Nephroptosis
Introduction
Introduction to renal ptosis Renal sag refers to the condition in which the kidney moves beyond the normal range with respiratory activity, and thus causes the urinary system and other symptoms. Normal kidneys generally have an activity within 3 cm of respiratory activity. Most patients have a sore waist. Some patients have symptoms of chronic urinary tract infections, mostly urinary frequency, urgency and other bladder irritation. A small number of cases are also accompanied by a history of hypothermia or recurrent fever. Occasionally, the lower extremity edema and other performance. basic knowledge The proportion of illness: 0.005%-0.008% Susceptible people: no specific population Mode of infection: non-infectious Complications: chronic nephritis hydronephrosis pyelonephritis kidney stones chronic appendicitis pyloric obstruction
Cause
Cause of renal ptosis
Damage (20%):
The occurrence of renal ptosis may be related to damage (such as falling from a height or the body is violently oscillated), sedentary and standing for a long time, and so on. It may be a single factor, but most of them are the result of several factors.
Abnormal physiological structure (30%):
The occurrence of renal ptosis may be related to abnormalities of the body's physiological structure such as shallow kidney socket, long kidney pedicle, decreased perirenal fat, and loose connective tissue of the kidney.
Increased abdominal pressure (30%):
Increased pressure abdominal pressure (such as chronic cough, constipation) or sudden decrease in abdominal pressure (such as childbirth) can also cause renal ptosis.
Pathogenesis:
Renal sag can pull or distort the renal blood vessels, causing renal blood supply disorders, leading to kidney congestion, swelling, resulting in colic, hematuria, proteinuria or even no urine; the kidneys move down and cause the ureter to twist and become an angle, resulting in Hydronephrosis, and secondary infections and stones, renal ptosis often accompanied by other internal organs drooping.
Prevention
Kidney drop prevention
Kidney drooping care:
1) Dietary nutrition: The body is thin, and the reduction of body fat tissue is one of the important causes of kidney sag. Should strengthen nutrition, eat animal high-fat foods, increase weight. When gastrointestinal dysfunction, the spleen and stomach can be properly adjusted, and drugs that help digestion can be used.
2) Physical exercise: strengthen exercise, improve physical fitness, and can run, walk, and play Tai Chi. Pay special attention to abdominal muscle exercises, such as push-ups, horizontal bars, parallel bars, etc.
3) Prevention of infection: pay attention to general health, especially pay attention to genital hygiene, prevent secondary infection, and aggravate kidney damage.
4) Fertility: Women who have too many births are prone to kidney ptosis. Family planning is implemented.
Complication
Renal ptosis Complications Chronic nephritis, hydronephrosis, pyelonephritis, kidney stones, chronic appendicitis, pyloric obstruction
Renal ptosis can also cause a variety of renal pathophysiological changes, including chronic nephritis, hydronephrosis, pyelonephritis, kidney stones, renal ischemia, hypertension and renal atrophy. In addition, the sagging kidney itself can affect other organs and oppress the mesentery. The arteries can congest the cecum, which can cause chronic appendicitis. Compression of the duodenum can cause pyloric obstruction, bile duct and gastric dilatation. Renal ptosis can be accompanied by gastrointestinal symptoms (such as bloating, indigestion, nausea, vomiting), hematuria, and high Blood pressure, as well as clinical manifestations such as neurasthenia.
Symptom
Renal ptosis symptoms common symptoms fatigue dyspepsia hernia nausea bloating dizziness low back pain with kidney area sputum pain
Kidney ptosis occurs mostly in young women. The hospital analyzed a group of 100 cases of renal ptosis, with 71% of women. The age is more than 20 to 40 years old (83%), which is related to the younger middle-aged women's physical load, the age of childbearing, the relaxation of the abdominal wall muscles after birth, and the sudden decrease in postpartum abdominal pressure.
The course of disease accounts for 60% in June to 3 years. Most of them are diagnosed because of backache, chronic urinary tract infection, repeated hematuria and other symptoms.
Urinary system symptoms
Lumbar soreness accounted for 92%, more than 50% of patients have symptoms of chronic urinary tract infections, mostly urinary frequency, urgency and other bladder irritation. One third of the cases are accompanied by a history of hypothermia or recurrent fever. Occasionally, the lower extremity edema and other performance.
Digestive symptoms
Because of the kidney activity, the traction of the celiac plexus often leads to gastrointestinal symptoms, mostly bloating, nausea, vomiting, and decreased appetite.
Neurological symptoms
Such patients are often nervous, accompanied by insomnia, dizziness, fatigue, memory loss, etc., the incidence of which accounts for about 1/5.
The above symptoms are not necessarily proportional to the degree of renal ptosis. Sometimes, although the degree of sagging is not heavy, it can cause more obvious symptoms.
