Citation, DOI and article data
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.
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, 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.
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 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.
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.
- 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