Nephroptosis

　　The kidneys are located in the renal fossa on both sides of the thoraco-lumbar region. Due to the strong longitudinal muscles of the back and the fixation of abdominal organs, they generally do not move too much. However, because there is a potential loose space below the perinephric fat sac, when abdominal pressure decreases, the kidneys may shift downward, causing nephroptosis.

　　Nephroptosis can cause various pathophysiological changes in the kidneys, common complications include the following:

　　1, Chronic nephritis:It refers to the diffuse or focal inflammatory changes in the bilateral glomeruli caused by various etiologies, with different pathological types. The clinical onset is insidious, the course is protracted, and the disease usually progresses slowly. It is a general term for a group of primary glomerulonephritis.

　　2, Hydronephrosis:Due to the obstruction, accumulation, and retention of urine from the kidneys, renal pelvis and calyces gradually expand, leading to increased intrarenal pressure, which causes atrophy and destruction of renal parenchyma, collectively known as hydronephrosis.

　　3. Pyelonephritis:Pyelonephritis refers to inflammation of the renal pelvis, which is usually caused by bacterial infection, generally accompanied by inflammation of the lower urinary tract. It is difficult to differentiate strictly in clinical practice. According to the clinical course and disease, pyelonephritis can be divided into acute and chronic stages.

　　4. Renal calculi:Refers to the stones occurring in the renal pelvis, renal calices, and the junction of the renal pelvis and ureter. Most of them are located within the renal pelvis and calices, and renal parenchymal stones are rare. Radiographs show single or multiple circular, oval, or obtuse triangular shadows in the renal area.

　　5. Renal ischemia:Renal ischemia is one of the causes of acute renal failure. Hyperosmotic agents cause renal ischemia and hypoxia because most contrast agents are hyperosmotic, with a concentration of 1400-1800 mOsm/L, and a high iodine content of up to 37%. When hyperosmotic contrast agents reach the kidneys, on the one hand, they can cause vasoconstriction of the renal vessels, reduce renal blood flow, and lead to renal ischemia.

　　In addition, kidney ptosis itself can affect other organs. Compression of the superior mesenteric artery can cause congestion of the cecum, leading to chronic appendicitis. Compression of the duodenum can cause pyloric stenosis, leading to dilatation of the bile duct and stomach. Kidney ptosis can be accompanied by gastrointestinal symptoms (such as bloating, indigestion, nausea, vomiting), hematuria, hypertension, and neurasthenia, among other clinical manifestations. It is noteworthy that the occurrence of kidney ptosis sometimes is accompanied by other visceral ptosis, such as gastroptosis.

　　Mild kidney ptosis does not pose serious harm to the body, but severe kidney ptosis can cause ureteral torsion and induce hydronephrosis, which can damage kidney function. So, what are the typical symptoms of kidney ptosis?

　　1. Urinary system symptoms

　　Most patients have lumbago, some patients have symptoms of chronic urinary tract infection, mostly urinary frequency, urgency, and other bladder irritation symptoms. A few cases are accompanied by a history of low fever or recurrent fever. Occasionally, there are symptoms such as edema of the lower extremities.

　　2. Gastrointestinal symptoms

　　Due to the traction of the renal activity on the abdominal plexus, it often leads to gastrointestinal symptoms, mostly bloating, nausea, vomiting, and decreased appetite.

　　3. Neurotic symptoms

　　Such patients are often very anxious, accompanied by insomnia, dizziness, fatigue, and memory loss, with an incidence rate of about 1/5. The occurrence of these symptoms is not necessarily proportional to the degree of kidney ptosis. Sometimes, even if the degree of ptosis is not severe, it can cause relatively obvious symptoms.

　　4. Kidney area percussion pain

　　Some cases have kidney area percussion pain, because the right kidney is anatomically lower in position and the renal fossa is shallower, so kidney ptosis on the right side is more common than on the left.

　　Kidney ptosis is a common disease, but more than 80% of the cases of kidney ptosis are asymptomatic and are often discovered during abdominal examination. Patients with kidney ptosis often experience symptoms such as pain, lumbago, and back pain, especially after exercise, when symptoms may worsen. So, how should we prevent the occurrence of kidney ptosis?

　　1. Diet and nutrition

　　Body weakness and the reduction of adipose tissue in the body are one of the important causes of kidney ptosis. It is necessary to strengthen nutrition, eat more animal high-fat foods, and increase body weight. When gastrointestinal function is poor, it is appropriate to regulate the spleen and stomach, and use drugs to aid digestion.

　　2, Physical exercise

　　Strengthen physical exercise, improve physical fitness, can run long distances, take a walk, practice Tai Chi, etc. Especially pay attention to the exercise of abdominal muscles, such as push-ups, single bar, double bar, etc.

　　3, Mental adjustment

　　Patients with hypoplasia usually have a long history of illness and are prone to produce negative emotions such as depression and fear, which are not conducive to the treatment and recovery of the disease. According to the reasons for the negative emotions produced by the patients, targeted persuasion and education should be carried out to help patients build confidence and patience in overcoming the disease.

　　4, Fertility control

　　Women who have given birth to too many children are prone to hypoplasia. Implementing family planning, avoiding unplanned pregnancies and induced abortions, and controlling fertility are important measures to prevent hypoplasia. When the body is weak or hypoplasia is present, sexual activity should be appropriately restricted.

