Synonyms.—Floating Kidney; Dislocated Kidney; Wandering Kidney; Renal Mobilis.
Definition.—A condition where the kidney is released from its moorings of fat, peritoneum, and blood-vessels, and occupies an abnormal position. Various terms are used to designate this condition according to the degree of displacement; thus a palpable kidney is one where the lower edge of the organ can be felt only on deep pressure. A movable kidney is one where the displacement is sufficient to enable one, by firm pressure, to pass the fingers over the upper end of the organ during deep inspiration; while a floating kidney has the field at large.
Etiology.—This condition may be congenital, though usually acquired. It is found more frequently in women than in men, and the right is the one most frequently affected, owing to its position beneath the liver, as with each inspiration the organ is depressed. Tight lacing favors its dislodgment, while repeated pregnancies give rise to relaxation of the abdominal walls. Tumors may also crowd the organ from its natural position. Resorption or wasting of the perirenal fat also favors this condition. In men, heavy lifting or trauma may give rise to it. It is not uncommon in neurasthenics. Drummond believed that in a majority of cases there was a congenital relaxation of the peritoneal attachments.
Symptoms.—There may or there may not be any subjective symptoms. In the former case, the discovery is made during an examination for some lesion foreign to the kidney, or discovered during- an autopsy. The most common symptom is a dull, dragging pain in the loins and abdomen, being more prominent on the affected side. With this are associated symptoms of neurasthenia and hysteria, generally reflex, and due to pressure upon some organ or part. Or the patient, discovering a tumor, allows his imagination to run riot; cancer is his diagnosis, and a legion of nervous symptoms follow.
Dyspeptic symptoms are quite common.
A twisting of the renal vessels, or strangulation or compression of the kidney, give rise to severe attacks of abdominal pain, vomiting, chills and fever, and frequently attended by collapse. These attacks are known as Diehl's crisis.
Palpitation of the heart is a common symptom with. floating kidney. There are so many symptoms due to reflex conditions, that the patient's life is made miserable, not so much from the kidney direct as from the nervous derangement.
The physical signs of movable kidney are the most important evidences in the diagnosis of the lesion, and are determined by palpation, percussion, and inspection, which gives the only reliable information. In examining the patient we have him lie on his back with the abdomen relaxed. Place the left hand under the lumbar region, and with the right manipulate the abdomen from above downwards. During the manipulation, if no positive results are reached, have the patient take a full inspiration, when the kidney may be outlined. In thin subjects the tumor mass (kidney), can be readily felt, though rarely can it be grasped in the hand.
Diagnosis.—By careful observance of the physical signs just mentioned the diagnosis is comparatively easy, though gallstones may be taken for a movable kidney; here, however, there is marked jaundice, which is nearly always absent in movable kidney. Abdominal tumors of various kinds are sometimes confusing, but a careful manipulation will generally enable the physician to tell the one from the other.
Prognosis.—Unless complications occur, life is never endangered, and many times a cure may be affected by proper bandaging, the use of pads, rest in bed, attention to diet, and finally by surgical measures.
Treatment.—The treatment for misplaced kidney consists of mechanical, dietetic, and surgical measures, medical treatment being only used to allay reflex disturbances, and give relief when the patient is suffering pain.
Anders suggests that, since emaciation and resorption of perirenal fat is a cause of wandering kidney, the restoration of these will assist in a cure, and advises rest in bed and a diet that is fat-producing. While this may be true theoretically, it is not likely to effect a cure very often. After replacing the kidney, the patient should lie in a recumbent position for a few weeks, and before leaving the bed, a firm binder, with pad, should be applied. The bowels should be kept in a soluble condition to avoid severe straining at stool, and the patient should be cautioned against any severe physical exertion. A snug abdominal support may assist in the cure by holding up the intestines, thus acting as a support.
Should these measures fail, nephrorrhaphy, or stitching the kidney in place till adhesions fix it permanently, must be a final resort. After the operation the patient is to keep his bed for several weeks, to prevent the sutured organ giving way. Should this surgical measure fail, nephrectomy or extirpation is the final measure, though this should be avoided where possible, for the history of successful nephrectomies is not very brilliant.