Wandering kidney symptoms in women. Nephroptosis (prolapse of the kidney) - causes, symptoms, diagnosis and treatment. Contraindications for surgery

Nephroptosis- this is pathological mobility of the right, left, or two kidneys at once. If the organ moves beyond the anatomical bed slightly, the disease is asymptomatic. If hemo- and urodynamics are disrupted, pain in the lumbar region, pyelonephritis, hematuria, hydronephrosis, arterial hypertension, and nephrolithiasis appear.

It should be noted that not every displacement of the kidneys falls under the concept of nephroptosis. Normally, during physical activity or during the act of breathing, they can shift to the height of one lumbar vertebra. If the downward displacement of the kidney with a vertical body position exceeds 2 cm, and with forced breathing - 3-5 cm, we can talk about nephroptosis (wandering kidney).

The disease occurs more often in women and, as a rule, is right-sided.

Degrees of nephroptosis

According to the criterion of kidney displacement relative to the physiological norm, three degrees of nephroptosis are distinguished:

• with nephroptosis of the 1st degree, the lower pole of the organ descends by 1.5 lumbar vertebrae;
• with nephroptosis of the 2nd degree, the kidney descends more than 2 lumbar vertebrae;
• with nephroptosis of the 3rd degree, prolapse of the lower pole of the kidney by 3 or more lumbar vertebrae is diagnosed.

Clinical manifestations of the disease do not always characterize the degree of prolapse.

Causes of nephroptosis

Nephroptosis is an acquired disease. Its development provokes a pathological change in the apparatus that holds the kidney. This refers to the peritoneal ligaments, intrinsic fascial and fatty structures, and the renal bed. The mobility of the organ can also be caused by a decrease in its fat capsule and abnormal position of the joints of the renal pedicle.

Other common causes of nephroptosis include:

• sudden loss of body weight;
• performing heavy physical work;
• low muscle tone of the abdominal wall;
• doing strength sports;
• lumbar spine injuries.

Right-sided, left-sided and bilateral nephroptosis can be combined with congenital skeletal anomalies:

• underdevelopment of the ribs;
• violation of the position of the lumbar spine,
• lack of ribs.

In adolescents, kidney prolapse occurs due to a rapid change in body proportions during a period of rapid growth.

The best doctors for the treatment of nephroptosis

If you experience similar symptoms, consult your doctor immediately. It is easier to prevent a disease than to deal with the consequences.

Diagnosis of nephroptosis

Diagnosis of nephroptosis of the left or right kidney is based on:

• inspection data;
• patient complaints;
• results of instrumental and laboratory diagnostics.

If there is a suspicion of kidney prolapse, all studies are carried out with the patient standing and lying down.

• Polypositional palpation of the abdomen makes it possible to assess the displacement and mobility of the kidney.
• Monitoring and measuring blood pressure shows an increase of 15-30 mmHg. Art. when changing body position from horizontal to vertical.
• Urinalysis for kidney nephroptosis shows leukocyturia, erythrocyturia, bacteriuria, proteinuria.
• Ultrasound of the kidneys, performed in a standing and lying position, allows you to study the location of the kidneys and exclude the presence of inflamed tissues and stones.
• Ultrasound diagnostics of kidney vessels is necessary to assess blood flow indicators, visualize the vascular bed of the organ, and determine the degree of hemodynamic impairment.
• Renal venography and angiography are required to examine venous blood flow and the renal artery.
• Radioisotope dynamic nephroscintigraphy is carried out to determine the disturbance of urine passage and the functioning of the organ as a whole.
• Excretory urography is aimed at nephroptosis to determine the degree of pathological prolapse of the kidney in relation to the vertebrae.

If you need to check whether there is displacement of the organs of the gastrointestinal tract, additionally, radiography of the stomach, colonoscopy, irrigoscopy, and endoscopy are performed.

Treatment of nephroptosis

Nephroptosis of the 1st degree requires conservative therapy. The patient is recommended to wear special orthopedic devices - corsets, belts, bandages. Also mandatory is therapeutic exercises aimed at strengthening the abdominal and back muscles. If the patient is underweight, he should eat heavily. Physical activity should be limited.

Nephroptosis of the 2nd and 3rd degrees, accompanied by severe pain in the lumbar region, nephrolithiasis, pyelonephritis, hydronephrosis, urodynamics, requires nephropexy - a surgical operation performed to fix the kidney to the adjacent area of ​​the posterior abdominal wall and the twelfth rib. After treatment, the patient must remain in bed for a long time.

Contraindications to surgical treatment of right-sided and left-sided nephroptosis are:

• splanchnoptosis;
• elderly age;
• heavy intercurrent background.

Therapeutic exercises for nephroptosis

Exercise therapy helps improve the well-being of a patient with kidney nephroptosis. Some of the safest and most effective exercises include:

• alternately raising straight legs up (starting position - lying on the floor).
• "Bike";
• alternately pulling the legs bent at the knees towards the stomach in a lying position;
• breathing with the diaphragm while lying on the floor. When you inhale, stick your stomach out, and when you exhale, pull it in;
• raising straight legs up, followed by spreading the knees to the sides as you inhale and crossing them as you exhale;
• raising your leg up while lying on your side.

