Nephroptosis: What you need to know
In some cases, nephroptosis can cause severe symptoms, including flank pain and blood in the urine.
The condition has a long history of controversy that surrounds its diagnosis and treatment. However, imaging studies can now provide confirmation of its presence and of what is known as a floating kidney.
What is nephroptosis?
Nephroptosis is the medical term used for floating or mobile kidneys.
Nephroptosis is when there is increased mobility in the kidneys. People with nephroptosis have kidneys that move downward out of their normal position when they stand up.
The condition can lead to intense abdominal pain, nausea, and vomiting when standing, but it may also cause no symptoms at all.
Nephroptosis has long been controversial. The term was first used in 1885. Since then, it has been associated with many different symptoms, including:
Due to the variety of symptoms linked to nephroptosis, doctors began to disregard it as a real disease.
Today, however, the presence of nephroptosis can be confirmed through the use of medical imaging done while a person is standing and laying down.
As far as the treatment options are concerned, these have also been widely debated for many years.
For a long time, the treatment method of choice was to use surgery to attach the floating kidney to the abdominal wall. However, the procedure fell out of favor because of the risks and the fact that it did not always resolve the symptoms.
Today, some surgeons will still perform this procedure if someone shows long-lasting symptoms of nephroptosis.
Because nephroptosis is not well understood, doctors are not certain what causes the condition.
Some doctors believe that nephroptosis may be caused in part by any event that weakens the ligaments that hold the kidney in place within the body. These events could include any of the following:
- sudden, dramatic weight loss
- pregnancy and childbirth
- injury to the abdomen or spinal column
- frequent intense exercise
People with nephroptosis tend to have certain common traits. These traits may make a person more likely to develop nephroptosis.
Females are more likely to have nephroptosis than males. Other factors that may put a person at risk include:
- low body weight
- recurrent urinary tract infections or stones
- high blood pressure
- larger than usual area in the body containing the kidneys
Severe pain in the flank may be a symptom of nephroptosis.
Symptoms of nephroptosis can vary in intensity. Most people who have nephroptosis will not have many symptoms, or they will be mild.
The symptoms may include a feeling of heaviness or dragging in the abdomen when standing that is relieved when lying down.
However, in a small percentage of people with nephroptosis, symptoms can be severe. These can include the following:
- severe flank pain that comes and goes
- blood in the urine
- abnormally rapid heart rate
- nausea and vomiting
- producing only small amounts of urine
When a person experiences these symptoms, it is known as Dietl's crisis.
Nephroptosis is unlikely to be dangerous. However, there are complications that can occur. These include:
- kidney stones
- kidney infections
- high blood pressure
- lack of blood flowing to the kidneys
A person with nephroptosis can expect other possible causes of their symptoms to be worked through during a diagnosis.
Doctors will often test the blood and urine. Blood work will sometimes come back normal while blood will be found in the urine. At this time, a doctor may order imaging studies.
Nephroptosis can best be diagnosed by a series of imaging studies that create what is known as a urogram. If a doctor suspects nephroptosis is the cause of a person's symptoms, they will likely order the test to be done with dye added to the bloodstream to help them view the kidneys.
The test should be done when the person is laying down and when they are standing up. The images in a person with nephroptosis clearly show the kidney descending down by approximately 5 centimeters.
Abdominal wall strenghtening exercises may improve the symptoms of nephtoptosis.
There are many treatment approaches to nephroptosis. Some doctors recommend starting treatment with noninvasive approaches, such as weight gain or exercises to strengthen the abdominal wall.
If symptoms do not improve with these treatment options, doctors may consider surgery. There are several techniques that can be used to fix the mobile kidney into a permanent location.
Due to the rarity of nephroptosis, however, not much is known about surgical outcomes and whether or not surgery treats the symptoms effectively. Some research does suggest that those who undergo a surgical treatment may have good outcomes.
Laparoscopic renal fixation appears to be the most promising surgical treatment available. With this technique, only a small cut is made to allow the surgeon to access the kidney.
As the need to perform this type of surgery is so small, this procedure has not become standardized yet, and outcomes have not been well studied or recorded.
There is evidence suggesting that the majority of people who meet certain surgical criteria and have a surgical procedure performed will experience some amount of pain relief.
However, it is still unclear how long the pain relief will last, if the condition will recur, and to what extent most people can expect to find long-term relief from nephroptosis.