Nephroptosis, also referred to as a “wandering” or “floating” kidney, is a condition in which the kidney descends more than 2 vertebral bodies or >5 cm during a position change from supine to upright.1,2 It is possibly due to a defect in the renal fascia and perirenal fat, and the kidney can return to its normal anatomical site with position change. Abdominal pain is the most common symptom, likely due to acute obstruction or ischemia, reflecting effects on the ureter or renal vessels. Hypertension may occur in nephroptosis. In this case, a woman in her 40s with hypertension, microscopic hematuria, and recurrent acute episodes of abdominal pain and nausea accompanied by worsening hypertension was eventually diagnosed with nephroptosis, and following surgical repair (nephropexy), she became symptom free. The figures show radioisotope imaging of the kidney with Tc99m-MAG3 (mercaptoacetyltriglycine; MAG3 scan) in the (A) seated position with the right kidney showing a caudal displacement and rotation and (B) supine position with normal location of both kidneys.
Abdominal pain with transient micro- or macroscopic hematuria can occur in an acute episode, and more chronically, hypertension could arise due to a chronic overstretching and dysplastic vascular wall change of the kidney artery or effects on the sympathetic nervous system.3 The diagnosis is a diagnosis of exclusion after ruling out other causes of abdominal pain.
Article Information
Authors’ Full Names and Academic Degrees
C.R. Susanto, MD, and Anne Arens, MD.
Support
None.
Financial Disclosure
The authors declare that they have no relevant financial interests.
Peer Review
Received July 30, 2019. Direct editorial input from the Editor-in-Chief. Accepted in revised form August 8, 2019.
References
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