Why does the kidney drop?
The kidney is held in place not by ligaments in the usual sense, but by a complex of structures: perirenal fatty tissue, fascia, vascular pedicle and intra-abdominal pressure. If the fat capsule becomes thinner and the muscles of the abdominal wall weaken, support is lost, and the kidney moves downward when moving to a vertical position.
The right kidney descends more often: it is initially located lower than the left and has a shorter vascular pedicle.
The displacement itself is not dangerous. Problems begin when, during descent, the renal vein and artery are bent or stretched - blood flow is disrupted - or the ureter is bent, and the outflow of urine is disrupted.
Causes and risk factors
- Sudden weight loss is the most common reason: the fatty capsule of the kidney decreases faster than a new support is formed
- Thin build and weak abdominal muscles
- Heavy physical labor and heavy lifting
- Multiple births and abdominal muscle strain
- Injuries of the lumbar region with damage to the fixation apparatus
- Congenital weakness of connective tissue
- Prolonged cough
- Work involving constant vibration
Degrees and symptoms
- I degree - the kidney can be palpated while inhaling in a vertical position; usually no complaints
- II degree - the kidney completely emerges from the hypochondrium in a standing position; a nagging pain appears
- III degree - the kidney is displaced into the pelvis; symptoms are severe, complications are possible
The key feature is the connection with body position: pain appears or intensifies while standing, walking, running, or physical activity and decreases or disappears when lying down. This sign helps to distinguish nephroptosis from spinal diseases, in which pain usually behaves differently.
What do patients complain about?
- Drawing, aching pain in the lower back or side when standing
- Relief when lying down, especially on the sore side
- Increased pain with physical activity, running, shaking
- Attacks resembling renal colic when the ureter is kinked
- Increased blood pressure in an upright position
- Blood in urine after exercise
- Recurrent urinary tract infections
- Nausea, loss of appetite, bloating
- Fatigue, irritability, sleep disturbances over a long period of time
Diagnostics
- Ultrasound of the kidneys is required in two positions - lying and standing; comparison of the level of the kidney is the basis of diagnosis
- Excretory urography in two positions - assessment of displacement and condition of the ureter
- Doppler ultrasound of the renal vessels while standing and lying down - identifying blood flow disturbances during prolapse
- Dynamic nephroscintigraphy - assessment of urine function and outflow
- General urine test, culture
- Measuring blood pressure in a lying and standing position
- Blood creatinine
- Examination of the spine for unclear pain
Treatment
Most patients do not need surgery. Treatment begins with conservative measures aimed at restoring support for the kidney.
- Wearing a bandage: put on in the morning while lying down while exhaling, removed in the evening
- Physical therapy to strengthen the abdominal and lower back muscles
- Gradual gain of body weight with its deficiency - restoration of the fatty capsule of the kidney
- Drinking enough
- Limiting heavy lifting, running and jumping during treatment
- Painkillers and antispasmodics for pain syndrome
- Treatment of urinary tract infections
- Blood pressure control
- Nephropexy - surgical fixation of the kidney; performed laparoscopically
When is surgery needed?
- Persistent pain that significantly reduces quality of life and is not amenable to conservative treatment
- Impaired urine outflow with the development of hydronephrosis
- Arterial hypertension associated with kidney prolapse
- Recurrent pyelonephritis against the background of nephroptosis
- Recurrent hematuria
- Decreased kidney function according to scintigraphy
- Formation of stones due to stagnation of urine
The opposite is also important: the very fact of prolapse without pain, without disrupting the outflow of urine and without increasing pressure does not require surgery. Nephropexy “just in case” is not justified.
Where to get examined in Tashkent
The key to a correct diagnosis is a competent examination: ultrasound in two positions, urography and blood flow assessment.
In Tashkent, such examination and treatment of nephroptosis is carried out at the UROLOGIC COMPLEX medical center and at the Tashkent Medical Park clinic.
When coming to your appointment, be sure to tell whether the pain is related to the position of the body and whether there has been a sudden weight loss: these two facts often determine the diagnosis even before the examination. Clinic contacts are below on the page.