The danger of nephroptosis

When the kidney prolapses, the normal outflow of urine from the renal structures is disrupted. This leads to increased intrarenal pressure and impaired blood circulation in the organ. As a result, hydronephrotic transformation of the kidney may develop.

Another dangerous complication of nephroptosis is pyelonephritis, which can be acute with severe pain. Torsion of the renal arteries often leads to arterial hypertension, which manifests itself as difficult-to-treat hypertension.

A wandering kidney can provoke the occurrence of an inflammatory process in the surrounding perinephric tissue, which promotes the development of adhesions between fatty tissue, the kidney capsule and other organs. Scar connections make the kidney poorly mobile and fix it at an even lower level.

In pregnant women, nephroptosis can cause spontaneous miscarriages.

Risk group for nephroptosis

Most often, nephroptosis is diagnosed in individuals with systemic weakness of the ligamentous apparatus and connective tissue:

• myopia;
• visceroptosis;
• joint hypermobility.

People of certain professions are susceptible to the disease:

• loaders (due to carrying heavy loads);
• drivers (due to vibration occurring during driving);
• hairdressers, surgeons (since they spend a lot of time on their feet), etc.

Prevention of nephroptosis

Prevention of nephroptosis includes:

• proper nutrition, reducing the amount of salt consumed;
• correct posture;
• prevention of lumbar injuries;
• strengthening the abdominal muscles;
• refusal of heavy physical work.

This article is posted for educational purposes only and does not constitute scientific material or professional medical advice.

Even in a healthy person, the kidney is not in one place all the time, but moves up and down several centimeters. This is a normal physiological phenomenon that should not be feared. However, in some cases, the kidney begins to move chaotically in the cavity, sometimes even being fixed in another place. This pathology is called “wandering kidney” or, scientifically, “nephroptosis”.

The disease is fraught with serious complications and disruption of the functioning of the body. We will tell you what symptoms a wandering kidney manifests itself and how you can cope with the problem.

A little anatomy and physiology

The kidney is a paired, bean-shaped organ that is responsible for a number of vital functions in the body. The kidney is located in the lumbar region, on the side of the last thoracic and first lumbar vertebrae.

The kidney does not have a strong fixation, but seems to be suspended on a special ligament. This ensures the mobility of the organ. When you inhale, the kidney moves 2-4 cm down, and when you exhale, it moves back up. With a deep breath, the displacement increases to 4-6 cm. This feature allows the organ to ensure normal evacuation of urine from the body. If the kidney were immobile, the urine would stagnate.

With pathology, the ligamentous apparatus is not able to hold the kidney within normal amplitude. The organ begins to wander - shift to the other side, fall and rise, rotate around its axis in different planes. In some cases, the kidney may become dislodged and become fixed by adhesions. In this case, the blood vessels are twisted, the outflow of urine is disrupted, nerve fibers are affected, and pressure occurs on adjacent organs and tissues.

Even if the kidney returns to its anatomically correct place, it usually does not last long. After a while, the organ begins to wander again. Nephroptosis develops.

Causes of a wandering kidney

The causes of nephroptosis are factors that damage or weaken the ligamentous apparatus. The most common reasons:

• sudden weight loss;
• various types of infections;
• pregnancy in women;
• decreased tone of the muscles of the anterior abdominal wall;
• injuries, especially from falling from a height or improper lifting of heavy objects.

In some cases, a combination of two or more factors is necessary for nephroptosis to form. In other situations, one reason is enough for the development of pathology.

The disease is characterized by the duration of the increase in the intensity of symptoms and the presence of a latent course. There are cases when a patient consulted a doctor several years after receiving an injury or another factor provoking the pathology.

A wandering kidney is a pathology of the urinary system, which is characterized by excessive movement of the renal organ outside the anatomical bed.

Due to high mobility, the kidney can drop significantly downwards, reaching the pelvic area.

A mobile kidney is more characteristic of women due to the peculiarities of the anatomical structure of the body. Elderly people are also susceptible to this pathology.

Both renal organs are naturally mobile, but their normal deviation from their usual place is no more than 1-2 cm.

If the displacement of the kidney exceeds this figure, doctors diagnose a pathology such as nephroptosis, a type of which is a wandering kidney.

Wandering kidney in the picture

Since the left kidney is located higher than the right, the mobility of the latter is slightly higher, so it is the right kidney that is more often diagnosed as wandering.

Doctors currently cannot say with absolute certainty what specific causes provoke this pathology.

Normally, the kidneys shift during the act of breathing: by 3-4 cm when inhaling, by 5-6 when exhaling. Also, with various body movements, they are also capable of shifting. This determines the normal outflow of urine. There are situations in which the kidney is not able to stay in its designated place.

This can happen when the elements that fix it are weak, among which are:

• lower back muscles;
• ligamentous structures of the abdominal cavity;
• fatty tissue and fibrous capsule.

All of the above components form the kidney bed; it differs in appearance in males and females. For the former it is cone-shaped, and for the latter it is cylindrical.

