result of which the likelihood of kidney prolapse increases.

At the very beginning it was already mentioned that women suffer from this pathology much more often than men. Here we have analyzed one example, which clearly indicates that in many ways, women themselves provoke the development of many ailments, including kidney prolapse.

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