Nephroptosis
Citation, DOI, disclosures and article data
At the time the article was created Henry Knipe had no recorded disclosures.
View Henry Knipe's current disclosuresAt the time the article was last revised Daniel J Bell had no financial relationships to ineligible companies to disclose.
View Daniel J Bell's current disclosures- Floating kidney
- Wandering kidney
- Ren mobilis
Nephroptosis, also known as floating/wandering kidney or ren mobilis, refers to the descent of the kidney more than 5 cm or two vertebral bodies when the patient moves from a supine to upright position during IVU 1,2.
Displacement can also occur medially across the midline, so-called medial nephroptosis 8,9. A 2013 case report even demonstrated anterior displacement 10.
On this page:
Clinical presentation
It may be present in up to 20% of young, slim females and is mostly asymptomatic 2. It is more often seen on the right side, and in up to 20%, is bilateral.
Symptoms may include flank pain on standing that is relieved on lying down, with the hypothesis being that movement of the kidney causes intermittent renal tract obstruction 1. Rarely it can cause intermittent nausea, vomiting, hypotension, oliguria and proteinuria, a syndrome known as Dietl's crisis 5. It may occur in childhood as well 11,12.
Radiographic features
Intravenous urography, renal scintigraphy with various tracers, CT and ultrasound may all allow for the diagnosis (performed supine and upright, lateral decubitus in medial ptosis) 3,4,8,9.
Color Doppler ultrasound (CDI) with estimation of renal arterial resistive index (RI) has been shown to be sensitive in detecting renal blood flow impairment and may thus aid in decision for laparoscopic nephropexy 3.
Treatment and prognosis
Laparoscopic nephropexy, usually reserved for cases with vascular and/or obstructive renal impairment, has been shown to be successful in relieving symptoms caused by renal compromise 3,6,7,12.
Differential diagnosis
After dynamic imaging depicting kidney descent with renal compromise, there is virtually no differential diagnosis. The entity may well be under recognized clinically 3,4,8.
References
- 1. Al-Tubaikh JA. Internal Medicine. Springer. ISBN:3642037089. Read it at Google Books - Find it at Amazon
- 2. Srirangam SJ, Pollard AJ, Adeyoju AA et-al. Nephroptosis: seriously misunderstood?. BJU Int. 2009;103 (3): 296-300. doi:10.1111/j.1464-410X.2008.08082.x - Pubmed citation
- 3. Strohmeyer DM, Peschel R, Effert P et-al. Changes of renal blood flow in nephroptosis: assessment by color Doppler imaging, isotope renography and correlation with clinical outcome after laparoscopic nephropexy. Eur. Urol. 2004;45 (6): 790-3. doi:10.1016/j.eururo.2003.12.011 - Pubmed citation
- 4. Murari SB, Gadepalli T, Rao VP et-al. Renal scintigraphy in diagnosis and management of nephroptosis. Indian J Nucl Med. 2012;27 (1): 52-4. doi:10.4103/0972-3919.108874 - Free text at pubmed - Pubmed citation
- 5. Zajaczkowski T. Joseph Dietl (1804-1878). Reformer of medicine and his contributions to urology. Urologe A. 2006;45 (1): 85-94. doi:10.1007/s00120-005-0955-9 - Pubmed citation
- 6. Barber NJ, Thompson PM. Nephroptosis and nephropexy-hung up on the past?. Eur. Urol. 2004;46 (4): 428-33. doi:10.1016/j.eururo.2004.03.023 - Pubmed citation
- 7. McDougall EM, Afane JS, Dunn MD et-al. Laparoscopic nephropexy: long-term follow-up-Washington University experience. J. Endourol. 2000;14 (3): 247-50. Pubmed citation
- 8. Bilal Hazaimeh et al. Symptomatic Medial Nephroptosis: Another Imaginary Disease, or Just Under-Diagnosed: A Case Report. JRMS December 2011; 18(4): 65-68
- 9. Patel AS, Barber-Riley WP. Symptomatic medial nephroptosis-an ultrasonic diagnosis. Br J Radiol. 1982;55 (651): 244-6. Pubmed citation
- 10. Sobel DW, Jumper BM. The case of the wandering kidney. Case Rep Urol. 2013;2013: 498507. doi:10.1155/2013/498507 - Free text at pubmed - Pubmed citation
- 11. Akberov RF, Khaĭrullova ZI. Complex radiation diagnosis of nephroptosis in children. Vestn Rentgenol Radiol. 2005; (1): 26-30. Pubmed citation
- 12. Heiland G, Unrein HD, Nentwich HJ. Surgical treatment of nephroptosis in children. Z Urol Nephrol. 1979;71 (12): 875-9. Pubmed citation
Incoming Links
Related articles: Anatomy: Abdominopelvic
- skeleton of the abdomen and pelvis
- muscles of the abdomen and pelvis
- spaces of the abdomen and pelvis
- anterior abdominal wall
- posterior abdominal wall
- abdominal cavity
- pelvic cavity
- perineum
- abdominal and pelvic viscera
- gastrointestinal tract
- spleen
- hepatobiliary system
-
endocrine system
-
adrenal gland
- adrenal vessels
- chromaffin cells
- variants
- pancreas
- organs of Zuckerkandl
-
adrenal gland
-
urinary system
-
kidney
- renal pelvis
- renal sinus
- avascular plane of Brodel
-
variants
- number
- fusion
- location
- shape
- ureter
- urinary bladder
- urethra
- embryology
-
kidney
- male reproductive system
-
female reproductive system
- vulva
- vagina
- uterus
- adnexa
- Fallopian tubes
- ovaries
- broad ligament (mnemonic)
- variant anatomy
- embryology
- blood supply of the abdomen and pelvis
- arteries
-
abdominal aorta
- inferior phrenic artery
- celiac artery
- superior mesenteric artery
- middle suprarenal artery
- renal artery (variant anatomy)
- gonadal artery (ovarian artery | testicular artery)
- inferior mesenteric artery
- lumbar arteries
- median sacral artery
-
common iliac artery
- external iliac artery
-
internal iliac artery (mnemonic)
- anterior division
- umbilical artery
- superior vesical artery
- obturator artery
- vaginal artery
- inferior vesical artery
- uterine artery
- middle rectal artery
-
internal pudendal artery
- inferior rectal artery
-
perineal artery
- posterior scrotal artery
- transverse perineal artery
- artery to the bulb
- deep artery of the penis/clitoris
- dorsal artery of the penis/clitoris
- inferior gluteal artery
- posterior division (mnemonic)
- variant anatomy
- anterior division
-
abdominal aorta
- portal venous system
- veins
- anastomoses
- arterioarterial anastomoses
- portal-systemic venous collateral pathways
- watershed areas
- arteries
- lymphatics
- innervation of the abdomen and pelvis
- thoracic splanchnic nerves
- lumbar plexus
-
sacral plexus
- lumbosacral trunk
- sciatic nerve
- superior gluteal nerve
- inferior gluteal nerve
- nerve to piriformis
- perforating cutaneous nerve
- posterior femoral cutaneous nerve
- parasympathetic pelvic splanchnic nerves
- pudendal nerve
- nerve to quadratus femoris and inferior gemellus muscles
- nerve to internal obturator and superior gemellus muscles
- autonomic ganglia and plexuses