The main causes of a wandering kidney:

• sudden weight loss, which depletes fatty tissue near the kidney;
• serious injuries;
• hereditary failure in the structure of the muscle corset and connective tissue;
• constant exhausting physical activity with lifting heavy objects;
• a short break between two pregnancies or carrying several babies at the same time;
• curved spinal column;
• decreased muscle tone in old people.

If the kidney is located in an uncharacteristic place for a long time, then when adhesions form, it can be fixed there.

Stages of the disease

The wandering kidney can be classified into several stages. In its development, three stages of the pathological process are distinguished.

The first stage in which the wandering kidney can be identified by palpation.

The kidney is palpated on inspiration. As you exhale, it moves to the right hypochondrium. Usually seen in thin people!

At the second stage, the kidney can move from the hypochondrium. At the same time, in a lying position, it returns to the same place.

The third stage is characterized by the fact that the kidney descends. Namely - in the small pelvis.

At the first stage of this disease, kidney displacement may not cause any symptoms other than dull pain in the lumbar region, aggravated by physical activity. Already at the second stage of nephroptosis, the kidney is able to rotate around its axis, which leads to the development of various complications.

Kidney prolapse has degrees that are distinguished based on its severity:

1. The first degree is characterized by the fact that the mobile organ can be palpated through the abdominal wall during inspiration (if there is no nephroptosis, then the kidney can be detected only in thin people).
2. The main symptom of the second degree is the protrusion of the kidney from under the ribs in a standing position; in a horizontal position, it hides again.
3. The third degree is distinguished when the kidney appears from under the ribs in both vertical and horizontal positions of the person, and it is also capable of wandering in the small pelvis.

In children

Nephroptosis in children is a rare phenomenon. This was thought so, at least for quite a long time. Now the process is quite common.

The wandering kidney is observed on the right. Than on the left in children. More often the disease affects girls. Boys are less susceptible to the disease.

What is the etiology of the disease in children? The most common reasons include:

• - heredity;
• - thinness;
• - respiratory diseases;
• - injuries

All these factors, one way or another, contribute to morbidity. It is known that heredity is a common cause. Since with nephroptosis, the mother’s child will certainly fall ill.

In adults

Nephroptosis can appear at any age. This pathological condition of the kidney is observed mainly in women. Although there are cases of manifestation in men.

According to statistics, in 2% of cases the disease affects women of childbearing age. More often during pregnancy. Or under the influence of infections or injuries.

What else could cause the process? The disease can develop due to an anatomical predisposition. Let’s say that the structure of the female organs, one way or another, contributes to the wandering of the kidney.

It is known that women have a certain pelvic structure. Wider pelvis and decreased abdominal wall tone.

In adults, the kidneys are in a mobile state. When you inhale and exhale, they move a certain number of centimeters. This directly contributes to the physiological excretion of urine.

The insidiousness of the disease is that with the duration of the location of the kidney. It can be fixed in a certain place for a long time.

Signs of a moving kidney

Symptoms of the disease

The main difficulty in identifying nephroptosis is the absence of characteristic and pronounced symptoms. As a rule, the development, course, variations and severity of the symptom complex are individual in each case. The most common symptoms include:

• fatigue, weakness, insomnia, frequent dizziness;
• constipation, diarrhea, feeling of heaviness in the abdomen, bloating, decreased or complete lack of appetite;
• frequent mood swings, hysteria, hypochondria, neuralgia of the femoral, regional and sciatic nerves;
• the presence of hematuria, increased and rapid heartbeat, sudden jumps in blood pressure;
• the formation of pyelonephritis, cystitis, urethritis, pain similar to renal colic, heaviness in the affected side of the lower back, the presence of protein in urine is possible;
• pain in the kidney area, the main feature is the disappearance or reduction in the lying position.

For information! Increased mobility on the right affects the right side, on the left - the left side.

The very first symptom is pain in the hypochondrium. A person may also experience a feeling of heaviness in the area of ​​the diseased kidney. When lying on your back, these symptoms weaken or even disappear completely. When palpating the abdomen under the free edge of the ribs, a kidney can be felt with nephroptosis. Pressing on it is quite painful.

Other symptoms of a wandering kidney:

• irritability, short temper;
• neuralgic pain.

Nephroptosis is a urological disease that affects the urinary system, resulting in active mobility of the organ and its gradual prolapse. A wandering kidney (nephroptosis) is the first sign of urolithiasis, arterial hypertension, pyelonephritis, hepatic colic and other urological diseases. In this article we will tell you why a floating kidney is dangerous, we will analyze the symptoms of the pathology and treatment methods.

Characteristics of nephroptosis

The pathology “walking kidney” is quite complex and has various complications.

There are acceptable standards for organ mobility; they allow the kidney to shift by 1-2 vertebrae during the process of breathing and changing posture. If this norm exceeds the permissible value, nephroptosis or kidney mobility is established. Pathology can occur in two ways:

• fixed nephroptosis - a characteristic feature is the prolapse of the organ and its strong fixation;
• wandering kidney - a characteristic feature is vertical displacement and constant movement of the organ from side to side.

For information! The pathology “walking kidney” is quite complex and has various complications.

