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Urinary Disorders

Problematic ptotic kidney

04/15/2011

Question:

I had my first kidney stone in 2001 and during a lithotripsy in 2002, to remove several calcifications the dr. realized the kidney was ptotic and in fact fooled him to thinking the calcifications had passed. Continually since then have been infections, stones., and constant mild to moderate pain in my lower back. While at my chiropractors office he recommended we re xray and it was he who saw the rt. kidney sitting on top of my pelvic bone, in standing position, and like myself believes it must not be draining. Local urologists seem puzzled, although to me it seems clear, it doesn`t drain, so I don`t release toxins easily and therefor, feel bad. I`m tired of just taking pain meds and living with the pain and leaking and pinching and lethargy, can you help??

Answer:

A ptotic kidney (nephroptosis) can sometimes result in obstructed drainage from the kidney in certain body positions (usually in standing up/erect position), when the kidney drops down from it's normal position. This can sometimes cause pain, which might be diffficult to diagnose with certainty. In such situations, it is reasonable to obtain two lasix renal scans (done by Nuclear Medicine) - in the supine/lying down position and then in the erect/standing up position, to try and objectively assess if there is any change in the the function/drainage of the kidney associated with the ptosis in the standing position.

If the ptosis is demonstrated along with findings of obstruction on the renal scan with change in position, then a surgical procedure called as Nephropexy (to fix the kidney and prevent ptosis) can be performed. This procedure can be perfomed using minimally invasive techniques such as laparoscopy or rrobotic surgery. It is important to know that sometimes the pain can still persist even after such a procedure. I would suggest that you discuss your clinical situation and the option of further evaluation (lasix renal scan) with your treating physician/urologist, and then proceed accordingly.

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Response by:

Krishnanath  Gaitonde, MD Krishnanath Gaitonde, MD
Assistant Professor of Clinical Urology
College of Medicine
University of Cincinnati