Kidney ectopia is a violation of the normal arrangement of organs. Ectopias are divided into congenital and acquired, bilateral and unilateral. During the period of embryonic development, the kidneys are laid in the pelvic area, therefore, more often, a pathologically located organ is found at the entrance to it or below. More rare localizations are thoracic, lumbar, iliac. In addition to the wrong location, with dystopias, the kidneys are often deformed, have an irregular shape, anomalies in the blood supply and ureteral outlet. Ectopia is often combined with congenital pathologies other organs. For example, underdevelopment of the uterus, fallopian tubes or ovaries.
Symptoms of ectopic kidney
Manifestations of pathology are most often associated with a violation of the outflow of urine and compression neighboring bodies. There may be pain in the pelvic region and lower back, colic, frequent urge to urinate, impaired defecation, nausea and vomiting. With the development of inflammation, there is an increase in temperature and deterioration general well-being. The incorrect position of the kidneys is fraught with the appearance of complications - increased pressure, the development of kidney stones, kidney failure. Timely access to a doctor and diagnosis of renal ectopia will prevent the occurrence life threatening states.
Diagnosis and treatment
A doctor can suspect ectopia if there are complaints about chronic pain in the pelvic region, frequent inflammatory processes, in case of detection of developmental anomalies urinary tract or genitals. Pelvic ultrasound, x-ray examination, excretory pyelography will help to confirm the diagnosis. Often the pelvic kidney bears little resemblance to a familiar organ and must be distinguished from tumor processes pelvic area. When the kidney is located in chest area it is visible on fluorography.
Treatment of renal ectopia is necessary in case of complications. Perhaps conservative and surgical treatment of the consequences of ectopia. In some cases, it is necessary to remove the altered organ. If the second kidney is functioning normally, such an operation does not affect the quality of life of the patient. Most often used non-surgical methods therapy aimed at correcting organ dysfunction.
Indications for surgery
Definition
Dystopia (ectopia) of the kidney is called its absence in the usual place, in the renal bed. Distinguish the following types Kidney ectopias (in descending order of frequency): simple, cross-fused, cross-unfused, and pelvic ectopia. The congenital absence of one or both kidneys is called renal agenesis.
Causes
With a simple ectopia, the kidney may not be in the renal bed at any level in the course of its physiological rise in the prenatal period. An ectopic kidney may take an uncharacteristic shape, as it "adapts" to the place of unusual localization. Such a kidney may appear as a palpable mass. The blood supply can come from different sources.
In fusion anomalies, the ectopic kidney usually fuses at the superior pole with the inferior pole of the orthotopic kidney. An ectopic kidney can be identified by its ureter, which crosses middle line of the body in the area of the entrance to the pelvis and flows into the bladder in a normal place (i.e., the mouth of the ureter of the cross-dystopic left kidney is located orthotopically, in the left part of the bladder triangle). The pelvis of an ectopic kidney is often located in front.
Symptoms
In most cases, patients with ectopic kidneys have no clinical symptoms, but voiding cystourethrography can reveal vesicoureteral reflux into the ectopic kidney. The abnormal anatomy of the LMS is conducive to urinary stasis and complications (stones and infection).
Diagnostics
Radiography. Anomalies of the kidneys with fusion in some cases are difficult to detect without the use of tomography. The horseshoe kidney would have been displaced to the midline. With pelvic ectopia, the kidney does not pass to the opposite side of the pelvis. A typical manifestation of a cross-ectopic kidney with fusion on an excretory urogram is S-shape kidneys.
CT scan. Both kidneys are on the same side of the spine (i.e. one kidney is cross-ectopic).
The ureter of the cross-ectopic kidney crosses the midline and flows orthotopically into the bladder triangle, and the ureter of the upper kidney flows into the triangle from its side. These data are sometimes difficult to analyze when cross-ectopic fused kidneys are located in the pelvic cavity.
With pelvic ectopia, the kidney will not be found in the renal bed, but in the pelvic cavity on the same side. The ureter of the pelvic kidney flows into the bladder triangle on its side.
Ultrasonography. Ultrasound can detect solitary hypertrophied kidney in combination with the absence of a kidney in the renal bed on the other side. However, if a kidney is not found on the same side (from the pelvis to the renal bed) when assessing the migration path, it is possible that best method detection of functionally intact renal tissue, there will be nephroscintigraphy.
Prevention
Treatment is not necessary, except in cases accompanied by clinical symptoms(eg, vesicoureteral reflux, infection, or kidney stones).
Agenesis of one of the kidneys is found more often in 1 in 500-1000 live newborns. It is usually asymptomatic and does not lead to kidney failure. Agenesis of both kidneys is incompatible with life.
The relationship between anomalies of the urinary and reproductive systems was noted.
