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Percutaneous Nephropexy
Ismail A., Zaghmout O., Muzrakchi
A., El Sherif A. and Al Dabbagh M.
Hamad Medical Corporation Doha, Qatar
  Case
Report :
A seven-year-old girl presented with recurrent
left renal pain, generalized weakness and lack
of energy. Ultrasound scanning showed bilateral
pelvic kidneys. Intravenous urography (IVU) demonstrated
bilateral floating kidneys (Figures 1 a, b). Nuclear
scintigraphy performed in both the upright and
recumbent positions showed slight impairment of
drainage in the upright position on both sides.
Percutaneous nephrostomy was performed on the
symptomatic left kidney (Figure 2). The technique
is well described by one of our authors(1).
The patient was kept in a slight head down position,
at an angle of 15°, for seven days post-nephrostomy.
The nephrostomy tube was kept for 10 days.
Figure 1a: IVU
showing floating kidneys
Figure 1b: IVU showing floating kidneys
Figure 2: Percutaneous nephrostomy in left upper
calyx.
The patient has remained asymptomatic for eight
months after the procedure, she has gained weight
and is a much happier child. Follow up IVU, with
inspiration and expiration views, showed no alteration
in the position of the left kidney but there was
a slight lateral re-orientation of its pelvis.
The right kidney remained mobile.
 Discussion:
Nephroptosis is asymptomatic in most people although
in some it may present with recurrent renal pain
and a sense of weight or weakness in the abdomen.
The etiology of the pain in this condition is
not certain although kinking of the pelvi-ureteric
junction causing some drainage impairment. Kinking
of the renal vessels leading to renal ischemia
and stretching of the peri-pelvic nerves are thought
to be possible mechanisms for this pain.
Neurasthenia is closely linked to nephroptosis,
as was the case in our patient. This is thought
to be due to the chronic pain experienced by these
patients.
The diagnosis of this condition is achieved by
excretory urography in the upright position and
the demonstration of movable kidneys on applying
pressure to the lower abdomen. Impairment of kidney
drainage in some patients can be demonstrated
by isotope renography.
The traditional surgical treatment of a confirmed
symptomatic floating kidney is open surgery and
fixation of the mobile kidney in a high retroperitoneal
position. This, of course, carries the risks of
any open surgery.
Recently there have been various reports in the
literature of laparoscopic nephropexy(2). All
were done by a transperitoneal approach which
entails a lengthy surgical procedure with intra-abdominal
dissection and its potential morbidity.
In our opinion percutaneous nephrostomy, as done
in our patient, fixes the kidney to the posterior
abdominal wall through the fibrosis produced by
the tissue reaction to the presence of the nephrostomy
tube and to some urine extravasation around the
nephrostomy tract. This method of nephropexy is
simple, minimally invasive, safe and cost effective.
References:
1. Al Muzrakchi A: Portable C arm
fluoroscopic unit improvised simultaneous biplane
fluoroscopy. A simple & useful technique in
interventional radiology. J Interv. Rad. 9, 37-43,
1994.
2. Fornara P, Doehn C, Focham D: Laparoscopic
nephropexy: 3 year experience. J Urol. 158(5);
1679-83, 1997.
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