Abnormal Renal Mobility Research Articles

Abnormal renal mobility--an indication for surgical intervention.

Movable kidney is a debated entity and therefore not diagnosed in many cases. According to our experience the diagnosis should be made much more frequent in patients who suffer from loin and/or abdominal pain which is relieved by recumbent position. Twenty-nine cases of patients who suffered from loin and/or abdominal pain and were diagnosed as suffering from abnormal renal mobility by medical history, intravenous pyelogram, angiography and dynamic scanning were operated upon with a reported high rate of relief of pain (87%; 25/29). The technique employed was the modified Deming operation.

NEPHROPTOSIS AND HYPERTENSION

The degree of renal mobility was measured in patients with and without hypertension to evaluate a suggested causal relation between nephroptosis and hypertension. In contrast to men, women often showed pronounced renal mobility and the degree of renal mobility correlated positively with the blood-pressure. Fibromuscular dysplasia of the renal artery was always accompanied by a considerable degree of renal mobility on the side involved. The results of this study indicate that in women there may be an association between abnormal renal mobility and the development of high blood-pressure.

Medial ptosis of the kidney

Medial ptosis implies an abnormal renal mobility towards or across the midline of the body. In two cases presented, the right kidney could be moved across the spine to the left side. Six previous cases found in the literature are reviewed. They all involve adult females and, with one exception, the right kidney. The present author's cases had no significant symptoms, but others have been apparently relieved of relevant complaints by nephropexy. Medical renal ptosis can be confirmed by observing abnormal mobility when urography is performed in the lateral decubitus position. The normal appearance of the lateral decubitus urogram is demonstrated by a small pilot control series. However, one of the controls with ordinary nephroptosis also showed medial ptosis. This may be a much more frequent occurrence than indicated by the paucity of reports in the literature. The author suggests that an awareness of this diagnosis may lead to discovery of more cases by appropriate studies, which may be of occasional clinical significance.

Nephroptosis with nocturnal polyuria

Severe nocturnal polyuria is described in a hypertensive patient with unilateral nephroptosis. The normal diurnal rhythm of renal excretory activity was reversed. Results of postural studies of renal function and of the arteriographic appearance of the kidneys led to the hypothesis that during ordinary daily activities the mobile kidney became ischemic and caused retention of salt and water; on this basis the polyuria could be attributed to excretion of the excess salt and water during recumbency at night. Surgical correction of the abnormal renal mobility relieved the patient's distressing complaint.

UPRIGHT RENAL ARTERIOGRAPHY IN THE STUDY OF RENAL HYPERTENSION.

Renal arteriography was employed in 51 hypertensive patients in the upright position and was found to have several advantages over conventional techniques. Improved filling of the renal vascular tree was regularly observed and stenotic lesions of the renal arteries were discovered more readily. Nephroptosis was encountered in 12 of 17 patients with fibromuscular hyperplasia of the renal artery. This high incidence suggests that abnormal renal mobility may produce this obscure disease of the arterial wall. Evidence has been found that renal ptosis may cause orthostatic hypertension by elongating and narrowing the renal artery in the presence or absence of underlying stenotic disease.

Abnormal renal mobility and hypertension

Abnormal renal mobility and hypertension

Reversible suppressed function in unilateral renal malrotation.

Anomalous or faulty rotation of the kidney, a term applied to congenital variation in position, is seldom the cause in itself of renal functional disturbance.1However, in conjunction with intrinsic deformities of renal mass, such as horseshoe kidney, or with some of the common anatomic aberrations of vascular supply,2acute or chronic interference with renal function may occur.3Similarly, renal torsion, an acquired malrotation, such as results from growth of a retroperitoneal tumor, may impair function of the kidney. These rotational anomalies are clinically distinct from abnormal renal mobility for which nephropexy is advocated to relieve Dietl's crises4associated with mechanical obstruction.5 The renal pelvis faces anteriorly at the end of the first month of embryonic life. In the sixth week, the kidney derives blood supply from the adjacent area of the aorta, which will eventually be the aortic bifurcation. New arteries are acquired stepwise

Relation of Coincident Anomalies of the Gastro-Intestinal Tract and Renal Ptosis to Digestive Disturbance

Study of a group of patients with duodenal regurgitation revealed that congenital faults of the gastro-intestinal tract and of the urinary tract, and a short first metatarsal in the osseous system, were common. The digestive tract anomalies are seldom of clinical significance but act as signposts directing attention to the upper urinary tract as the reflex cause of the gastro-intestinal symptoms. Tixier and Clavel (1) showed by animal experimentation that traction on the renal pedicle produced definite reflex motor response in the gastro-intestinal tract. Smith and Orkin (2), inspired by that work, charted the reflex pathways over which such stimuli traveled and gave us the “reno-digestive reflex arc.” We thus have the explanation of why abnormal renal mobility and silent lesions of the upper urinary tract may give rise to symptoms in the alimentary tract. Abnormal renal mobility in women is found almost entirely in those with a short first metatarsal. Feet showing this characteristic are potentially weak and, when overused or fitted with short shoes, give rise to symptoms. Night cramps of the calf muscles are not uncommon, and the adductor longi muscles may be spastic. Study of additional cases since this paper was read shows that, if the pelvic muscles are examined, a spastic piriformis may usually be found, more often unilateral. This latter observation is important, as pressure on or massage of the piriformis may reproduce not only the low backache and supragluteal distress which occurs in so many of these cases but also, in about 20 per cent, will give rise to an indefinite distress or sometimes fairly sharp pain across the lower abdomen, between the navel and the symphysis pubis. Patients will state that this latter symptom is a distress or pain from which they frequently suffer and have attributed to gas. It is not the low right- or left-side pain from an overdistended kidney pelvis. One really puts his finger on the cause and exaggerates this distress if it is present or reproduces it if it is not. Gootnick (3) has discussed the mechanism of night cramps of the legs. Study seems to be indicated here to establish the “trigger mechanism” producing spasticity of the piriformis and sometimes, also, of the coccygeus and levator ani muscles, and to explain the association with abnormal renal mobility and short first metatarsals. A series of 179 patients (61 males and 118 females) was selected for this study because of the presence of duodenal regurgitation. The age grouping is shown in Table I. The significance of stasis and regurgitation has been a controversial subject. This is because the behavior patterns of the duodenum have been misunderstood. The close association of the pylorus, duodenum, and gallbladder must be recognized and they must be studied together. Delay in gastric emptying, duodenal regurgitation, gastrospasm and rapid gastric emptying require careful consideration.

NEPHROLYSIS, URETEROLYSIS AND NEPHROPEXY

There is probably no subject in medical literature which has given rise to such extreme divergence of opinion as the relative importance of abnormal renal mobility as an etiologic factor in the production of lumbar, abdominal and pelvic pain. In more recent years, the association of faulty ureteral or renal pelvic drainage with the persistence or recurrence of renal infection, the formation of calculi and the development of hydronephrosis has furnished additional study and controversy among those most interested in these subjects. With the marked improvement in modern methods of urologic diagnosis, notably the procedure of clearly outlining the ureter and renal pelvis with opaque material in the roentgenogram, it might seem that sufficiently accurate data could be obtained to decide whether or not, in a carefully studied patient, abnormal renal mobility actually resulted in distressing or damaging sequelae. On the contrary, additional information of obstructive processes in and about