The diagnosis Nephroptosis


  • Nephroptosis not easy
  • Errors in diagnosis Nephroptosis - it is not rare
  • Angiography - the most informative method of diagnosis Nephroptosis

  • Nephroptosis not easy

    Until recently it was regarded as nephroptosisthe disease is not life-threatening and causes a sensation of pain. But doctors and researchers alerted that surgery often does not bring satisfactory results, and this fact has forced them to take a closer look to this disease. What do they see?

    Disappointment in the surgical treatment of Nephroptosis,unsuccessful results of which had recently been observed quite often associated with the absence of clear indications to him, the wrong choice of the method of fixing the kidneys, the lack of information on changes in the kidney blood vessels and therefore the complications of this disease. The last years are characterized by an increased interest in Nephroptosis as the cause pyelonephritis, hypertension and hematuria.

    Studies in recent years related to the developmentangiography (X-ray examination of the blood and lymph vessels of the kidney), have established a significant change in the kidney when nephroptosis that cause severe functional and morphological disorders leading to serious complications.

    Errors in diagnosis Nephroptosis - it is not rare

    The diagnosis Nephroptosis

    Studies have explained the reason for the frequentfailures in nephropexy (operation "suturing" lowered the kidneys) when during the operation does not take into account the state of the cardiovascular system and the kidneys are not made correction of existing vascular disorders. In addition to diagnostic Nephroptosis and its complications, the use of angiography in the diagnosis to distinguish the true from the false nephroptosis caused kidney tumors, kidney nephroptosis and dystopia. It is these states are the most common cause of diagnostic errors. Of the 328 patients admitted to the hospital with a diagnosis of Nephroptosis, from 5.1% identified secondary nephroptosis caused by displacement of the kidneys down due to the pressure of other bodies, hydronephrosis, polycystic, kidney tumor compression of retroperitoneal space.

    Some patients have suffered in the last step -nephropexy. Before surgery, they have not made vazograficheskoe research and, as it turned out after his performance, dystopic kidney was found. Unnecessary tension renal pedicle entailed severe hemodynamic and urodynamic disorders in the kidney.

    As a result of the identified diagnostic errorsPatients had to be subjected to repeated surgical intervention. We have produced two nephrectomy due to wrinkling of kidney and kidney at 2 distopirovannyh installed in physiological position.

    Angiography - the most informative method of diagnosis Nephroptosis

    Performing nephropexy without priorangiography is unacceptable, because the excretory urography (one of the modern methods of diagnosis Nephroptosis) is sometimes difficult to distinguish from the dystopic kidney lowered. According to statistics, in such a situation the error observed in 15% of cases.

    When a kidney tumor in the force of gravity is shifted downwardand probing her mistake you can be taken for lowered. This error usually admit when examining the patient in the outpatient conditions when not produce X-ray radiography or a limited review. Less error occurs in a hospital, if the survey is not made in full or incorrectly elect a method of research. Confirmation of this fact is identified in the study 3 patients with renal tumors who have long established diagnosis Nephroptosis.

    kidney offset downwards by virtue of gravity, in additiontumors, can cause other pathological processes accompanied by an increase in body size and originally mistaken for nephroptosis, hydronephrosis, or pressure on her neighboring organs.

    To avoid diagnostic and tactical mistakesall patients nephroptosis, strongly recommend - along with excretory urography in the horizontal and vertical position to make the necessary vazograficheskie research. Because only then can determine the indications for surgical treatment and the right to outline the scope of the operation (it will nephropexy, correction or other vessels).

    In determining the necessary operationalNephroptosis treatment is also necessary to evaluate the results and arterio venography as indications for surgery are not so much the mobility of the kidney, as manifestations of the disease, its complications, the nature and extent of vascular disorders in the kidney. Where there is evidence of impaired venous drainage from the kidney (twisting of veins, scar adhesions in the area of ​​its confluence with the vena cava, intraorganic varices) nephropexy must be preceded by revision of the pedicle.

    Studies have shown thatdiagnostic and tactical mistakes, unfortunately not uncommon in medical practice, and they occur mainly due to the absence of oncological alertness, wrong choice of method of X-ray examination or failure of its volume, including angiography.

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