Wandering kidney - Nephroptosis

Japanese: 遊走腎 - ゆうそうじん（英語表記）Nephroptosis
Wandering kidney - Nephroptosis

What is the disease?

Supine position ( harm ) The height of the kidneys in the standing position is 2 times higher than that in the lying position. Vertebral body ( I want to follow ) (About 10 cm) or more of kidney position Ptosis ( Kasui ) This condition is considered to be a partial symptom of organ ptosis (Figure 4).

What is the cause?

① Congenital factors Kidney Renal fibrous capsule ( Human rights violations ) The kidney is wrapped in a layer of fat called the Gerota fascia, which is made up of fat around the kidney. This disease occurs when the surrounding tissues that support the kidney are weak.

② Acquired factors: In addition to relaxation of abdominal muscles and decreased abdominal pressure, the decrease in perinephric adipose tissue can be mentioned. In any case, the right kidney is more likely to sag than the left kidney due to factors such as the weight of heavy organs such as the liver being placed on the kidney when standing.

How symptoms manifest

Patients often complain of lower back pain, flank pain, or lower back pain that subsides when lying down or sitting; in most cases, this is a dull pain that worsens when standing, walking, or bearing weight.

Hematuria, along with abdominal pain, is a common symptom of floating kidney, and is usually microscopic hematuria that is invisible to the naked eye. Although gross hematuria may be seen, it does not cause anemia. Also, when standing with the back arched, slight Proteinuria ( Protein ) Sometimes we acknowledge that.

As urinary symptoms Frequent urination ( Reception ) Some people complain of bladder irritation symptoms such as residual urine and pain during urination, but these are not specific symptoms of the wandering kidney. Other symptoms include loss of appetite, nausea, diarrhea, constipation, stomach upset, etc. Bloating ( Boumankan ) They may also make complaints such as:

Testing and diagnosis

Palpation of the kidneys in the supine and sitting positions and comparison of the position of the kidneys in the supine and sitting positions on intravenous urography are central to the diagnosis.

Intravenous urography can reveal the degree of renal ptosis during upright stress, as well as renal rotation, torsion, deviation, and Renal pelvis ( Jinu )・Calyx ( Jinpai ) We will observe changes in morphology, etc.

Treatment methods

If there are no symptoms, the patient should be monitored and monitored. Even if the patient has the above symptoms, conservative treatment should be prioritized. It is important to understand that this is not a serious disease and will not lead to kidney failure.

As a conservative treatment, thin people are encouraged to gain weight to increase the fat mass around the kidneys and provide support and reinforcement to the kidneys.

In addition, physical therapy involves exercise therapy to strengthen the abdominal and back muscles, and a corset or abdominal belt is used to maintain tension in the abdominal wall.

Nephropexy is performed very rarely as a stand-alone procedure for a wandering kidney.

What to do if you notice an illness

Please visit a urologist and have a specialist explain the disease to you and advise you on treatment options.

Atsushi Kurusu

Figure 4 Wandering kidney
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Figure 4 Wandering kidney


Source: Houken “Sixth Edition Family Medicine Encyclopedia” Information about the Sixth Edition Family Medicine Encyclopedia

Japanese:

どんな病気か

　臥位(がい)（寝た姿勢）での腎臓の高さに比べ、立位で2椎体(ついたい)（約10㎝）以上腎臓の位置が下垂(かすい)する状態を指します。本症は内臓下垂の部分症状と考えられています（図4）。

原因は何か

①先天的要因　腎臓は腎線維被膜(じんせんいひまく)に包まれ、その外側に腎周囲脂肪からなる脂肪被膜があり、さらに外部を腎筋膜（Gerota筋膜）という膜がおおっています。この病気は、これら腎臓を支えている周囲の組織が弱いために生じます。

②後天的要因　腹筋の弛緩、腹圧低下に加えて、腎周囲脂肪組織の低下があげられます。いずれにしても、立位では肝臓など重量に富む臓器の荷重負荷がかかるなどの要因から、右腎は左腎と比較して下垂しやすくなっています。

症状の現れ方

　臥位・座位などによりおさまる腰痛、側腹部痛、腰背部痛を訴えることが多く、その多くは鈍痛で、立位歩行や荷重などで、症状が悪化します。

　血尿は、腹痛と並んで遊走腎でよくみられる症状で、通常は目に見えない顕微鏡的血尿が主体です。肉眼的血尿がみられることもありますが、血尿により貧血を生じることはありません。また立位で背中を反る体位をとった時に、軽微な蛋白尿(たんぱくにょう)を認めることもあります。

　尿路症状として頻尿(ひんにょう)、残尿感、排尿痛などの膀胱刺激症状を訴える人もいますが、遊走腎による特異的症状とはいえません。そのほか食欲不振、吐き気、下痢、便秘、胃部膨満感(ぼうまんかん)などを訴えることもあります。

検査と診断

　臥位と座位における腎臓の触診と、静脈性尿路造影での臥位と座位での腎臓の位置の比較が診断の中心となります。

　静脈性尿路造影では、立位負荷をかけた時の腎臓の下垂の程度に加えて、腎臓の回転、捻転、偏位および腎盂(じんう)・腎杯(じんぱい)の形態変化などを観察します。

治療の方法

　遊走腎は症状がない場合はそのまま経過観察し、上記のような症状がある場合でも、原則的に保存的治療を優先すべきです。重い病気ではなく、腎不全にはならないことを理解することが重要です。

　保存的治療としては、やせている人は腎周囲の脂肪を増加させ、腎臓の支持・補強を行うため体重を増加させます。

　また、理学療法として腹筋・背筋力強化のための運動療法を行うとともに、コルセットや腹帯などを用いて腹壁の緊張を保持します。

　遊走腎に対する単独の手術として腎固定術が行われることは、極めて少数です。

病気に気づいたらどうする

　泌尿器科を受診し、専門医からこの病気について説明を受け、治療法に関して相談をしてください。

来栖　厚

図4　遊走腎
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図4　遊走腎


出典　法研「六訂版 家庭医学大全科」六訂版 家庭医学大全科について　情報

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