This means a distinctly mobile condition of the kidney (almost always
acquired, but may be congenital), due to the lax condition of the
tissues which support it and to the elongation of the renal vessels
which allow the kidney to move in certain directions. Rapid loss
of tissue that absorbs the fat surrounding the kidney is a cause.
There are almost invariably lesions in the dorso-lumbar region that
predispose to an abnormal mobility of the kidney. These lesions
undoubtedly weaken the innervation to the surrounding and supporting
kidney structures. A posterior spine, with consequent downward and
constricting displacement of the floating ribs, is common, although
lateral and anterior spines (dorso-lumbar region) may be found.
Strains, heavy lifting, and various violent exertions are important
exciting factors. Tight lacing, pregnancies, an enlarged liver and
gastro— and enteroptosis are also important factors. This condition
is found more commonly in women, and undoubtedly is a frequent cause
of direct, gastro-intestinal, reflex, and obscure disturbances. There
are very different degrees of mobility in different cases. It may be
so slight as hardly to be recognized or so great that it can easily
be felt by the hand through the abdominal walls, resembling a movable
tumor in the abdomen.
=Symptoms.=—Often there are no noticeable symptoms. Sometimes when the
displacement and mobility of the kidney are most marked, the reflex
symptoms are not noticeable. The right kidney is the one usually
affected, on account of its relation to the liver which moves during
the respiratory act. Usually there is pain in the lumbar region and
the patient experiences a heavy, dragging pain in the abdomen, which
especially manifests itself while standing and walking. There may be
intercostal neuralgia. Various colicky and other gastro-intestinal
pains, and nervous symptoms as neurasthenia, melancholia, hysteria and
headache are common. There may be obstinate indigestion, palpitation
of the heart, flatulence and cardialgia; also, an irritable bladder,
due to pressure. At times the kidney becomes tender and swollen as
a result of twisting of the renal vessels or of the ureter (Dietl’s
crises), causing engorgement of the organ; this may be associated
with agonizing pain and symptoms of collapse. Hydronephrosis may be
manifested.
=Diagnosis.=—The shape of the tumor, marked mobility, and lessened
resistance on percussion of the renal region will make the diagnosis.
The disorder very rarely proves fatal. In doubtful cases utilize the
X-ray.
=Treatment.=—Many cases rarely give trouble directly, but may be a
source of reflex and obscure symptoms. Attention to the general health
of the patient and persistent treatment of the dorso-lumbar region
greatly strengthen the relaxed tissues about the kidney and cure a
number of cases. Having the patient attempt to replace the organ after
he goes to bed will be of value. Treatment of the abdomen to strengthen
the walls and lessen any liver congestion and to keep the bowels active
is very beneficial. Teach the patient how to stand and walk correctly,
especially holding the abdomen in and up. A liberal diet to the point
of increasing the weight is worthy of trial. The use of supports is
not always satisfactory. Surgical treatment for fixing the kidney is
of permanent value, but do not advise operation unless absolutely
indicated. (See Prolapsed Organs, Part I).
To =determine the presence of a movable kidney=, it is best to have
the patient in the dorsal position, the head slightly lowered and
the abdominal walls relaxed by flexing the thighs moderately upon
the abdomen. Then with the left hand in the lumbar region behind the
eleventh and twelfth ribs, and the right hand in the hypochondriac
region, the kidney can usually be detected after full inspiration
followed by complete expiration; or, have the patient in a standing
posture with the body bent slightly forward and the hands placed upon
a table, then perform bimanual palpation; or, perform the manipulation
in the knee-elbow position. When in this position (knee-elbow), if
the kidney has become dislodged, a resonant note will be obtained by
percussion over the normal location of the kidney.