- in men with agenesis of one of the kidneys, cysts of the seminal vesicles can be found on the side of the absence of the kidney;
- women with anomalies urinary tract, especially in those who are not able to conceive a child, one should look for anomalies of stops formed from the Müllerian duct.
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Simple ectopia kidneys. This anomaly is an incomplete movement of the kidney in the caudal direction, while its relationship with the ureter is absolutely normal, apart from a slightly changed direction due to the incomplete rotation accompanying this process.
Depending on at what stage of kidney migration the "stop" occurred, simple ectopia is divided into pelvic, lumbar and abdominal. The ectopic kidney may be slightly reduced in size, and its axis sometimes has an unusual direction (from slightly inclined to completely horizontal), while the pelvis is located in front.
Particular attention should be paid to the aberrant perfusion of the ectopic kidney, with many vessels coming from the more proximal large vessels, but never from the aorta at the level where the normal renal artery is normally located.
A simple ectopia of the kidney is usually not clinically manifested, only sometimes a tumor-like formation is accidentally detected during palpation of the abdomen in its lower sections. Most often, an ectopic kidney is detected during examination. beam methods on a different occasion. In patients with simple ectopic kidney, there is increased risk the development of hydronephrosis, stasis, infection or stones due to the anterior localization of the ureteropelvic segment and the possible high discharge of the ureter.
In pelvic and lumbar ectopia, the low-lying kidney is more prone to injury than the "normal" one, and therefore is often detected during examination for trauma in patients with microhematuria.
At timely diagnosis and appropriate treatment, if indicated, a simple ectopic kidney does not present any problems different or more difficult than those usually encountered in the treatment of patients with pathology of a normally located kidney.
Another very rare variant of kidney ectopia deserves mention - thoracic ectopia. This unusual type of ectopia, usually left-sided but sometimes bilateral, most likely results from accelerated process cranial movement of the kidney, which has time to pass through the Bogdalek fissure before the completion of the fusion of the elements of the diaphragm.
At the same time, through a posterolateral defect in the diaphragm, the kidney pulls its vascular pedicle and ureter along with it. The thoracic kidney is extrapleural and usually does not adversely affect lung function. This type of ectopia is not clinically manifested. Diagnosis is usually made by x-ray taken for another reason.
Cross ectopic kidney. When the kidney moving in the cranial direction under the influence of any forces deviates to the opposite side or beyond the midline, then an anomaly occurs, which is called the cross-ectopia of the kidney.
In rare cases (about 10%), a cross-ectopic kidney does not merge with the opposite kidney, while its axis usually has a horizontal or other wrong direction. The ectopic nonunion kidney is located, as a rule, below the non-ectopic one, functions normally and has a well-formed cavitary and urinary system.
In cases where a cross-dystopic kidney is the only one, there are usually associated anomalies of the genital area, in particular the absence of the vas deferens and cryptorchidism in boys and vaginal atresia or an anomaly in the development of one of the halves of the uterus in girls. In addition, quite often these patients have malformations of the skeleton and anorectal region.
There are several forms of a cross-ectopic fused kidney (see Fig. 47-2): S-shaped (or sigmoid), single, L-shaped, disk- or biscuit-shaped. None of these types of ectopy and fusion has any specific clinical features inherent in this particular form of anomaly.
The only problem in all patients with a cross-ectopic fused kidney is a violation of the outflow of urine due to the incorrect location of the kidneys, which contributes to the attachment of infection and the formation of stones. These complications can occur at any time.
In the literature, there are scattered isolated reports of cases of the formation of stones in such kidneys, which, as a rule, did not give symptoms.
Horseshoe kidney. The most common fusion anomaly is the horseshoe kidney. With this defect, two separate kidneys grow together with their lower, rarely upper poles, connecting to each other by a narrow segment of the renal parenchyma or fibrous tissue which is called the isthmus.
The horseshoe kidney is usually located lower than normal kidneys, which is explained by a violation of the process of cranial movement of the kidneys. Some researchers suggest that the movement is stopped by the fused isthmus located under the inferior mesenteric artery and holding the kidneys in a more caudal position.
Since fusion occurs before rotation has occurred, the pelvis and ureters are usually located in front of the isthmus, but may also be behind it. Variants of the anatomy of the horseshoe kidneys are extremely diverse (Fig. 47-3).
Rice. 47-3. pathological anatomy horseshoe kidneys.
Information about the frequency of horseshoe kidney is very contradictory, in the literature there are figures from 1:312 to 1:1800. The ratio of boys to girls is approximately 2:1. The incidence of horseshoe kidney in children is statistically higher than in adults, which is explained by the combined multiple anomalies that determine the survival rate of children with this defect.
