Description:

The label of ‘an ineffective treatment for an imaginary disease’ has largely been successfully stuck to the condition of nephroptosis and its surgical management, nephropexy. As a result, younger urologists, especially in the US and UK, have little knowledge of the condition nor why such accusations were made. In this review we explore the historical background to this statement, including descriptions of some of the more exotic surgical procedures employed in the past and visit the diagnosis again in the setting of the modern era, armed with more sophisticated diagnostic tools and less invasive and thus morbid surgical techniques. We aim to demonstrate that with appropriate diagnostic criteria, the diagnosis of symptomatic nephroptosis can be reliably made and that laparoscopic techniques provide an excellent approach in the successful surgical management of this condition. Four females were admitted with hypertension. Other causes of hypertension were excluded on clinical grounds. Digital substraction angiography performed in 3 patients revealed no stenosis of the renal arteries. The 99mTc-Mag3 renogram showed diminished perfusion and excretion on the affected side. Right-sided nephropexy was performed in all 4 cases via lumbotomy after which all 4 patients became normotensive. We conclude that nephroptosis is a considerable cause of renovascular hypertension and deserves particular attention in cases of possible renovascular hypertension when angiography shows no stenosis. We also conclude that renography is the preferred diagnostic method in the diagnosis of renovascular hypertension due to nephroptosis.

Vertical and medial nephroptosis was assessed on 60 consecutive excretory urographic examinations. Ptosis, both vertical and medial, was seen more commonly in females, and vertical ptosis was more frequent than medial ptosis. In our series there was no significant evidence of predominance on the right side. Dietl crisis, nausea, vomiting, hypotension, oliguria, or orthostatic hypertension was not encountered. Nephtroptosis was mostly asymptomatic. In thos patients with symptoms, lumbar pain was common and could be either aggravated or relieved by change in position. A new sign, paradoxic displacement, is described. This could be of value to the surgeon and radiotherapist in evaluating enlargement of huge abdominal — a difficult task to acess huge abdominal mass - a difficult task to assess clinically.

The degree of renal mobility was measured in patients with and without hypertension to evaluate a suggested causal relation between nephroptosis and hypertension. In contrast to men, women often showed pronounced renal mobility and the degree of renal mobility correlated positively with the blood-pressure. Fibromuscular dysplasia of the renal artery was always accompanied by a considerable degree of renal mobility on the side involved. The results of this study indicate that in women there may be an association between abnormal renal mobility and the development of high blood-pressure.

With Regards
Susan
Journal Coordinator
Global Journal of Research and Review