IS Case 214: Right nephroptosis

Parul Patel, MD


Imaging Sciences URMC 2008
Publication Date: 2009-05-22

History

Patient is a 27-year-old female with intermittent but worsening right flank pain and right abdominal pain.

Findings

Prompt, bilateral renal tracer activity is visualized on renal scan, with symmetric intensity, but apparent asymmetric size (left > right). After patient was converted to supine position, the apparent size discrepancy resolved, with kidneys in more normal position. Asymmetric renal function, (right > left), which is reduced bilaterally, revealing bilateral pelvicalyceal retention that responds normally to Lasix (when patient supine). Right nephroptosis and probable rotation when patient is upright, with normalization when patient supine.

Diagnosis

Right nephroptosis

Discussion

Nephroptosis is the descent of a kidney by 5cm or more on orthostasis. It is known to be more common in women and affects the right kidney more commonly than the left. This condition occurs bilaterally in 20% of cases. It is commonly thought to occur in slim young woman due to the fact that they tend to have little supportive perineal fat. Although nephroptosis is thought to occur commonly, it is rarely thought to cause symptoms. When there are symptoms present, nephroptotic pain is usually the most common presenting symptom. However, recurrent upper tract urosepsis, hypertension and renal stone disease have also been seen. The classical history is usually of flank pain in the upright position that reduces or is relieved by lying down. This symptomatology is related to intermittent functional excretory obstruction. On occasion, there can also be forceful traction on the renal artery, leading to ischemia and pulling on the perirenal nerves. Diagnosis of nephroptosis can usually be achieved by intravenous pyelography by obtaining erect and supine films, and/or radioiosotope renography. These studies demonstrate the classical renal descent with significant rotation and decrease in renal blood flow when the patient moves from the supine to the erect position. In the past, nephropexy was the mainstay of treatment for nephroptosis. Modern urologists however have the benefits of laparocopic techniques to provide patients with minimally invasive treatment options.

References

  1. Barber NJ, Thompson PM. Nephroptosis and nephropexy--hung up on the past? Eur Urol. 2004 Oct;46(4):428-33. [PMID: 15363554].

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