　　5, Labor and rest in harmony

　　Too much comfort, lack of exercise of the abdominal muscles, is not conducive to the fixation of the kidneys; too much fatigue, excessive consumption of body fat, is also not conducive to the fixation of the kidneys. Therefore, a combination of work and rest should be maintained, and neither overwork nor overrest should be allowed.

　　The specific examination items that patients with hypoplasia need to undergo are as follows:

　　First, X-ray examination

　　Intravenous pyelography must be followed by an upright film to understand the degree of mobility, but since the upright film must be taken immediately upon standing, otherwise the contrast agent will be excreted and the kidneys will not be visible. Therefore, sometimes the kidneys have not yet descended to their usual position.

　　Second, ultrasonic examination

　　After half an hour in a head-down, feet-up position, the mobility of the kidneys can be determined by using ultrasound to check the position of the kidneys before and after movement.

　　Third,低头卧位试验

　　Instruct the patient to lie in a head-down, feet-up position for 3 days (a brick can be raised to the height of the long diameter of the bed leg), and measure the urine routine or the urine blood cell excretion rate per hour before going to bed and after neutralization, and observe whether the symptoms are relieved. If the blood cells in the urine decrease significantly or even disappear after sleeping, and the symptoms are relieved, it supports the diagnosis of hypoplasia. If the symptoms are not relieved, hypoplasia can be ruled out.

　　Fourth, water injection test

　　To determine whether the patient's lumbar pain comes from the kidneys, water can be injected into the renal pelvis through the ureteral catheter inserted via cystoscopy until the patient feels distension and pain in the腰部. If the nature and location of the pain are similar to those during normal episodes, it is positive and supports the diagnosis of hypoplasia; if not similar, it is negative and not a symptom caused by hypoplasia.

　　Fifth, urine routine examination

　　It can be found that the number of red blood cells varies, and there may be protein occasionally. It can also be used for contrast experiments, that is, to ask the patient to urinate before going to bed, sleep in a supine position, collect urine samples the next morning, and collect another urine sample after getting up and moving around. Observe the difference in red blood cell counts between the two samples. Usually, the red blood cell count in the second sample should be higher than that in the first sample. In the case of concurrent infection, pus cells may be present in the urine.

　　Sixth, excretory or retrograde pyelography

　　The first and last X-ray films taken in the supine and upright positions, respectively, are used to determine the position of the renal pelvis. If the renal pelvis is one vertebral body lower than the normal position, it is considered to be hypoplastic. If it descends to the level of the transverse process of the third lumbar vertebra, it is grade 1; if it descends to the fourth lumbar vertebra, it is grade 2; if it descends to the transverse process of the fifth lumbar vertebra, it is grade 3; and below the fifth lumbar vertebra, it is grade 4.

　　Being thin and having a reduction in adipose tissue in the body is one of the important causes of nephrectropia. Nutritional supplements should be strengthened, more animal high-fat foods should be eaten to increase weight. When gastrointestinal function is poor, it is appropriate to regulate the spleen and stomach, and to use drugs that help digestion. Strengthen exercise to improve physical fitness, such as long-distance running, walking, Tai Chi, etc. Pay special attention to abdominal muscle exercise, such as push-ups, single bar, double bar, etc. Pay attention to personal hygiene, especially the hygiene of the genital area, to prevent secondary infection and exacerbate kidney damage.

　　Most patients with nephrectropia have mild symptoms or are asymptomatic, so no special treatment is needed. If the pain is severe or complications occur, treatment can be considered, including non-surgical and surgical treatment.

　　1. Non-surgical Treatment

　　After diagnosing nephrectropia, regardless of the degree, it is advisable to first undergo non-surgical treatment, especially when there are only clinical symptoms without complications. Non-surgical treatment includes high-temperature and high-calorie diet, increasing perinephric fat; more bed rest, raising the thighs when lying down; strengthen exercise, increase perinephric fat; more bed rest, raising the thighs when lying down; strengthen exercise, increase abdominal wall tension; abdominal massage, eliminate infection foci; use various types of abdominal bands and kidney supports.

　　2. Sclerosing Agent Injection

　　After injecting the sclerosing agent into the perinephric fat capsule, a chemical and aseptic inflammation is produced, and the kidney adheres and fixes with the surrounding tissues. Common drugs include quinine gelatin, phenylacetic acid, autologous blood, etc. The indications are severe symptoms that affect work and life. Any narrowing of the renal pelvis and ureteral junction, wandering blood vessels or fibrous bands compressing the ureter, etc., are contraindications for mechanical obstruction. After injection, the patient should be in a head-down position for 1 week and then in a supine position for 1 week before getting up to move around. A repeat injection can be performed for failures.

　　3. Nephrectropia Fixation

　　The indications for surgery are severe pain lasting more than 3 months, and sometimes or long-term use of analgesics; standing renal function decline or renal hydrops; more than 3 urinary tract infections per year; combined with kidney stones, hypertension. The contraindications for surgery are neurasthenia or total visceral prolapse, symptoms are not related to body position, that is, symptoms do not relieve when lying flat, and it is also not suitable for surgical treatment.