According to statistics, women suffer from this disease more often than men, this is caused by a peculiarity of the anatomical structure. As a rule, the disease manifests itself in adulthood. Displacement of the right kidney occurs more often than the left; this is due to a physiological feature and the underdeveloped fixation apparatus of the organ.

For information! Only 10% of nephroptosis is bilateral.

It is worth noting that fixation of the kidneys in a certain place occurs subject to such factors as:

• presence of renal fascia;
• support of the renal bed, consisting of the quadratus lumbar and psoas muscles;
• the renal vascular system, which provides interaction with the aorta and inferior vena cava.

You can learn more about the wandering kidney from the video and the article “What is kidney nephroptosis.”

The site provides reference information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. Consultation with a specialist is required!

Introduction

The kidney is held at the physiological level by ligaments, fascia that form the renal bed, intra-abdominal pressure (created by the muscles of the anterior abdominal wall and the diaphragm), the fascial-fatty capsule of the kidney and the fatty tissue between the adrenal gland and the kidney.

According to statistics, nephroptosis is currently observed in 1.5% of women and 0.1% of men. The predominant age for this pathology is 25-40 years. Nephroptosis is observed predominantly on the right. This is explained by the fact that the left kidney has a stronger ligamentous apparatus and the fact that the right kidney is normally located lower than the left. In some cases, bilateral prolapse is noted ( ptosis) kidney.

Causes of kidney prolapse

• significant and rapid weight loss can lead to a decrease in the volume of the fatty capsule of the kidneys;
• hereditary predisposition to increased extensibility of connective tissue (Ehlers-Danlos syndrome);
• trauma to the lumbar region with damage to the ligamentous apparatus and the formation of a hematoma in the perinephric tissue;
• heavy physical activity and work with heavy lifting;
• infectious kidney diseases;
• excessive stretching of the muscles of the anterior abdominal wall during pregnancy.

Stages of nephroptosis

• at stage 1 the drooping kidney is palpated during inspiration through the abdominal wall, and during exhalation the kidney again goes under the costal edge and cannot be palpated;
• at stage 2 nephroptosis, the kidney can be completely palpated below the hypochondrium when the patient is in an upright position, but in a supine position it goes back into the hypochondrium;
• at stage 3 the kidney completely (regardless of the position of the body) comes out of the hypochondrium and can even move into the pelvis.

Such vascular changes lead to impaired blood supply to the kidney tissue: hypoxia and increased venous pressure, impaired lymphatic drainage. Changes in hemo- and lymphodynamics create conditions for the development of chronic pyelonephritis (inflammation of the pelvis and kidney tissue).

In stage 3 nephroptosis, the ureter may be kinked, which will lead to impaired urine outflow and dilation of the renal pelvis. An inflammatory and then adhesive process can occur around the kidney (perinephritis). These adhesions will fix the kidney in a pathological position. As nephroptosis develops with disturbances in hemodynamics and urine outflow, clinical manifestations of nephroptosis appear.

Symptoms of kidney prolapse

As the prolapse of the kidney increases, the intensity and frequency of pain increases; diffuse abdominal pain may appear, radiating to the back. In stage II nephroptosis, protein and red blood cells appear in the urine due to hemodynamic disturbances in the kidney.

In stage III, the pain is constant and does not disappear in a horizontal position. This may reduce the patient's ability to work. Attacks of renal colic are also possible, when the pain becomes unbearable and may be accompanied by nausea and vomiting.

At stage III of nephroptosis, there is a deterioration in appetite, impaired intestinal function, and signs of depression appear. The progression of the disease leads to the appearance of signs of pyelonephritis, increased blood pressure, and hydronephrosis may form (persistent, progressive expansion of the renal collecting system due to impaired urine outflow).

An increase in blood pressure is initially observed only when the patient is in an upright position (orthostatic hypertension). In some patients, fornical bleeding (bleeding that occurs during exercise) or symptoms of pyelonephritis are the first manifestations of nephroptosis.

Why is nephroptosis dangerous?

• Impaired urine outflow contributes to the development of an infectious process and the formation of calculi (stones) in the renal pelvis.
• A wandering kidney can cause spontaneous abortion.
• As the process progresses, nephroptosis will cause an increase in blood pressure, which also has very serious complications (strokes and myocardial infarction).

Diagnosis of nephroptosis

• interviewing the patient about complaints, past illnesses and injuries;
• examination of the patient with palpation (palpation) of the abdomen;
• X-ray examination (excretory urography and plain radiograph of the kidneys);
• Ultrasound of the kidneys (lying and standing);
• scintigraphy or radioisotope scanning clarifies the position of the kidneys;
• renography allows you to clarify the state of kidney function;
• laboratory analysis of blood and urine allows us to identify and clarify the presence of complications of nephroptosis.

Nephroptosis during pregnancy

Abdominal pain increases with physical activity and decreases when lying down. In this case, nausea and loose stools may occur. Urinary syndrome is manifested by the appearance of red blood cells, white blood cells, protein and bacteria in the urine. Dysuric syndrome is manifested by urinary incontinence (at night and during the day).

