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Lumbar dystopia of the right kidney - causes and methods of treatment. Abnormal location of a paired organ - kidney dystopia: reasons for the development of the anomaly and rules for treating the disease Lumbar dystopia of both kidneys

Kidney dystopia is a pathological placement in an uncharacteristic area, as a result of a developmental defect. The kidneys initially develop in the small pelvis and then rise to the level of the XI-XII thoracic - I-III lumbar vertebrae. Dystopia occurs when this process is disrupted. The kidney is tightly fixed to the pathological site and is immobile.

Location of pathology

The unilateral type of dystopia is observed more often, expressed in the absence of one of the kidneys, sometimes there is also no vas deferens on the same side, and other congenital anomalies of the reproductive system are found.

If the kidney, when displaced, does not go in the opposite direction, this is homolateral dystopia; the displacement of one or two kidneys to the other side of the body is cross, or heterolateral dystopia. IN the latter case fusion of both kidneys is often diagnosed.

Depending on the location, dystopia is divided into the following types:

  • Lumbar dystopia of the kidneys: the kidney is displaced downward from the physiological level, located between the pelvis and the diaphragm. The arteries of the kidney branch from the aorta in the region of the II-III lumbar vertebrae, normally they should be at level I. Palpation is determined in the hypochondrium. Must be differentiated from nephroptosis or neoplasm. The most favorable type of dystopia, since it does not manifest itself as significant compression of other organs and their dysfunction.
  • Iliac dystopia: the kidney is displaced into the iliac fossa. Often diagnosed as an ovarian tumor.
  • Pelvic dystopia: the kidney is found between bladder(in men, in women - uterus) and rectum. The ureter is short, dystopia symptoms resemble an inflamed ovary, or an ectopic pregnancy.
  • Intrathoracic dystopia: the kidney rises into the thoracic cavity. The vessels and ureters are elongated, and the kidney itself can often be identified as a tumor or local inflammatory process.

How does it manifest clinically?

  • Lumbar rarely manifests itself symptomatically, sometimes characterized as weak dull pain in the lumbar region. Lumbar dystopia right kidney always gives symptoms localized to the right. Manifestations of lumbar dystopia of the left kidney are characterized by pain on the left when bending the body.
  • Pelvic pain is expressed by pain in the rectal area, problematic periods, urination is frequent and painful. Observed frequent constipation as a result of compression of the rectum.
  • Ileal dystopia is determined by complaints of pain in the stomach and lower abdomen; women indicate painful menstruation. There are dystopias with impaired urine output, intestinal compression, causing problems with the gastrointestinal tract as a whole.
  • Intrathoracic dystopia is characterized by chest pain after eating. This type of dystopia often occurs in conjunction with a diaphragmatic hernia.

Cross dystopia often leads to renal failure chronic nature and nephrogenic arterial hypertension.

The abnormal location of the kidneys is considered a risk factor for the appearance of kidney stones, pyelonephritis, hydronephrosis, due to difficulty in urine output, the development of urostasis and pathology of the renal vessels.

How is it diagnosed?

This pathology is detected by physical, laboratory and instrumental methods. A nephrologist makes a diagnosis based on complaints, anamnesis, symptoms, palpation data, results of blood and urine tests, ultrasound data, urography, angiography, radioisotope method and MRI.

Iliac and lumbar dystopia are determined by palpation of the frontal abdominal wall; pelvic dystopia is diagnosed by manual examination. To clarify, contrast urography is required.

Thoracic dystopia is detected on x-ray chest in the region of the posterior mediastinum as a dense rounded shadow above the level of the diaphragm.

Visualizing instrumental methods help differentiate dystopia from nephroptosis and tumors.

Treatment

Lumbar dystopia, as a rule, does not require treatment unless complications and abnormalities occur. neighboring organs. IN similar cases Treatment is most often conservative, with the aim of preventing or eliminating infection and removing stones.

Developed pyelonephritis is treated with a course of antibiotics and drugs to improve renal blood flow. Hydronephrosis and calculosis become indications for surgical intervention; in case of organ death, nephrectomy is used.

Surgical manipulations with a dystopic kidney present certain difficulties due to the small caliber of the vessels and the scattered blood supply.

