DIAGNOSING NEPHROPTOSIS

Diagnosis of this condition is usually a diagnosis of exclusion when all other potential causes of abdominal pain have been ruled out and investigated.  The challenge with this diagnosis is that traditional CT scans, X-rays and ultrasounds are usually performed when the individual is laying down making a prolapsed kidney appear entirely normal. 

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Individuals with nephroptosis often struggle for a diagnosis due to a lack of awareness of the condition. The other difficulty receiving a diagnosis for this condition is that without clinical suspicion of nephroptosis, scans which detect the abnormal kidney descent  would not be routinely requested by healthcare professionals. 

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Only scans performed laying flat and also in the upright position for example an IVP scan (isotope renography) or ultrasound can demonstrate the positional change of the kidney individuals with nephroptosis. 

 

Individuals with nephroptosis may have a palpable abdominal mass which they may be able to move into a more anatomical position which can temporarily relieve symptoms.  If symptoms return when the kidney returns back into a prolapsed position,  a diagnosis of nephroptosis could be suspected. 

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Imaging studies

 

 * Each of these studies must all be performed with the patient both in the supine and upright position in order to  demonstrate the descent of the kidney (>5cm) and if there is any functional alteration/ obstruction in the upright position *

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• Ultrasonography (US) with Colour Doppler Imaging  (CDI)

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• Radioisotope Renography Scan (Tc-MAG3)

 

• Intravenous Urogram (IVU) 

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    (Ultrasound imaging with CDI has been demonstrated in several studies to have a significantly

    more sensitive detection of the changes in renal blood flow in comparison to isotope renography)

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Findings which support nephroptosis on imaging studies:

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• Ptosis >5cm when moving from a supine to upright position 

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• Obstruction or kink in the ureter when upright but not supine 

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• Decreased renal perfusion and GFR when upright but not supine  

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• Renal Pelvic Dilation/ Hydronephrosis

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• Delayed Emptying 

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** If you think you may have symptoms of nephroptosis and are struggling for a diagnosis you can request to have any of these imaging studies performed in a laying down and upright position. This can demonstrate evidence to support your diagnosis and help you get the appropriate treatment **

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