Prevention of nephroptosis in childhood consists of proper physical education of the child, eliminating excessive stress (including psycho-emotional), ensuring a balanced diet and preventing childhood injuries.

Treatment of nephroptosis (prolapse of the kidney)

Conservative treatment

Drug therapy is used only to treat complications of nephroptosis (pyelonephritis, urolithiasis, arterial hypertension).

Sodium causes fluid retention in the body, which contributes to edema and increased blood pressure. Therefore, the consumption of table salt should also be limited.

Orthopedic treatment (bandage)
Wearing a bandage is very useful for nephroptosis. You should put on a bandage (or an orthopedic belt, or a corset) in the morning, while still lying in bed. The orthopedic bandage should be worn only when exhaling, otherwise wearing it will be useless. The bandage should be removed in the evening before going to bed.

Currently, there is a large selection of corsets, bandages, and orthopedic belts. Before purchasing any of them, you should consult a doctor, as there are a number of contraindications for their use. One of the contraindications is “fixed nephroptosis”.

Exercise therapy
Physical therapy and abdominal massage have an effect only in stage 1 of nephroptosis. Therapeutic exercises should be performed daily in the morning for 30 minutes. The exercises are performed while lying on your back. You can place a small cushion under your lower back.

1. The legs are slightly bent at the knees. Make 5-10 breathing movements using the diaphragm: when inhaling, stick your stomach out as much as possible, and when exhaling, pull it in as much as possible.
2. 5-8 rub. raise your straight legs alternately.
3. 6-8 rub. pull each leg bent at the knee towards your stomach.
4. Perform the “bicycle” exercise for 1-2 minutes.
5. Squeeze a small ball between your knees for 6-8 seconds. Repeat the exercise 4-5 times.
6. 5-10 rub. Raise both extended legs up as you inhale, and lower as you exhale.
7. Raise your legs straight up, knees and heels together. As you inhale, spread your legs apart, and as you exhale, cross your legs. Repeat the exercise 5-6 times.

When the kidneys prolapse, sedentary games and walks on level ground are allowed. Jumping, hanging, stretching and running are prohibited.

Spa treatment
For stage I nephroptosis, sanatorium-resort treatment is widely used, especially with the use of hydrotherapy - swimming, baths, drinking mineral water.

This treatment can be carried out in local sanatoriums, as well as at the resorts of the Caucasian Mineral Waters (Kislovodsk, Pyatigorsk, Essentuki, Zheleznovodsk) and in Truskavets (Ukraine).

Surgical treatment

The purpose of surgery is to fix the kidney (nephropexy) in its anatomical bed for a long time.

Currently, this operation is performed primarily by laparoscopy. It has a number of advantages: there is a lower risk of complications, the method is less traumatic, there is virtually no blood loss, and the patient’s recovery after surgery is easier.

Treatment with folk remedies

Recipes for preparing folk remedies:
1. It is recommended to eat sunflower seeds, pumpkin seeds, flax seeds, and any nuts. Flax seeds can be irrigated with drinking water, sprinkled with powdered sugar and fried in a dry frying pan. Take 3-4 r. per day 1 tsp. (chewing thoroughly).
2. Take 2 tbsp. chopped stems of broom kochia, pour 300 ml of boiling water, leave for 12 hours, strain. Take 5 ml 3 times between meals. in a day.

Nephroptosis (prolapse of the kidney): causes, symptoms, methods of diagnosis and treatment - video

Treatment of nephroptosis (bandage, laparoscopy) - video

Do people with nephroptosis get drafted into the army?

Nephroptosis in the Schedule of Diseases is classified according to Article 72. The suitability category is determined depending on the degree of nephroptosis.

Conscripts with 1st degree nephroptosis are classified according to Article 72, paragraph “G” - fit for military service.

Examined with stage II nephroptosis. and with secondary pyelonephritis are classified according to Article 72, paragraph “B” and are exempted from military service, they are enlisted in the reserve.

Examination for kidney diseases is carried out on the basis of inpatient examination and treatment.

Nephroptosis- abnormal mobility of the kidney when it leaves its bed and descends into the abdominal cavity. This disease is accompanied by pain in the lower back or hypochondrium, most often on the right side. Nephroptosis is dangerous because the kidney can twist around its axis. At the same time, the blood vessels feeding the organ are pinched and stretched. This leads to inflammation and the formation of kidney stones.

Normally, the kidneys are immobile. They can shift by 1-1.5 cm when breathing and during movements. If the kidney moves more than 5 cm, then this is already considered a pathology.

Kidney prolapse of varying degrees is a fairly common phenomenon. Nephroptosis occurs in 1.5% of women and 0.1% of men. Most often it is accidentally diagnosed during an ultrasound. Nephroptosis causes pain in only 15% of people.

The average age of patients is 30-50 years, but the disease also occurs in childhood. Women are 5-10 times more likely to suffer from nephroptosis. This ratio is associated with the characteristics of the female body, repeated pregnancies and addiction to diets.

Anatomy of the kidney and renal ligaments

Kidneys- the most important paired organs of the urinary system, which ensure blood purification and maintain chemical balance in the body.