Operations in case of dystopia:

  • Angioplasty or stenting renal arteries to expand their lumen
  • Plastic surgery of the ureteropelvic system
  • Puncture of a renal cyst with removal of fluid
  • Nephrectomy

Kidney dystopia suggests a low protein diet to avoid complications due to increased load to a changed kidney.

The location of cells, organs or tissues in places uncharacteristic for them is usually called dystopia. One of the organs whose development can end up in an abnormal position in the body is the kidneys.

Causes

Kidney dystopia is a pathology that arises due to the characteristics of a person’s individual development. Such a deviation is considered an anomaly of a genetic nature and does not depend on the method of birth of the child or the qualifications of the doctors delivering the child.

Dystopia appears in the process intrauterine development fetus There are several factors that contribute to the progression of the pathology. Among them are:

  • drinking alcohol;
  • constant stress;
  • influence of chemicals;
  • smoking;
  • psycho-emotional trauma of the mother during pregnancy;
  • poor quality food.

Existing types of renal dystopia

Incorrect position of the bean-shaped organ can also be inherited by the baby. Renal dystopia can be either unilateral or bilateral. Incorrect position of both kidneys is a fairly rare occurrence. In most cases, the genetic deviation affects the right paired organ (more than 58% of pathologies). An anomaly of the left kidney occurs almost 2 times less often (in 33% of patients). It is extremely rare that a shift of both kidneys is diagnosed (in 8.5% of patients).

There are several types of dystopia, depending on the location of the organ:

  • Pelvic dystopia of the kidney. Accounts for about 21% of all cases of anomaly. An organ displaced to the pelvic area in women is found between the uterus and rectum. In males, the kidney is located between the bladder and rectum. With such an anomaly, the ureter turns out to be shorter than usual. Those who have joined reproductive age In women, dystopia of this type can be confused with an ectopic pregnancy;
  • Ileum. The incidence of development of deviation is about 12%. The organ itself is located in the iliac fossa. In this case, a considerable number of excess vessels are diverted from the artery. During diagnosis, displacement of the kidney into the iliac region is often confused with a cyst or other neoplasm;
  • Lumbar kidney dystopia. This deviation is diagnosed in approximately 67% of cases. The pelvis of the organ is located towards the peritoneum, and its vessels are located at the level of the 2-3rd lumbar vertebra. In this case, the bean-shaped organ is displaced below the correct anatomical position and, upon palpation, resembles a tumor localized in the hypochondrium;
  • Subphrenic or thoracic. The bean-shaped organ is localized in this disease much higher than its normal location. The kidney can be found towards the diaphragm, and its vessels branch in the area of ​​the 12th thoracic vertebra. The pathology is quite rare (only 2% of all cases of the disease). Often, subdiaphragmatic displacement is mistaken for pleurisy, a malignant process in the lungs, or a cyst.

A rotational or cross genetic anomaly is characterized by the displacement of organs “crosswise”. In case of such a deviation, both kidneys can be on the same side and function as a single unit. In patients with rotational displacement of the organ already in at a young age Complications such as renal failure and arterial hypertension may occur.

Statistics say that lumbar dystopia of the right kidney accounts for the majority of cases of congenital abnormality

Does the pathology have symptoms?

The anatomical features of renal dystopia determine clinical picture diseases. The most pronounced symptoms are characteristic of iliac displacement of the kidney. Due to the fact that an abnormally located organ puts pressure on neighboring ones and also affects blood vessels and nerve endings, the following symptoms occur:

  • dyspeptic disorders;
  • discomfort in the epigastric region;
  • flatulence;
  • dysfunction of the urinary system.

During menstruation in women, these symptoms can manifest themselves especially clearly.

If the displaced organ is located in the pelvis, patients note dull painful sensations. People suffering from pelvic dystopia often complain of pain in the rectal area. In female representatives, such manifestations are supplemented by algodismenorrhea and toxicosis (in pregnant women). Clinical manifestations displacement of the kidney into the small pelvis is similar to the symptoms of acute surgical diseases. With severe pressure on the rectum and bladder, patients complain of constipation and problems with urination.

The subdiaphragmatic location of the bean-shaped organ is often accompanied by painful sensations in the chest area, which intensify after eating. This form of pathology is in many cases combined with a diaphragmatic hernia (congenital).

