Nephroptosis: Floating (mobile) kidney as a cause of unexplained abdominal and flank pain

Overview

Renal ptosis, nephroptosis or “floating kidney,” describes a phenomenon where the kidney descends within the retroperitoneal and causes a range of symptoms including episodic renal colic-like severe pain, flank pain, abdominal pain, testicular pain that can be accompanied by nausea and vomiting.

  • The distance of descent downward of the kidney is defined as >5cm or two vertebral bodies while moving from the supine to erect position.
  • Diagnostic studies to confirm this elusive diagnosis include a range of different imaging modalities combined with supporting history.

Below is a list of articles I read to help me understand how I will approach this enigmatic and controversial diagnosis for a patient I care for who has suggestive symptoms.

I have shared this list for colleagues that may need to consider this diagnosis in a patient.

If you want to get a sense of what patients report and how nephropexy can resolve symptoms, read a few of the case reports. This diagnosis will not be easy to make, but if you make the correct diagnosis and treat the patient, you may save him or her a lot of pain and suffering.

 

Selected Literature

Hoenig DM, Hemal AK, Shalhav AL, Clayman RV. Nephroptosis: a “disparaged” condition revisited. Urology. 1999 Oct;54(4):590–6.

Nanayakkara PWB, van Bunderen CC, Santerse B. A bumpy ride to a discarded diagnosis. Lancet. 2007 Feb 3;369(9559):436.

Yoshida S, Matsumura M, Maekawa K, Minaga K, Kamata K, Nozawa M, et al. Recurrent abdominal pain caused by nephroptosis. Clin J Gastroenterol [Internet]. 2020 Feb 28; Available from: http://dx.doi.org/10.1007/s12328-020-01110-x

Taylor J, Prasad K, Rohrer R. Dynamic Renal Ptosis Demonstrated on 18F-FDG PET/CT. Clin Nucl Med. 2019 Apr;44(4):303–4.

Mogorovich A, Selli C, De Maria M, Manassero F, Durante J, Urbani L. Clinical reappraisal and state of the art of nephropexy. Urologia. 2018 Nov;85(4):135–44.

Arnerlöv C, Söderström M, Öhberg L. Mobile kidney pain provocation ultrasonography before surgery for symptomatic mobile kidney: A prospective study of 43 consecutive patients. Scand J Urol. 2016;50(1):61–4.

Golab A, Slojewski M, Gliniewicz B, Sikorski A. Retroperitoneoscopic nephropexy in the treatment of symptomatic nephroptosis with 2-point renal fixation. Surg Laparosc Endosc Percutan Tech. 2009 Aug;19(4):356–9.

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

Plas E, Daha K, Riedl CR, Hübner WA, Pflüger H. Long-term followup after laparoscopic nephropexy for symptomatic nephroptosis. J Urol. 2001 Aug;166(2):449–52.

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