The buds are bean-shaped. The average length of the organ is 12 cm, width 5-6 cm, thickness 3.5 cm. The weight of the organ is 130-200 g. Moreover, the left kidney is usually slightly larger than the right.

The kidneys are located in the abdominal cavity and are adjacent to its posterior wall at the level of 11-12 thoracic and 1-2 lumbar vertebrae. The kidneys are almost completely covered by the lower ribs. Normally, the right kidney is located slightly lower than the left, and its upper edge is adjacent to the liver. In this regard, in 80% of cases the right kidney is displaced.

Kidney structure. Each kidney consists of a system for the formation and excretion of urine. The outside of the kidney is covered with a dense capsule of fat and connective tissue. With their help, the kidney is secured inside the abdominal cavity.

The following are responsible for fixing the kidney:

• Vascular pedicle consists of the renal artery and renal vein. However, the vessels can stretch and therefore do not provide reliable fixation.
• Fat capsule, consisting of fatty tissue, protects the organ from hypothermia and injury. In women, it is wider and shorter, so it fixes the kidney weaker.
• Renal fascia. 2 sheets of fascia made of strong connective tissue are located on the anterior and posterior surfaces of the kidney. They grow together at the upper pole of the kidney and pass into the fascia of the diaphragm. Thus, the kidney is in limbo. The fascia bears the main burden of fixing the organ.
• Abdominal ligaments. The inside of the abdominal cavity is lined with a thin membrane of connective tissue - the peritoneum. Its folds form ribbons - ligaments that secure the organs in the abdominal cavity. The right kidney is supported by the hepatorenal and duodenal ligaments. The left kidney is fixed by the pancreatic-renal and splenorenal ligaments.
• Kidney bed, formed by the diaphragm, the muscles of the abdominal wall, the intestinal mesenteries and fascia.

If one of the components of this fixing apparatus weakens, then the kidney moves downward under its own weight.

• Consequences of pregnancy and childbirth. After childbirth, pressure in the abdominal cavity drops due to weakening of the abdominal muscles, and the kidney loses support. The larger a woman's belly during pregnancy, the higher the risk of kidney prolapse after childbirth. During repeated pregnancies, the likelihood of developing the disease increases sharply.
• Heavy lifting and excessive exercise cause a strong increase in pressure in the abdominal cavity, resulting in stretching of the fixing apparatus of the kidney (ligaments and fascia).
• Severe repeated coughing attacks for whooping cough, tuberculosis, chronic bronchitis. A cough is accompanied by tension in the muscles of the diaphragm; it moves down, displacing the abdominal organs, including the kidneys.
• Injuries, falls from heights. Bumps and falls can cause damage to the integrity of the ligaments - tears form on them and the ligaments lengthen. In this case, the fixation of the kidney ceases to be reliable.
• Bruises and hematomas displacing the kidney. When the lower back is bruised, hematomas form in the perinephric tissue, which displace the organ and compress it.
• Sudden weight loss causes thinning of the fat capsule that supports the kidney.
• Hereditary predisposition for diseases associated with connective tissue weakness (Ehlers-Danlos syndrome, connective tissue dysplasia). With these pathologies, the ligaments are thin and easily stretched, which leads to prolapse of the internal organs.
• Decreased muscle tone of the abdominal wall with a sedentary lifestyle, physical inactivity. Weakening of the muscles leads to the fact that intra-abdominal pressure drops, the kidney leaves the renal bed and stretches the fascia.
• Prolonged stay in the vibration zone. Vibration causes stretching of ligaments and fascia.
• Long-term infectious diseases leading to exhaustion are malignant tumors, tuberculosis, cirrhosis of the liver. A decrease in subcutaneous fat leads to dramatic weight loss and a decrease in intra-abdominal pressure.

Degrees of kidney prolapse

Depending on the course of the disease, there are three stages of nephroptosis.

1. First stage. When inhaling, the organ moves 5-9 cm and the lower 1/3 of the kidney is felt under the ribs. As you exhale, it returns to its place.

   As a rule, there are no symptoms of the disease. But if the kidney is lowered by more than 7 cm, then the fascial capsule stretches, and dull pain occurs, radiating to the lower back. They usually appear when the patient sits up from a lying position.

   There are no changes in urine.

2. Second stage. In an upright position, the kidney drops below the rib line by 2/3, but when the patient lies down, it returns to its place.

   Symptoms become more pronounced. During physical activity and changing body position, intense pain occurs, reminiscent of renal colic. Relief occurs when the person lies on his back.

   Protein and red blood cells appear in the urine. The changes are associated with a violation of the outflow of venous blood from the kidney.

3. Third stage. The kidney extends below the line of the ribs and can descend to the pelvis.

   The pain is constant, spreads to the lower abdomen and radiates to the groin area. The sensations do not depend on the position of the patient’s body, but are associated with inflammation of the kidneys (pyelonephritis, hydronephrosis).

   There is blood and mucus in the urine, which is associated with increased renal pressure and stagnation of urine in the renal pelvis.

Symptoms of kidney prolapse

Symptoms of nephroptosis increase gradually. In the first stage, discomfort or aching pain appears only after physical activity. Over time, the kidney drops lower, the disease progresses, and new symptoms appear.

