Positioning

After intubation and placement of all appropriate tubes and lines, the patient is rolled onto the lateral decubitus position, allowing the torso to fall back to an angle of 70° from the horizontal, with the side of the lesion in the nondependent position. The operating table is flexed in order to help distract the kidney from the nearby structures. The bottom leg is flexed at the hip and knee, whereas the upper leg remains straight. It is important to fully pad all pressure points, including both the top and the bottom legs and to ensure the patient is adequately secured to the operating table.

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

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.

Care must be taken to ensure that the suture only catches the renal capsule without penetrating the renal parenchyma

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