What Causes Nephroptosis & How Is It Treated?

Nephroptosis which in layman’s terms is called as floating kidney is a condition in which the kidney moves out of its normal anatomical space and descends more than 5 cm. This happens when the individual goes from a supine to an upright position. When upright, this translocation of the kidney can cause a variety of symptoms including severe pain in the abdomen and vomiting due to severe obstruction of the kidney. Nephroptosis is extremely rare and studies estimate that about 20% of females have Nephroptosis but very few actually tend to have symptoms due to the condition.^[1]

It is very rare for males to have this Nephroptosis. In more than 70% of the cases, it is the right kidney that gets affected with Nephroptosis. What exactly causes this translocation is not clearly understood and is not well defined in the literature. However, majority of the cases of Nephroptosis are seen in thin white females which points to fat depletion and weak fascial support as probable cause for this condition.^[1]

Additionally, it has also been observed that people with Nephroptosis tend to have abnormally long renal vascular pedicle which results in the kidney descending downwards. This article highlights some of the potential causes and treatment options for Nephroptosis.^[1]

As stated, Nephroptosis is a rare disease and this is the reason as to why this condition is not adequately understood. This is also the reason why not much data is available on the literature which is why most physicians are not sure as to the cause of this condition. There are many theories that have been postulated as to the cause of Nephroptosis. Some physicians suggest that anything or event that makes the ligaments that hold the kidney in position weak may cause the kidney to move out of its place causing Nephroptosis.^[2]

Some of the events that may lead to weakness of the ligaments include sudden weight loss as seen with malignant conditions. Females who are pregnant may also be at risk for having Nephroptosis due to weak ligaments. The same is the case after childbirth. An injury or trauma to the abdominal area or the spine may also cause the ligaments that hold the kidney in position to become weak causing Nephroptosis. People who do rigorous exercises also are at an increased risk for developing Nephroptosis.^[2]

As stated, females tend to develop Nephroptosis more than males. Additionally, low body weight also makes an individual vulnerable to developing Nephroptosis. An individual generally a female who has a history of frequent urinary tract infections also is at increased risk for developing Nephroptosis. Hypertension is also a common risk factor for Nephroptosis.^[2]

Coming to the treatment options for Nephroptosis, these may be both surgical as well as conservative. Noninvasive approaches towards treating Nephroptosis include exercises to strengthen the abdominal muscles and ligaments so that they are able to hold the kidney in position. Emphasis is also given to increase body weight through diet as this condition is mostly seen in people who are frail and thin with low body fat.^[2]

Despite these measures, if the individual finds no relief of symptoms then the physician may choose a surgical route. There are several techniques which can be employed to bring the kidney back into its normal anatomical space and fix it there. The efficacy of these procedures however remains unknown due to the rarity of the disease but some studies have reported good prognosis after surgical treatment of Nephroptosis.^[2]

Among all the surgical procedures used for treating Nephroptosis, laparoscopic renal fixation is the most preferred route. This procedure involves making a very small nick to get access to the kidney to bring it back to its normal position. The requirement of this surgery has been so minimal that it has not become a standard treatment for Nephroptosis as such and the prognosis postsurgery also remain unknown.^[2]

In conclusion, Nephroptosis is a rare medical condition in which the kidney moves out of its normal position and descends more than 5 cm when an individual moves from supine to upright. This condition is seen more in females than in males. Females with low body fat and weight are at maximum risk for developing this condition. It is very rare for an individual with Nephroptosis to have any symptoms. However in some cases when the patient moves from supine to upright position she may experience vomiting and severe abdominal pain.^{[1, 2]}

The primary cause for this condition is not yet known but some researchers suggest that weak abdominal muscles and ligaments that hold the kidneys in position may be the reason behind the kidney translocating. Treatment wise, both conservative and surgical options are available. Conservative treatments involve strengthening the abdominal muscles so that they can keep the kidney in position and also increase body weight with a well-balanced diet.^{[1, 2]}

There are also certain surgical procedures that are available for treatment of Nephroptosis; however, the efficacy of these treatments is not known due to the rarity of this condition.^{[1, 2]}

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