• Aching pain in the lower back. The lumen of the renal vessels narrows and the outflow of blood and urine from the kidney is disrupted. Edema develops. The enlarged kidney stretches the sensitive fibrous capsule, which contains pain receptors.
  Relief occurs if blood flow improves. This happens when a person lies on his back or on his “healthy” side.
  At the first stage, discomfort or pain appears when changing posture and in an upright position.
  In the second stage, after exercise, severe paroxysmal pain appears that lasts from several minutes to several hours.
  In the third stage, the swelling does not decrease, so the pain is constant.
• Pain in the abdomen, groin, genitals, thigh. When the kidney prolapses, the nerve plexuses that are located nearby are irritated. The pain is sharp, cutting in nature, and can be mistaken for an attack of appendicitis. They are so strong that a person loses the ability to walk and talk.


• Bleeding during urination. When the vascular bundle is twisted, the outflow from the renal veins located in the small calyces is disrupted. The wall of the vessel becomes thinner, bursts, and blood mixes with urine. The urine turns dark red.


• Digestive disorders: constipation and diarrhea, nausea, vomiting, loss of appetite. Disruption of the gastrointestinal tract is caused by reflex irritation of their nerve endings located next to the affected kidney.


• General intoxication: weakness, fatigue, irritability, possible fever during an attack of severe pain. These are signs of intoxication, which develops due to impaired kidney function and increased levels of toxins in the blood.

Diagnosis of nephroptosis

At an appointment with a nephrologist, a patient

• Collection and analysis of complaints. To make a correct diagnosis, it is important to clearly describe the sensations: how long ago the problems appeared, the nature of the pain, when and after what it appears.


• Probing. The kidney can be felt through the anterior abdominal wall below the rib line as a dense, round and painful formation.


• Urography of the kidneys- X-ray examination using a contrast agent to determine the stage of the disease. It is carried out in vertical and horizontal positions. The study allows us to identify the exact location of the kidney and the condition of its blood vessels.


• Ultrasound of the kidneys. Ultrasound examination is considered insufficiently informative. Often it is performed only in a supine position, when the kidney returns to its place, so it may not reveal nephroptosis of the I and II degrees.


• Analysis of urine
  • Proteinuria - the appearance of protein in the urine, over 0.4 g/l.
  • Hematuria - blood in the urine, more than 10 red blood cells in the field of view.
  • Leukocytes in the urine (more than 5 per field of view) may indicate inflammation if nephroptosis is complicated by pyelonephritis.

Consequences of kidney prolapse

• Venous hypertension of the kidney vessels. Twisting and lengthening of the vascular pedicle of the kidney leads to the disruption of blood outflow. The kidney veins become congested and the pressure in them increases. The vascular walls become thinner and burst.
• Pyelonephritis- inflammation of the kidney. Due to compression of the vessels, insufficient oxygen and nutrients enter the kidney - kidney ischemia develops. Poor circulation leads to a decrease in the protective functions of the organ, which promotes the proliferation of microorganisms and the development of inflammation. Bacteria can be carried into the kidney through the bloodstream from any part of the body during bronchitis, sinusitis, pharyngitis. In some cases, bacteria travel up the ureter from the bladder.
• Hydronephrosis- when the ureter is twisted, the drainage of urine from the kidney is disrupted. Urine stagnates in the kidney tissue, leading to stretching of the renal pelvis and calyces. Subsequently, the parenchyma of the organ atrophies and ceases to perform its functions.
• Urolithiasis disease . Violation of the outflow of urine leads to the deposition of salts in the kidney ducts. Over time, stones of various sizes form in this place, which can cause severe pain.

Treatment of kidney prolapse

Treatment of nephroptosis aimed at returning the kidney to the renal bed and fixing it.
Conservative treatment of nephroptosis includes therapeutic exercises and wearing fixing bandages.
Surgical treatment of nephroptosis - These are 150 types of different operations, during which the kidney is sutured to the peritoneum and ribs with synthetic materials or fixed with the help of fascia and muscles.

Gymnastics and exercises to strengthen the abdominal and lower back muscles

Physical therapy for nephroptosis is aimed at strengthening the abdominal and lower back muscles, as well as normalizing intra-abdominal pressure.

A set of exercises for the treatment of nephroptosis

Gymnastics is performed lying on a flat surface. Starting position - lying on your back. Exercises are performed at a slow pace 5-10 times.

• Diaphragmatic breathing. As you inhale, inflate your stomach as much as possible - raise the abdominal wall. As you exhale, draw in your stomach.
• Alternately raise your straight legs as you inhale and lower them as you exhale.
• Alternately pull your legs bent at the knees towards your stomach as you inhale and straighten them as you exhale. You can place a small roll of a terry towel under your lower back to maintain the physiological curve of the spine.
• Perform the “bicycle” exercise for 1-2 minutes.
• "Scissors". Raise your straightened legs at an angle of 45 degrees and perform for 1-2 minutes.
• "Cat". Get on all fours, bend your back down, and lift your chin up. Stay in this position for 1-2 seconds. Arch your back, press your chin to your chest.
• Bend your knees, feet resting on the surface. Squeeze the ball with your knees and stay in this position for 6-10 seconds.
• Complete the gymnastics with diaphragmatic breathing.

