B28. Ptosis of the kidney: Symptoms, diagnosis, and treatments

From greek.doctor

Nephroptosis is a condition when the kidney which is not fixed to the retroperitoneum and therefore “floats”. The kidney will drop > 5 cm or > 2 vertebral columns when switching from supine to upright position. It's more common in thin females. In the upright position, the renal artery or pelvis may be compressed, causing renal ischaemia or upper urinary tract obstruction.

Clinical features

  • Often asymptomatic
  • Feeling of heaviness in abdomen
  • Pain after standing for long
    • Pain is relieved by lying down
  • Dietl’s crisis
    • Due to decreased renal perfusion and urinary obstruction
    • Severe flank pain
    • Haematuria/proteinuria
    • Tachycardia
    • Oliguria

Diagnosis and evaluation

  • In upright position
    • Urine analysis
      • RBC, protein
    • BP
  • Supine and standing intravenous pyelography
  • Doppler ultrasound
    • Detect decreased perfusion in upright position compared to supine
  • Radionuclide imaging

Management

  • Indication for surgery
    • Orthostatic hypertension
    • Orthostatic perfusion disturbance
    • Orthostatic urinary occlusion
    • Chronic pain
  • Techniques
    • Conservative
      • Weigh gain (for thin persons)
      • Abdominal exercise
      • Abdominal wall binders
    • Laparoscopic nephropexy
      • Most common
      • Suture lower pole of kidney to muscle
    • Percutaneous nephropexy
      • Alternative
      • Invented by professor at POTE uro clinic