Nephroptosis

Medically reviewed by Carissa Stephens, RN, CCRN, CPN on September 19, 2017Written by Jacquelyn Cafasso on September 19, 2017

Overview

Nephroptosis is a condition in which one or both kidneys drop into the abdomen when standing up. The kidneys are a set of two bean-shaped organs responsible for filtering waste from the blood and producing urine in the body. They’re located in the abdomen on either side of the spine, just below the rib cage. Nephroptosis may also be called floating kidney, wandering kidney, or renal ptosis.

The vast majority of people with nephroptosis don’t experience any symptoms and don’t require any treatment. People with severe cases might need a surgery called laparoscopic nephropexy to fasten the kidney in its proper place. However, most cases of nephroptosis are benign and don’t require medical care.

Symptoms

Most people with nephroptosis have no symptoms at all. In some individuals, symptoms occur when standing and are often relieved when lying down. These symptoms include:

  • a sharp side (flank) pain that radiates into the groin
  • nausea
  • vomiting
  • high blood pressure
  • an abdominal mass when standing upright
  • a weighing feeling in the abdomen
  • hematuria (blood in the urine)
  • proteinuria (excessive protein in the urine)
  • a history of repeated urinary tract infections (UTIs)

Roughly 70 percent of cases of nephroptosis affect the right kidney, 10 percent affect only the left kidney, and 20 percent affect both kidneys.

What causes nephroptosis?

Nephroptosis is a congenital condition, which means you are born with it. Like the other organs, the kidneys are relatively mobile. They can shift normally a couple centimeters without problems. In nephroptosis, however, the kidney or kidneys descend more than five centimeters when moving from a lying-down position to standing up. The exact reason for this is not well understood. It’s believed that the movement of the kidney is related to insufficient support from certain structures or the connective tissue surrounding the kidneys.

Nephroptosis is more common in women than in men, particularly in women who are thin. It’s estimated to occur in up to 20 percent of women. However, since 80 to 90 percent of people with nephroptosis don’t have any symptoms, exact numbers aren’t known.

Treatment

Nephroptosis is considered a benign condition. Treatment is only recommended in people with symptoms.

In the past, weight gain, frequent lying down, abdominal corsets or bandages, and abdominal exercise were recommended to help treat symptoms. Unfortunately, such conservative treatments have shown little success in managing symptoms. They are no longer recommended.

Nephroptosis is now treated with a surgical procedure known as laparoscopic nephropexy. It’s important to carefully consider the risks of having surgery. In this procedure, the floating kidney is secured in its normal position. Laparoscopic nephropexy is a minimally invasive modern treatment. It’s done under general anesthesia. The procedure generally takes 45 minutes and requires a hospital stay of two to four days.

In the past, nephropexy was a controversial procedure. It was often ineffective and carried a high risk of death. These issues may have been caused by poor diagnosis and because it was done as an open surgery. The procedure was so ineffective, that for some time it was nearly completely abandoned by urologists.

The modern version of the procedure is much safer because it’s done laparoscopically. This means the procedure is performed through small incisions with the aid of a camera. Advancements in diagnosis and surgical methodology have also made the surgery much more effective.

Complications

Some people with symptomatic nephroptosis may experience a syndrome called Dietl crisis. In Dietl crisis, the floating kidney obstructs the ureter, the narrow tube leading from the kidney to the bladder.

This can result in:

  • violent flank pain
  • nausea
  • chills
  • tachycardia (fast heart rate)
  • low urine output
  • hematuria (blood in the urine)
  • proteinuria (excessive protein in the urine)
  • an enlarged, tender kidney

Dietl crisis is usually resolved by lying down and bringing the knees up into the chest.

People with nephroptosis may also experience frequent UTIs. A UTI is a bacterial, fungal, or viral infection of the urethra, bladder, or kidneys. Symptoms of a UTI in the urethra or bladder include:

  • burning with urination
  • increased frequency of urination
  • bloody urine
  • cloudy urine

When the kidneys are involved, UTIs can be life-threatening. Symptoms of UTIs involving the kidneys include:

  • pain and tenderness in the upper back and sides
  • chills
  • fever
  • nausea
  • vomiting

Outlook

The majority of people with nephrotosis don’t have any symptoms at all and the condition is harmless. No treatment is recommended in these cases.

In people with symptoms, surgery is usually the only effective treatment to help relieve symptoms. In the past, surgery for nephrotosis was risky and had a high mortality rate. Modern surgical procedures are safe and effective.

One study evaluated the short- and long-term effectiveness of laparoscopic nephropexy. Some people reported a significant decrease in pain, a decrease in UTIs, and an overall improvement in quality of life following the procedure. There were no major complications during the course of the study.

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