Accordingly, not all patients with a horseshoe kidney survive to adulthood. As with all malformations of the kidneys, other anomalies of the genitourinary tract occur with a horseshoe kidney, for example, hypospadias and undescended testicles in boys, a bicornuate uterus and vaginal septa in girls.
Often, with a horseshoe-shaped kidney, anomalies of the urinary tract are also noted. The most common are ureteral duplication with or without an ectopic ureterocele, vesicoureteral reflux, obstruction of the pyeloureteral segment, and other anomalies that usually present clinically.
Accompanying hydronephrosis, infection and stones, as a rule, also give clinical symptoms, about which the examination is carried out, and the horseshoe-shaped kidney is revealed. From clinical manifestations the most common is a symptom complex associated with infection, but sometimes there is a tumor-like formation in the abdomen, caused by the horseshoe-shaped kidney itself or hydronephrosis, as well as hematuria.
In connection with high frequency associated anomalies and stratification various diseases all children with a horseshoe kidney should undergo a thorough comprehensive urological examination in order to maximize the anatomy and planning surgical intervention.
Of the anomalies of the cavitary system, the reason for surgical intervention the most common is obstruction of the pyeloureteral segment (PUS), associated primarily with primary internal stenosis or high ureteral outlet. The operation usually consists of a pyeloplasty and a side-to-side anastomosis with or without separation of the kidneys (Fig. 47-4).
Rice. 47-4. Pyeloplasty with side-to-side anastomosis, Hendren's method in the treatment of obstruction of the pyeloureteral segment of the horseshoe kidney.
The study of the long-term results of surgical treatment does not reveal any difference compared with the results of interventions in children with PUS obstruction of a normally located nonunion kidney. As for the life expectancy of operated children, there are no generalizing works in the literature in which the authors would analyze this indicator for large numbers observations.
The horseshoe kidney carries more high risk tumor development. Most often, these are hypernephromas, but there are also reports of tumors of the cavitary urinary system, as well as Wilms' tumor.
Tumors originating from the parenchyma, especially Wilms tumor, usually develop in the region of the isthmus of the horseshoe kidney. Fortunately, the horseshoe anomaly itself does not affect the outcome of the treatment of a tumor that has arisen in the horseshoe kidney.
The results of treatment in such cases depend on the histological nature of the tumor and the stage of its development. Although the anatomy of the horseshoe kidney and the localization of the tumor in the isthmus cause rather high technical difficulties of surgical intervention, nevertheless, the results of treatment, especially in children with Wilms' tumor, are no worse than with surgical treatment tumors of a normal, unfused kidney.
K.U. Ashcraft, T.M. Holder
ectopia renal system represents its incorrect position in abdominal cavity. This pathology often occurs in combination with exstrophy. Bladder. The disease is congenital, when the ascent of the organ to its main place is disturbed during embryogenesis, and acquired after surgery. While the anomaly prenatal development most often found in boys and is 1 case per 800 newborns with urological problems.
Treatment of the induced pathology with severe adverse symptoms is aimed at returning the kidney to its natural area or complete removal surgically. In other cases, the patient is registered for further observation and selection of the most effective treatment.
What is an ectopic kidney?
Clinical ectopia of the kidney is a violation in its location, in which its deformation is observed with anomalies in the blood supply and discharge of the ureter. However, they may be smaller, wrinkled and appearance different from normal organs.
The anomaly develops against the background of other pathologies, such as: uterine hypoplasia, bladder exstrophy, pathological disorder connection of the renal system with the ureter.
IN medical classification abnormal development of the genitourinary system this pathology is called Dystopia of the renal organ, when its location can be fixed in the most different places abdominal cavity. Pathology requires immediate treatment, depending on its form of manifestation.
Types of ectopia of the kidneys
The disease can be either unilateral or paired bilateral, when both organs are affected at once. At the same time, in medicine, the following forms of dystopia are distinguished according to the location of the paired organ:
- Lumbar;
- Pelvic;
- Iliac.
The listed forms of pathology belong to low dystopia and are located below the 4th section of the lumbar vertebra (normally between 1 and 3). On the basis of developmental disorders, such types of dystopia are distinguished as simple, cross with or without fusion, when the process of merging two kidneys into one abnormal organ occurs, that is, its doubling.
The reasons for the incorrect migration of the paired organ during the period of embryonic development are the following factors:
- Smoking;
- Alcoholism;
- Addiction;
- Reception medicines that are prohibited in the first trimester of pregnancy;
- Chemical poisoning.
In addition to these factors, there may be a hereditary predisposition if the family already had malformations of the genitourinary system.
Pelvic ectopic kidney
The pelvic location of the organ leads to impaired urination due to a short ureter, which is accompanied by a displacement of other nearby organs. For example, in a female, the renal pelvis is located between the rectum and the uterus, as a result it resembles ectopic pregnancy. In males, the location is closer to the bladder, which disrupts its natural work.
