Floating Kidneys: An Era Gone By
In this “Era Gone By” article, we look at a case about nephroptosis and how the approach by doctors in the 1930s compare to present day. As you will see, corsets once again enter in the conversation.
Although signs and symptoms of health problems have not changed, treatment and availability have. Comparing standards of care present day to that of hundreds of years ago, we can see the the improvement.
Barbara first presented to the doctor with nausea and vomiting, chills, fever, and severe abdominal pain. The doctor admitted her to the hospital to run tests and figure out what was wrong. Her urination output had decreased dramatically. After running some tests, the doctor told Barbara that she had a floating kidney. He sent her home with strict instructions to wear an abdominal belt, drink hot fluids and no strenuous activity. He would see her in a week to see if she needed surgery. In the meantime she must drink a lot of milk or cream and take the sedatives he gave her.
Barbara winced as she bent to sit at the dining room table. Her left hand cradled her abdomen as she reached with her right hand for her cup of tea. Inhaling the steam deeply, the nausea lifted slightly. Outside her window she saw the green leaves on the trees waving goodnight to the sunshine as the smell of rain washed over her. Dark clouds hovered not far away hastening the shadows of dusk. The belt around her waist didn't lessen her pain, in fact it was so tight it restricted her movement and pinched her skin. However, she would try everything before having surgery.
Lying in bed Barbara listened to the rain pound on the roof. The warmth of the heating pad over her right kidney felt good. With her feet propped up on pillows, she could hear the doctor saying, " Drink plenty of hot fluids and stay in bed as much as possible - with your feet elevated." He had also instructed her to not tie her corset so tight which Barbara didn't like; she took pride in her tiny waist. She had worked hard over the past couple of months to lose weight for her upcoming wedding. Not able to keep her eyes open, she succumbed to the sedative.
Malposition of the kidney or floating kidney is called Nephroptosis. In the book A Textbook Of Medicine by A.S. Blumgarten a book published in 1930 for nurses, states that the cause for the floating kidney is visceroptosis when all organs in the abdomen are displaced. Modern medicine calls it nephroptosis, involving only the kidney. It is seen mostly in women with the right kidney more common than the left one. When Barbara had to go to the hospital, she was having a Dietl's crisis. This is when there is a kink or twist in the ureter and little to no urine can drain and blood flow is restricted. Blumgarten mentions that symptoms such as the nausea, vomiting, severe abdominal pain, etc. are characteristic of those with a "nervous temperament".(sound familiar to any mature women?)
Dr. Chris in his article "Floating Kidney (Nephroptosis)" states that it is a myth to believe that jumping or strenuous activity can cause nephroptosis. Rather, the cause is usually a lack of body fat and/or sudden weight loss. Since 1881 surgery for a floating kidney has been performed, however, it is now done laparoscopically instead of an open surgical incision, called nephropexy. You can view a video of the surgery at the website: HealthHype.com. Or click on these two websites for more info and pictures.
Floating Kidney - Causes, Symptoms And Treatment - My Health Tips
Medscape: Medscape Access
As I read the old nursing textbooks, I see that women were often treated as fragile, emotional beings. In my experience that has slowly changed over the past 30 years, although evidence is still out there that when women present with the same symptoms as men, the women are sometimes not taken seriously with the symptoms being attributed to emotional issues. Although diseases or illnesses have the same signs and symptoms as they did years ago, how doctors viewed women in relation to their medical conditions will be another article.
I personally have never taken care of a patient with nephroptosis and I'm wondering if any of you out there have. Please share your experience with us! See my other four article in the series "An Era Gone By".
Blumgarten, A.S. M.D., F.A.C.P. A Text Book Of Medicine. The Macmillan Co; New York, 1930. Print.
Dr. Chris. "Floating Kidney (Nephroptosis)". Healthhype.com. 20 Feb. 2015. Web.Last edit by tnbutterfly on Jun 15, '18
Joined: Oct '14; Posts: 214; Likes: 785
RN at Gi Lab; from TN , US
Specialty: 23+ year(s) of experience in Gastrointestinal NursingMar 3, '15Great post. Again, thank you for showing how things have changed in history. I have not treated anyone with nephroptosis but I will definitely add it among my differentials.Sep 16, '17I am an LPN, going straight through my RN program. I had nephroptosis and was a "Google patient". I had bilateral nephroptosis and had a right sided nephropexy. My left one still needs to be done. I could push my kidney around similar to feeling around pregnant woman's stomach. Lucky my urologist was so open to the unknown. Googled it instantly, and fired up around me US machine right in his room and found my kidney below by umbilicus. Confirmed via IVP and referred me to someone who could do it laproscopically.Sep 16, '17As someone who had a doctor misdiagnose me because of my gender, I can totally relate to the whole "women get treated differently than men" thing. Will wait for the appropriate article to share my experience, however.Sep 16, '17Plus I'm an attractive young timid blonde. They thought I had a hernia, had to poop, drug seeking, .....
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