Patient Selection And Diagnosis

A history of flank or loin pain, relieved by lying down, is the most common symptom of patients with nephroptosis.

Sometimes, the full range of symptoms of Dietl's crisis may be seen as the initial presentation. Physical examination, especially with the patient in the upright position, usually reveals palpation of a mobile mass in the lower abdomen. Reduction of the mobile mass back to its normal position in the retroperitoneum with relief of symptoms is highly suggestive of the diagnosis.

Intravenous urography, usually performed in the supine and erect positions, has been the primary diagnostic tool for the assessment of nephroptosis. The ability to reproduce symptoms after the administration of a diuretic, with the patient upright, assists in confirming the diagnosis.

Erect and supine diuretic renography-documented renal obstruction, decreased renal perfusion, and/or changes in the degree of renal function has been used to identify patients with functional nephroptosis and has been recommended as the most definitive diagnostic study.

Retrograde pyelography in both supine and erect positions has also been used as an alternative diagnostic tool, but is more invasive than renography. Ultrasonography can also be used to confirm a mobile, ptotic kidney and can reveal hydronephrosis, with positional change. Recently, the use of ultrasound Doppler was proposed as a diagnostic tool for patient with nephroptosis by detection of changes in renal blood flow. The resistive index was measured in the segmental arteries, with the patient in both the supine and the erect position. In comparison with isotope renogram, resistive index measurement by Doppler ultrasound appears to be significantly more sensitive in detecting renal blood flow impairment (10).

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