Lumbar displacement of the organ is rarely accompanied by any symptoms. Mostly, patients characterize them as mild attacks of lower back pain.

Various diseases affect dystopic kidneys much more often than healthy ones. In patients who have genetic abnormality, nephrolithiasis, tuberculosis, hydronephrosis and an inflammatory process of bacterial etiology are often detected.

Characteristic of dystopia discomfort often resemble pain accompanying osteochondrosis

Diagnosis of developmental disabilities

It is not difficult to detect displacement of the kidney into the iliac or lumbar region. Incorrect position of the organ is felt upon palpation of the anterior abdominal wall. Pelvic dystopia in women is identified during gynecological examination. For men, a rectal examination is indicated.

The thoracic type of dystopia can be identified by doing fluorography or plain radiography of the chest. A kidney located in an unusual location is defined as dense shadow round shape, concentrated above the diaphragm.

Imaging methods that are used to detect a displaced organ:

  • ultrasonography;
  • scintigraphy;
  • Magnetic resonance imaging;
  • MSCT;
  • urography (both retrograde and excretory);
  • angiography.

Congenital anomalies in children can be detected through examination by a urologist and ultrasound.

Is surgery always necessary?

Necessity surgical intervention It does not depend at all on the type and degree of displacement of the affected kidney. The operation to return the organ to the right place is very difficult (due to the presence of small renal vessels) and is carried out only if the displaced kidney puts significant pressure on nearby organs. An indication for surgical intervention is damage to the bean-shaped organ itself due to impaired blood circulation.

Only in case of final necrosis of the kidney is nephrectomy used - this is a radical method that involves it complete removal. Before the operation, the specialist must determine the presence and location of the second organ of the pair, since with an existing congenital anomaly, the risk of the absence of a second kidney increases significantly.

In many cases, dystopia is discovered when the patient consults a doctor with complaints of symptoms of inflammation in the genitourinary system. In this case, the patient is prescribed conservative treatment aimed at destroying infectious agent. Among the drugs popular today are: Furamag, Ciprofloxacin and other medications.

The pain syndrome accompanying inflammation of a displaced kidney is relieved with analgesic medications: Spazgan, Baralgin, etc.

Lifestyle and diet

A patient who has undergone surgical or conservative treatment of renal dystopia must switch to a special diet. The patient is recommended table No. 7, which implies a strict restriction of alcohol, fried foods, smoked products and various extracts. Nutrition according to Pevzner must be adhered to not only after therapy, but throughout the rest of life.

The drinking regime of a person with dystopia also has its own characteristics. Should not be consumed in unlimited quantities mineral water, because those present in it minerals can serve as the basis for the formation of kidney stones and sand.

If an abnormal position of the bean-shaped organ is diagnosed, it is extremely dangerous disease it becomes a sore throat. Inflammation palatine tonsils causes hemolytic streptococcus, which has Negative influence and on kidney function. A person with a genetic anomaly must be attentive to his health and prevent hypothermia.

After treatment, patients are often recommended to visit resorts where there are healing muds and radon baths. Similar procedures often supplemented with physiotherapy. However, not every case allows physical therapy. If the displaced kidney is located in the heart area, the use of electrodes is prohibited.

Possible complications

WITH unforeseen consequences Kidney dystopia is encountered mainly by people who prefer traditional methods treatment. It is not always possible to detect organ displacement even with the help of modern devices Ultrasound. Traditional healers They do not have modern diagnostic equipment and sufficient knowledge, therefore, instead of inflammation of an incorrectly located organ, they are taken to treat a different, self-made diagnosis. As a result, the patient’s condition worsens, because the main cause feeling unwell continues to progress.

In many cases, after surgery, the patient is given a catheter to artificially remove urine from the body. A person who finds himself in such a situation often experiences difficulties with social adaptation. In this situation, it is advisable to seek help from a psychotherapist, especially if the problem affects a teenager or child

Another complication of the pathology is considered mechanical impact displaced organ to others. For example, if a woman has pelvic dystopia of the right kidney, pressure may be placed on the uterus. Venous vessels may be under the influence of an organ located out of place, ganglia and large arteries. Such cases are considered the most dangerous. Such exposure may cause neurological symptoms, for example, deterioration of sensitivity in certain areas of the body, as well as their trophic changes(poor skin condition, hair loss, etc.).