Examine
Renal ptosis
In 46% of cases, there is a pain in the kidney area. The right kidney is 64%, and the left side is 22%. Because the anatomical right kidney is located at a lower position, the kidney socket is shallower. Once it is hit by the liver, the right kidney sag is also more than the left side.
(a) X-ray examination of intravenous pyelography
It is necessary to add a standing film at the end to understand the degree of activity, but since it must be immediately engraved at the standing position, the kidneys cannot be displayed after the contrast agent is exhausted, so sometimes the kidney has not sagged to the usual position.
(two) ultrasound examination
The activity of the kidney can be obtained between the position of the kidney and the position of the kidney after the activity, half an hour after the low foot height.
(3) Low lying position test
The patient's head is low in the high position for 3 days (can raise the height of a brick at the foot of the bed), and the urine routine or hourly urine cell excretion rate is measured before and after the bedtime, and the symptoms are relieved. If the blood cells in the urine are significantly reduced or even disappeared after bedtime, the symptoms are relieved, and the diagnosis of renal ptosis is supported. If the symptoms are not relieved, the factors of renal ptosis may be excluded.
(4) Water injection test
In order to determine whether the patient's low back pain is from the kidney, the cyst can be injected into the renal pelvis after intubation through the ureter until the waist feels painful. If the nature and location of the pain are similar to those in the usual attack, the diagnosis of renal ptosis is supported. Similar to the negative, not the symptoms caused by renal ptosis.
(5) Urine routine examination
Red blood cells of different numbers can be found, and even protein can be used. It can also be used as a comparative test, that is, sputum patients urinate before going to bed, sleep in the supine, leave the urine specimen the next morning, and leave 1 urine specimen after getting up, observe two The difference in red blood cell count between the specimens, usually, the red blood cells in the second specimen should be more than in the first specimen, and there may be pus cells in the urine when the infection is combined.
(6) Excretory or retrograde pyelography
First, take the supine position X-ray film and finally take the erect position to understand the location of the renal pelvis. If the renal pelvis is lower than the normal position, the vertebral body is the ptosis. If it falls to the third lumbar vertebrae, the level is 1 degree. The fourth lumbar vertebrae were 2 degrees, which was 3 degrees to the fifth lumbar vertebrae and 4 degrees below the fifth lumbar vertebrae.
Diagnosis
Diagnosis of renal ptosis
diagnosis
According to the complete medical history and physical examination, the diagnosis can be made initially. The physical examination should be able to lick the kidneys. The kidneys are usually easy to reach. When the palpation is difficult, the patient can go up and down the stairs and then perform the palpation. Helps to lick the kidneys, standing and lying position IVP and B-ultrasound can further confirm the diagnosis.
Diagnostic criteria: The patient's symptoms, signs, and X-ray examinations can be combined to determine the degree of renal ptosis.
Mild: There are typical symptoms of back pain, no or only touching the inferior pole. Some patients have pain in the kidney area. The renal activity is 1 vertebral body in the venous pyelography. The renal activity is 3cm in the ultrasound examination. Sometimes there are hematuria (mostly microscopic examinations) or complications of urinary tract infections.
Moderate: There are clear symptoms of back pain with digestive system and neurological symptoms, which can affect the kidney. The renal activity in the angiography is within the two vertebral bodies. Ultrasound examination has an activity between 3 and 6 cm. Coming with complications of hematuria or urinary tract infection.
Severe: In addition to clear symptoms and signs, the renal activity in the angiography is more than two vertebral bodies, or although there are no more than two vertebral bodies, but there is obvious ureteral distortion, hydronephrosis, combined stones or renal function decline, ultrasound Check the renal activity above 6cm.
Differential diagnosis
1. Heterotopic kidney: It is a congenital abnormality of the kidney position. It can be located in the chest, retroperitoneum, pelvic cavity, etc. The ectopic kidney can be found during physical examination, but the position of the kidney does not move with the change of body position. Road angiography, B-ultrasound can confirm the diagnosis.
2. Polycystic kidney: It is also a congenital malformation of the kidney, which is characterized by upper abdominal mass and hematuria. When the physical examination, it can touch the kidney in the kidney area. Generally, both sides can touch the kidney, without mobility, after X-ray examination and B-ultrasound can help diagnose.
3. Kidney tumor: Generally, when there is a lumbar mass, it is already in the late stage of the tumor, there will be hematuria, pain symptoms, physical examination can be found that the tumor is relatively fixed, and there is tenderness, X-ray and B-ultrasound, CT examination helps to determine diagnosis.
4. Hydronephrosis: It can also be expressed as a lumbar mass, and the mass can be gradually increased, but the palpation can be sac sexy, the radionuclide kidney diagram shows the obstruction curve, and the B-ultrasound shows the cystic mass.
Other diseases that need to be identified include repetitive kidneys, retroperitoneal tumors, etc., and identification of renal ptosis is not difficult, mainly depending on the texture of the mass, mobility, urinary X-ray examination, B-ultrasound and CT examination results.
