腎下垂症

抄録

Nephroptosis, unilateral or bilatral, must not necessarily produce subjective or objective symptoms. This we may call “benign” nephroptosis which does not require surgical correction.
The evaluation of evident subjective and objective symptoms is difficult. To establish clearly the kidney as causative factor the following tests are suggested:
1) After the horizontal pyelogram the vertical pyelogram should be taken only after the patient has left the table, has jumped hard several times and has coughed to dislocate the kidney. Otherwise the kidney may remain in its bed and hide a nephroptosis (Fig. 2).
2) The patient can demonstrate on the x-ray film with his own hand relieve and increase of pain in pressing the kidney upward or downward, placing it in its bed or to its lowest possible point (Narath) (Fig. 3. 4 & 5).
3) Hypotony of the renal pelvis, often encounted in nephroptosis, may be visible by the Hutter or psoasedge symptom (Fig. 6 & 7).
4) A better proof of demonstrating hypotony is acomplished by slow filling of the renal pelvis with a small amount of contrast medium in vertical position. Due to retarded dynamics the heavy contrast medium is not readily mixed with the residual urine in the pelevis. This leads to meniscus formation (Narath symptom) (Fig. 8 & 9).
A typical case of suburemia due to nephroptosis is presented (Fig. 10), another of hypertensison (Fig. 11).
Repercussions on the parenchyma of urine or contrast material in the renel pelvis under pressure due to blocking of the ureter are shown in Fig. 12, A-D.
The reader is referred to the legends of the illustrations.