Summary

People with a genetic disorder are required to regularly visit a urologist. The further prognosis depends on the presence of complications (for example, pyelonephritis or tumors).

If the patient is diagnosed congenital anomaly, for example, pelvic dystopia of the left kidney, she is not prohibited from becoming pregnant, but in the process of bearing a child may arise serious complications. Incorrect position of the organ can cause fetal death, so a woman should register with a urologist and obstetrician-gynecologist as soon as possible.

Pregnancy – important stage in the life of a woman and her unborn child. Disruptions during pregnancy often lead to developmental abnormalities in newborns. One of these anomalies is ileal dystopia of the kidney.

This anomaly develops when, during intrauterine development, the correct movement of the primary kidney into the lumbar region from the pelvic region is disrupted.

Types of kidney dystopia

Dystopia can be either unilateral (only one of the kidneys is incorrectly located) or bilateral (both kidneys are incorrectly located). Unilateral dystopia is much more common than bilateral dystopia.

Depending on the location of the kidney, dystopia can be:

  • Subdiaphragmatic.
  • Ileum.
  • Pelvic.
  • Lumbar.

If the kidney has moved to the opposite side, then dystopia is called cross (heterolateral). If the kidney has moved on its side - homolateral.

Depending on which kidney has moved, dystopia is distinguished:

  • Right-sided - the most common type.
  • Left-handed.
  • Double-sided - the rarest type.

Ileal dystopia of the right kidney is one of the types of dystopia in which the location of the right kidney is disturbed; it is displaced into the iliac fossa. With this arrangement, the kidney has many arteries arising from the common greater iliac artery.

Symptoms of ileal dystopia of the kidney

A dystopic kidney often puts pressure on organs and (or) nerve plexuses located nearby. This causes the most common symptoms of ileal dystopia of the kidney:

  • Violation of urodynamics (improper outflow of urine).
  • Abdominal pain. In women, pain increases during menstruation.
  • Intestinal dysfunction and, as a consequence, vomiting, nausea, intestinal colic, flatulence, gastralgia, constipation.

All the described symptoms manifest themselves to the maximum in the presence of any disease of the dystopic kidney, for example, pyelonephritis, urolithiasis, hydronephrosis.

When palpating the abdomen, an incorrectly located kidney is clearly identified and is often regarded as an ovarian cyst or tumor. In medicine, there are cases of erroneous removal of a dystopic kidney, mistaken for a tumor.

Diagnostics

Ileal dystopia of the right kidney, like all other kidney anomalies, is diagnosed by the following methods:

Treatment

Treatment of ileal dystopia of the kidney is carried out only in the presence of an inflammatory process, pyelonephritis, urolithiasis, hydronephrosis. In this case, conservative treatment is carried out, which is aimed at reducing inflammation, reducing and removing stones.

If the kidney is dead, then they resort to surgery to remove it. Operations to change the position of a dystopic kidney are not performed due to large quantity renal vessels and their small size.

A congenital anomaly of kidney topography, during which the organs are located too low, shifting to the pelvic area, is called kidney dystopia. When such a disease is detected, it may manifest acute pain in the lumbar and abdominal areas, there is also a significant disruption in the functioning of the digestive system, and pyelonephritis is actively progressing. As a rule, dystopia is detected using ultrasound and angiography. As for the treatment itself, they are mainly surgical and are prescribed for the active development of various complications. From a medical point of view, kidney dystopia often refers to congenital pathologies kidney Abnormal placement of organs may be due to problems with rotation in the pelvis due to the process of embryogenesis. More on initial stage During the formation of the embryo, the kidney is laid in the small pelvis, then during its growth it moves slightly upward, occupying a standard location in the lumbar region, approximately at the level of the XI-XII thoracic vertebrae. In the event that negative conditions for migration develop, organs may be placed incorrectly; It is in such cases that the child is born with pathological topography of the kidneys. If you start comparing dystopia and, then in the first option the kidney does not have the properties of mobility, it is fixed.

