Some contributions to diagnosis of movable kidney

Abstract

Normal and physiological position of the kidneys was studied by pyelogram teken in the supine (in 474 cases) and erect (in 163 cases) positions. The following results were obtained.1) The center of the pyelogram of the right side in the supine position is at the level of the second lumbar vertebra, and that of the left side is located by less than one half of the lumber vertebra higher. No sex difference was noted herein.2) The center of the renal pelvis in the erect position was lower than that in the supine position by one vertebral height on both sides in male and on the left in female. On the right side in female it may descend even by one and a half vertebral height.3) The inclination of the longitudinal axis of the kidney against the vertebra was less than 120° in the supine position. In erect position the inclination reduces at most to 0° on the left side, while on the right it may reduce further even to minus angle (upwards opened angle), but not to more than -20°.4) The kidney rotates around the renal pedicle during the erect podition, but not more than 35°.5) The kidney which migrates or rotates beyond the overmentioned range is estimated to be pathologic and is rightly called “movable kidney”.Abdominal or loin pain was complained more often (2 to 3 folds) in movable kidney than in the normal one. Ptosis of the stomach was noticed in about one half of the cases of movable kidney. Infection of the upper urinary tracts occurred in higher frequency than in the normal Urinary stagnation, mostly of slight degree, in the renal pelvis (hydronephrosis) was encountered in 13.3per cent of 323 cases of nephroptosis. Hydronephrosis of A grade was found in 2 per cent and Narath's symptom in 13.6per cent of cases.For the diagnosis of movable kidney non-compressing intravenous pyelography provides the best information, as it represents the most physiological condition. To be sure of obtaining enough films for diagnosis it is recommended to take films in the erect position at first, 5 minutes after intravenous injection of the contrast medium, followed by taking films in the supine position.We have obtained excellent films by this method in 80 per cent of cases, while in 30 per cent, at most, in which the pyelography in the erect position was made after that in supine position.