Wandering kidney

from Wikipedia, the free encyclopedia

As floating kidney , Senkniere or Nephroptosis ( latin Ren mobilis ) an abnormal mobility is kidney referred to through which it may occur depending on position for lowering the kidney. Slender people are more likely to be affected. The migrating kidney is usually asymptomatic, but can also lead to painful complaints and an obstruction of the urine flow . In the rare cases in which conservative therapy is not sufficient, the kidney is fixed surgically ( nephropexy ).

definition

Nephroptosis (from " ptosis ") is defined as the sinking of a kidney in an upright posture by at least 5 cm or the height of two vertebral bodies .

The clinical picture has been known since the 9th century. The term nephroptosis has been in use since 1885, but was originally used for all possible clinical pictures, the cause of which was considered to be a sagging of the bowels. A variety of ailments have been linked to nephroptosis, from kidney pain and urination discomfort to gastrointestinal complaints, weight loss, palpitations , anxiety , hysteria and madness . In up to a third of all diseases, a migrating kidney was considered to be the cause; the diagnosis was only made through a physical examination . Overdiagnosis in the past and an imprecise definition led to the fact that the clinical picture was almost forgotten in the middle of the 20th century.

Symptoms

The main symptom of migrating kidneys is flank pain or pulling in the flank, which improve when lying down. However, bloody urine (hematuria) and an increase in blood pressure while standing can also occur. Other symptoms include nausea , vomiting , heart pounding and decreased urine production .

The symptoms are explained by the fact that the sinking of the kidney impairs the flow of urine through the ureter or the nerves , renal pelvis and ureter are stretched. The kidney blood flow can be disrupted by kinking the kidney vessels . A disturbance of the arterial renal blood flow may by increased renin - secretion lead to high blood pressure, an obstruction of the venous Blutabstroms to blood stasis in the kidney and bloody urine.

Epidemiology

Nephroptosis is more common in women than in men (sex ratio 10: 1) and usually occurs between the ages of 18 and 45. Most often the right kidney is affected, possibly because the right renal artery is longer. The frequency of nephroptosis is increased immediately after childbirth (postpartum period), probably because of the stretched abdominal wall and the relaxed abdominal wall muscles during this time . Slender women are more often affected; it is assumed that a reduction in the amount of fat in the kidney fat capsule (perirenal fat tissue) promotes nephroptosis. Nephroptosis can also occur in the context of congenital hypermobility syndrome .

Diagnosis

The diagnosis of nephroptosis is generally made radiographically by iv pyelography while lying down and standing. Other possible diagnostic tests include ultrasound including color Doppler sonography of the kidneys and kidney scintigraphy .

therapy

In the past, attempts were made to push the kidney into its natural position manually by applying pressure from the outside when the patient was lying on his back, then the abdomen was bandaged or tied into a corset . Attempts were also made to strengthen the abdominal muscles with physical exercise and to increase the perirenal fat tissue through a high-calorie diet; Long bed rest with raised legs was also prescribed. Around 1880 an operation was developed in which the kidney was sewn to the surrounding structures in its natural position ( nephropexy ).

Today one treats conservatively with exercises to strengthen the abdominal muscles and corset care.

If conservative therapy does not improve the symptoms, the kidney capsule can be attached to the psoas muscle by laparoscopic surgery . Within 1 to 5 years, laparoscopic surgery leads to an improvement in symptoms in over 70% of those affected.

Artistic processing

Georg Kreisler has dedicated his eponymous chanson to the hiking kidney.

In 2013 the short story The Wandering Kid - An Adventure in the Middle Kingdom was published .

literature

Web links

Individual evidence

  1. ↑ Shalom J Srirangam, Alf J Pollard, Adebanji AB Adeyoju, Patrick H O'Reilly: Nephroptosis: seriously misunderstood? . In: BJU International . 103, No. 3, February 2009, pp. 296-300. doi : 10.1111 / j.1464-410X.2008.08082.x . PMID 18990154 .
  2. ^ NJ Barber, PM Thompson: Nephroptosis and nephropexy - hung up on the past? . In: European Urology . 46, No. 4, October 2004, pp. 428-433. doi : 10.1016 / j.eururo.2004.03.023 . PMID 15363554 .
  3. ^ PH O'Reilly, AJ Pollard: Nephroptosis: a cause of renal pain and a potential cause of inaccurate split renal function determination . In: British Journal of Urology . 61, No. 4, April 1988, pp. 284-288. PMID 3382880 .
  4. ↑ Dagmar M Strohmeyer, et al .: Changes of renal blood flow in nephroptosis: assessment by color Doppler imaging, isotope renography and correlation with clinical outcome after laparoscopic nephropexy . In: European Urology . 45, No. 6, June 2004, pp. 790-793. doi : 10.1016 / j.eururo.2003.12.011 . PMID 15149754 .
  5. ↑ C Arnerlöv, E Petersen, M Söderström, L Ohberg: Dynamic sonography with provocation of pain for diagnosis of symptomatic mobile kidneys . In: European Journal of Surgery . 167, No. 3, March 2001, pp. 218-221. PMID 11316410 . doi : 10.1080 / 110241501750099492 (currently not available) .
  6. Jump up ↑ JH Clorius, M Kjelle-Schweigler, P Georgi, HJ Sinn, K Moehring: Position dependent renogram changes of the mobile kidney . In: European Journal of Nuclear Medicine . 2, No. 2, June 30, 1977, pp. 67-70. PMID 891560 .
  7. ^ DG Wilcox: A Case of Nephrorraphy for Fixation of a Floating Kidney . In: Annals of Surgery . 7, No. 3, March 1888, pp. 192-194. PMID 17856213 .
  8. ↑ Yoshiyuki Matsui, Yosuke Matsuta, Kazutoshi Okubo, Koji Yoshimura, Akito Terai, Yoichi Arai: Laparoscopic nephropexy: treatment outcome and quality of life . In: International Journal of Urology: Official Journal of the Japanese Urological Association . 11, No. 1, January 2004, pp. 1-6. PMID 14678177 .
  9. ↑ Kathrin Brückmann : The Wandering Kid - an adventure in the Middle Kingdom . ISBN 978-3-8476-2818-7