Abnormal development an organ with an incorrect position

Incorrect placement of the kidneys can be as follows: one-sided, so bilateral. When there is no displacement of the kidney in reverse side, that is, the probability of developing homolateral dystopia, sometimes observed cross anomaly, it is characterized by the movement of one or two kidneys simultaneously to the opposite side. IN in some cases during cross dystopia, a connection of two organs at the same time is noticed.

Depending on the location of the organ, there are several types of dystopia - pelvic, lumbar, iliac, thoracic. As a rule, this classification directly depends on the degree of displacement from the arteries of the kidney from the main trunk of the aorta, which, according to standards, must correspond to the first lumbar vertebra. Basically, lumbar dystopia of the right kidney is often observed, in which the organ is located slightly below the standard anatomical level, in this case the kidney is located forward with the pelvis, it can be easily palpated in the hypochondrium area, it is generally perceived as a tumor.

As for ileal dystopia, then it is mainly manifested by the departure huge number renal arteries. The organ in this situation is located in the iliac fossa, in medical practice this is often mistaken for a huge new development in the field abdominal cavity.

When observed pelvic dystopia, the arteries of the kidneys are separated from the main artery, as a result the organ begins to shift between the ureter and the rectum, in these situations the ureter becomes slightly shorter. Thus, a kidney located incorrectly in the pelvic area is often mistakenly perceived as a hematometra or an inflammatory process in the appendages with adnexitis.

Main types of renal dystopia

When detected thoracic dystopia of the kidney noticeable displacement of the arteries of the kidney from the level of the body to the twelfth vertebra in thoracic region. In such cases, the organ is located quite high, rarely even in the chest area, while the ureter and absolutely all vessels become much longer than standard indicators. Basically, pelvic dystopia of the kidney is determined by tumors or neoplasms, abscesses. As a rule, this anomaly in the right kidney is noticed much more often than in the left.

Symptoms

The main symptoms of the disease are revealed by pathology of the anatomical form; it should be noted that lumbar dystopia of the kidneys is completely asymptomatic, characterized by insignificant aching pain in the lumbar region. When identifying iliac dystopia, the main signs are pain in the abdomen and pelvis. Such sensations of pain are directly caused by an increase in pressure, which directly affects all other organs. As a result of the above, it is noticed active formation uro dynamic disorders - urine begins to be difficult to excrete. During compression of any part of the intestine, constipation, nausea and vomiting may be noticed.

As for pelvic dystopia, it is often accompanied severe pain in the area of ​​the appendages, pain syndrome during such an organ location, in some cases it can provoke various surgical anomalies. With such compression of the rectum and bladder, constipation, painful and frequent urination. Similar pathology may cause development various pains behind the sternum, they are often associated with direct food intake, as a rule, they provoke the formation of congenital diaphragmatic hernia. Also, cross-dystopia is often characterized, and if narrowing of the renal vessels is noticed, then persistent arterial hypertension may even occur.

This pathology provokes the development of diseases such as tuberculosis, which is also explained by the presence of additional renal vessels.

In some cases, if you start carrying out various surgical operations in the area of ​​the sternum or abdominal cavity, an incorrectly placed organ can sometimes be damaged; in such a situation, it is necessary to stitch the affected vessels of the renal pelvis, and if it is not possible to save the organ, then a nephrectomy is performed.

Diagnostics

Basically, diagnosis is carried out by examining the anterior abdominal wall; as for pelvic dystopia, it can be identified during a rectal examination. With such a study, the problem is revealed in the form of a dense, immobile neoplasm, which is mainly located near the rectum. Other types of disease are easily determined using preventive fluorography or conventional radiography of the chest area; in such cases, the diseased organ is mainly detected in the form of a dense rounded shadow in the background of the diaphragm.

Pain is one of the most important symptoms pathology

In order to correctly diagnose the disease and identify its stage, various urological imaging techniques are often used - ultrasound, retrograde and excretory urography, renography.

At the same time, ultrasound diagnostics helps to accurately detect the absence of a kidney on your right place and identify the stage of the disease, but excretory urography allows you to correctly identify the pathological localization of the kidney, the stage of its rotation and the type of limited mobility. When a significant decrease in kidney functionality is noticed, pyelography is performed, during which the degree of displacement of the renal arteries from the base of the aortic trunk is determined. Likewise differential diagnosis carried out in cases of suspected kidney and intestinal tumors.