Some sports are contraindicated for nephroptosis. Running, race walking, heavy lifting - weightlifting, jumping, horse riding - are not advisable.

Wearing special corsets for nephroptosis

Bandage for nephroptosis increases intra-abdominal pressure, limits the mobility of the abdominal organs and fixes the correct position of the kidneys. It must be worn all day, taking off only during exercise and before bed.

The corset is worn for 3-12 months, during which time the ligaments are strengthened and securely fix the organ. However, during this period it is necessary to simultaneously train the abdominal muscles using gymnastics, otherwise they will weaken during the period of inactivity under the bandage, and the treatment effect will not be achieved.

The purpose of wearing a bandage for nephroptosis strengthen the supporting apparatus of the kidney (ligaments, fascia, fat capsule), prevent twisting of the blood vessels supplying the organ.

How to put on a bandage? The bandage is put on in the morning while lying in bed. In order for the kidneys to fall into place, you need to take a deep breath, and then raise your pelvis and fasten the bandage.

To avoid chafing and ensure sweat absorption, it is recommended to wear the corset over your underwear.

How to choose a bandage? Universal medical corsets are sold in pharmacies. In most cases, the ruler has 4 sizes. Choose a bandage based on your waist size. Thanks to the system of fasteners and Velcro, the corset is tightly fixed to the figure.

Types of bandages

• Universal kidney bands. The kidney is prevented from descending into the abdominal cavity, fixing its position. They are effective for stages 1-2 of kidney prolapse. Such bandages are contraindicated with severe pain and the development of inflammation of the kidneys, as they can worsen its blood supply.
• Warm bandages recommended for inflammatory diseases. They are made of wool, retain heat well and activate sensitive skin receptors. This helps to dilate blood vessels, improve blood circulation and speed up recovery.
• Pre- and postnatal bandages- recommended from the 22nd week of pregnancy. Their function is to support the abdomen and prevent stretching of the abdominal muscles and a decrease in intra-abdominal pressure.
• Postoperative bandages necessary after kidney surgery to fix the organ and reduce the load on the diseased area. In most cases they are made individually.

Corsets are invisible under clothing and do not restrict movement. They are very effective in the initial stages of nephroptosis, but they must be combined with therapeutic exercises.

Surgery for prolapsed kidneys

Surgery to treat nephroptosis is performed in rare cases in 1-5% of patients. There are strict indications for surgical treatment of kidney prolapse.

Indications for surgery for nephroptosis

• severe pain that impairs ability to work;
• complications (pyelonephritis, hydronephrosis) that are not amenable to drug treatment;
• bleeding from the renal veins;
• kidney stone disease.

Contraindications for surgery

• old age of the patient;
• general splanchnoptosis - prolapse of all abdominal organs;
• severe illnesses that increase the risk of surgery.

Method of operation

All surgical techniques for nephroptosis can be divided into 4 groups:

1. A suture is made in the fibrous capsule of the kidney with a kergut and with its help the kidney is fixed to the XII rib and to the lumbar muscles.
2. Fixation of the fibrous capsule to the rib without suturing it, using flaps of connective tissue of the capsule or peritoneum. This avoids the formation of a scar on the kidney.
3. Fixation of the organ using flaps of perirenal fatty tissue, as well as synthetic materials: nylon, nylon, Teflon. They form a kind of hammock in which the kidney is placed.
4. Fixation of the kidney to the ribs using muscle flaps.
   The last group of operations is the most effective and is used more often than others. The surgeon makes an incision in the abdominal wall up to 10 cm long. He secures the kidney using a section of the thigh muscle, which was previously taken from the same patient.

After the operation, the patient must observe strict bed rest for 2 weeks. To improve blood circulation, the foot end of the bed is raised by 25-30 cm.

Recently, laparoscopic operations have become widespread. Through holes of 1-1.5 cm, thin tubes with a surgical instrument attached to the end are inserted into the abdominal cavity. With their help, the fibrous capsule of the kidney is sutured. During the procedure, there is no need to open the abdominal cavity, due to which the rehabilitation period is reduced to 5-7 days and the number of complications is sharply reduced.

Prevention of nephroptosis

What do we have to do?

• In the absence of kidney complications, there is no need to adhere to a diet. Nutrition should be varied and nutritious to maintain immunity.
• Wear a support bandage during pregnancy.
• Do gymnastics to strengthen your abdominal muscles.
• Several times a day, it is recommended to lie down for a few minutes to improve blood circulation and urine flow.
• Maintain optimal weight.
• Strengthen your immune system with good nutrition and vitamins.

What should you avoid?

• Work involving long periods of standing in an upright position.
• Prolonged stay in the vibration zone.
• Lifting weights.
• Injuries in the lumbar region.
• Hypothermia of the lower body and legs.
• Radical diets and sudden weight loss.

People with the first stage of nephroptosis need to visit a nephrologist at least once a year, undergo an ultrasound of the kidneys and take a urine test. This will help to timely adjust treatment and prevent further development of the disease.