Pelvic localization of the kidneys is accompanied by symptoms such as:
- Failure of the menstrual cycle;
- Pain in the pelvic region, aggravated by menstruation;
- There may be nausea and stomach pain.
The main causes of the appearance of pelvic ectopia of the kidney indicate pathogenic factors that disrupt the development and movement of the paired organ from the small pelvis to the natural renal region.
Lumbar ectopic kidney
Lumbar localization of the renal organ in neonates with abnormal development urinary system observed much more often and accounts for 65-70% of all cases. In this case, the renal pelvis is located in such a way that it is easily palpable with fingers, like a tumor formation.
Lumbar dystopia may not manifest itself in any way at first, even when both the left and Right side. Over time, unusual discomfort appears in lumbar and develops kidney failure in conjunction with pyelectasis, which requires treatment so that the consequences are not severe. If not start timely treatment, there are problems in the urological and gynecological sphere.
Treatment of ectopic kidney
After the diagnosis, the doctor chooses the most effective and effective method treatment, medical or surgical. After the diagnosis is made, the doctor must clearly determine how to treat the ectopic kidney so that the consequences are minimal or nullified.
Because this anomaly renal development entails other types of diseases, constant monitoring is required internal organs and following a diet so as not to overload the digestive system.
For treatment without a pronounced clinic, the following agents are prescribed:
- Painkillers;
- Diuretics;
- antibiotics;
- vitamins;
- Immunostimulants.
Indication for surgical method treatment are signs such as: the formation of stones, severe incessant pain, difficulty urinating due to an excessively narrowed urethral orifice.
Consequences of an ectopic kidney
With ectopic kidney, frequent inflammatory processes are observed in genitourinary system in the form of pyelonephritis or pyeloectasia. This is due to the fact that the blood supply is loose and there is a decrease in the main protective function organism. If you do not follow the diet, abnormal development is accompanied by the formation of kidney sand and stones.
In more severe cases tuberculosis of the renal tissue, hydronephrosis, necrosis or complete death may occur. main reason severe consequences serves as non-compliance with the prescribed preventive measures. Therefore, it is very important to consult a doctor in time to conduct a thorough diagnosis and find the most effective and favorable method treatment of ectopia.
Most people are born with two kidneys, which are located retroperitoneally, on either side of the spine under the ribs. But sometimes the development of the kidneys can be disturbed. The following information will help you discuss your problem with your urologist.
What happens normally?
The kidney is an organ whose main function is to filter toxins from the blood and maintain proper blood pressure and produce red blood cells bone marrow. As the baby develops in the mother's uterus, the kidneys form lower in the abdomen and gradually rise to their final position and develop.
What happens with ectopic kidney?
The ectopic kidney is located in unusual place. Ectopic kidneys occur in 1 in 1,000 births, but only one in ten is diagnosed.
Some are discovered by chance, when performing any research not related to kidney pathology. The descent kidneys may be located on the way of their normal movement from the place of formation to the place of the final location. At simple version kidney ectopia are located on right side but in the wrong position. At cross version ectopic kidney is located on the opposite side from its normal location so that both kidneys are located on the same side. They may be unfused or fused. It is important to note that ectopia of the kidneys is often combined with anomalies of other organs and systems.
What are the symptoms of ectopic kidney?
Initially, the function of the kidney is not impaired, but due to the violation of normal anatomical relationships, disorders may gradually occur. Up to 50% of ectopic kidneys have at least partial block. If the obstruction to the outflow of urine persists for a long time, then there may be serious complications such as urinary tract infections, kidney stones, kidney failure. In ectopic kidneys, vesicoureteral reflux occurs more often, in which urine is thrown from the bladder into the ureter. Reflux that persists for a long time can cause infection of the kidney, which eventually leads to impaired kidney function. Also, with ectopic kidney, there may be concomitant strictures of the ureter.
Common symptoms that occur with ectopic kidney may be associated with urinary tract infections, abdominal pain, or a palpable mass in the abdomen.
What are the treatments for ectopic kidney?
Treatment for ectopic kidney is necessary in the presence of stricture or vesicoureteral reflux. If the kidney has not lost most its function by the time this anomaly is detected, it is possible to eliminate the stricture and vesicoureteral reflux with the help of surgery.
However, if kidney function is significantly impaired, nephrectomy may be the best option.
What happens after the removal of an ectopic kidney?
You will be able to live normal life after removal of a kidney, provided that the remaining kidney is functioning well.
The article is informational. For any health problems - do not self-diagnose and consult a doctor!
V.A. Shaderkina - urologist, oncologist, scientific editor of Uroweb.ru. Chairman
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