Treatment

If possible, then medical specialists try to prescribe strictly conservative look treatment aimed at eliminating and stopping the development infectious process, they also carry out additional prevention of the appearance of stones and their removal. In the case when it is revealed active development pyelonephritis, a course of treatment is prescribed using various antibacterial drugs, sulfonamides, nitrofurans, which help improve renal blood flow.

- This congenital disorder topography of the kidney, in which the organ may be located low, displaced into the pelvic cavity, sacroiliac region, chest, etc. Pain in the lower back or abdomen, dysuric and digestive disorders may occur, and also develop urolithiasis disease, pyelonephritis, hydronephrosis. Pathology is diagnosed using renal ultrasound, excretory urography, and angiography. Treatment of kidney dystopia is required when complications develop. At inflammatory processes appointed antibacterial therapy, with nephrolithiasis, stones are removed.

General information

Complications

Pelvic dystopia can cause toxicosis of pregnancy and complicate the course of spontaneous labor. In addition, the growing uterus further displaces the dystopic kidney, causing a characteristic clinical symptoms. Cross dystopia is often accompanied by the development of chronic renal failure, and in the case of narrowing of the renal vessels - persistent nephrogenic arterial hypertension at a young age.

Dystopic kidneys are susceptible to the development of diseases (hydronephrosis, nephrolithiasis, pyelonephritis, tuberculosis), which is associated with the presence of additional renal vessels, obstructed urine outflow and urostasis. When carrying out various surgical interventions on the abdominal or chest cavity An abnormally positioned kidney may be accidentally damaged. In this case, suturing of damaged vessels, parenchyma or renal pelvis is required, and if it is impossible to preserve the organ, nephrectomy is performed.

Diagnostics

With iliac and lumbar dystopia, the kidney can be palpated through the anterior abdominal wall. Pelvic dystopia can be detected during a rectal (in men) or bimanual gynecological (in women) examination. During a digital rectal or vaginal examination, the dystopic kidney is palpated as a dense, sedentary formation located next to the rectum or posterior vaginal fornix.

Thoracic dystopia is diagnosed during preventive fluorography or plain chest radiography. A dystopic bud is more often defined as a dense rounded shadow in posterior mediastinum above the diaphragm. For correct diagnosis To diagnose pathology and determine the form of the disease, urological imaging methods are used - kidney ultrasound, retrograde and excretory urography, radioisotope renography (scintigraphy), renal angiography, MRI, MSCT of the kidneys.

Ultrasound of the kidneys makes it possible to determine the absence of a kidney in its anatomical location and differentiate dystopia from nephroptosis. Excretory urography, as a rule, accurately identifies the abnormal localization of the kidney, the degree of its rotation and limited mobility. At sharp decline Retrograde pyelography is performed for renal function. During renal angiography, the level of origin of the renal arteries from the aortic trunk is determined. Differential diagnosis Anomalies are carried out with nephroptosis, tumors of the kidney, intestines, and appendages.

Treatment of kidney dystopia

Treatment of pathology is, if possible, conservative, aimed at eliminating the infectious process, preventing the formation of stones or removing them. In case of development of pyelonephritis, a course of treatment is carried out antibacterial drugs, sulfonamides, nitrofurans, agents that improve renal blood flow.

Kidney dystopia, complicated by calculosis or hydronephrosis, may require surgical removal kidney stones (pyelolithotomy, nephrolithotomy, nephrolithotripsy, etc.). If an abnormally located kidney dies, nephrectomy is indicated. Surgical relocation of the kidney presents significant difficulties due to the scattered type of blood supply and the small caliber of the vessels.

Prognosis and prevention

Patients with diagnosed kidney dystopia are subject to observation by a urologist. Further forecast determined by the presence of complications - hydronephrosis, pyelonephritis, renovascular hypertension, neoplasms. Pelvic dystopia of the kidney cannot be a contraindication for pregnancy, but it often causes complications leading to fetal death. Therefore, pregnant women with kidney dystopia with early dates should be observed by an obstetrician-gynecologist and urologist. Preventive actions not developed.