Synonyms:—Dislocated kidney; floating kidney; wandering kidney.
Definition:—A condition in which the kidney is separated from its supports and is movable in the abdominal cavity by changes in the position of the patient or from exterior causes. A distinction is made by most writers between a movable kidney and a floating kidney. In the former case the kidney retains its main position behind the peritoneum, showing but slight lateral movement, the movement being upward or downward, the organ being sometimes distinctly outlined when crowded upward. When the organ falls so far forward as to draw with it the peritoneum, which envelops it, but permits the kidney to move freely laterally on its pedicle, which consists of the ureters and vessels as well as of the peritoneum, it is then described as floating kidney. The condition is almost invariably unilateral.
Etiology:—The condition occurs more frequently in females than in males, the proportion being at least seven to one. About the same proportion also exists in favor of the right kidney. It occurs more commonly in tall, slender women, those who have practiced tight lacing or who have been subject to undue muscular effort or to sudden falls. Persistent high reaching or lifting has caused it also. In other cases no known cause may be attributed to its occurrence, as the symptoms have been present for a long time with but little inconvenience, and the condition is only accidentally diagnosed. It often appears after the first pregnancy, but sometimes does not appear until after multiple pregnancies. It may result from wasting disease, with extreme reduction of fat, or it may depend upon the development of abdominal tumors, which displace the organ. There seems to be in these patients inherent weakness of the supports or a laxness of muscular fiber. It is not uncommon among hysterical patients or neurasthenics, and the probable outcome may be a source of constant anxiety so great as to result in monomania.
Symptomatology:—The symptoms are largely subjective. The patient is conscious of some moving object in the side, there is a sensation of pressure and heaviness in the loins, with a dragging pain after physical exercise or prolonged walking, which is easily distinguished from that which occurs from uterine displacement. Occasionally there are sudden attacks of sharp, colicky pain, but this is rare. There may be only an aching sensation in the kidney. A common result is disorder of the gastrointestinal tract. It induces the various forms of indigestion, with slight nausea, and occasionally there is some jaundice, with hepatic colic. Usually there is constipation. There is often palpitation, irregular heart action, with feebleness, and in rare cases some edema of the ankles. The condition interferes very materially with the menstrual function. In rare cases there may be some torsion of the ureter, which results in renal hemorrhage or pyuria; or there may be an extreme quantity of the urates in the urine.
While the symptoms when present are very distressing, I have several patients yet under observation, in whom I diagnosed movable kidney many years ago, who have suffered but little inconvenience from the condition, and care but little about it. With these there was prescribed a careful mode of life, and dietary measures were suggested.
Diagnosis:—Careful palpation where but little fat is present will determine the presence of the dislocated kidney below the ribs. Pressure will show that it is movable. It may be found elsewhere in the abdominal cavity, and may be easily moved. Changing the position of the patient causes the individual to plainly feel a change in the position of the kidney. Pressure upon the organ causes a sensation of nausea and discomfort very objectionable to the patient. If a thin patient lies prone upon the back, with the limbs flexed, with pressure made from above with the right hand downward, while the left hand is pressed upward in the lumbar region, the organ may be distinctly outlined. Steady pressure should be made with the right hand until the muscular rigidity is entirely overcome. Then if the patient, after a deep inspiration, exhales freely, the fingers passed down with the exhalation will overcome all resistance and may almost grasp the organ.
Treatment:—In mild cases no treatment is needed. The patient's mind must be freed from anxiety concerning the outcome of the condition by the positive assurance of its probable harmlessness. She should be careful to avoid muscular strain and overexertion, and if the symptoms are at any time aggravated the patient should spend some days quietly in bed. I have applied a compress or pad over the upper end of the kidney and over this a firm bandage, to be worn for stated periods or when the patient is obliged to exercise physically to any undue extent, with good results. These cases should avoid overeating as well as the accumulation of gas in the stomach or bowels, and constipation.
An operation for the relief of the condition has been satisfactory in a few cases. But usually the unpleasant features are not sufficient to make it necessary for the patient to submit to an operation.