MOVABLE KIDNEY.
A kidney which is unduly movable either by reason of the pres ence of a mesonephron permitting it to float, or in consequence of the loosening of its natural attachments to the abdominal parietes by whatever means it may be caused, is often a considerable source of discomfort to the individual. Without discussing the pathology of the subject and the varieties it presents, I would lay stress on the quency with which the painful form of the disorder is traceable to a previous injury.
Instances often come under observation of persons suffering from it as a result of violent concussions to which the body has been jected. Hence the importance of rest and support in all cases where injuries of this kind have been sustained. I had a gentleman under observation who suffered much inconvenience from a movable kidney, which was not complained of before he had a severe fall from his horse. Mr. Bruce Clarke has drawn attention to the resemblance between what he describes as acute renal dislocation and the parox ysms of renal colic.
A kidney which moves about from whatever cause sometimes pro vokes symptoms of much distress to the patient—symptoms which, though often attributed to dyspepsia, have this peculiarity that no medicine for indigestion and the like disorders ever alleviates them. There is pain and abdominal dragging and sensations of a most per sistent character.
In many instances a kidney that moves unduly may be recognized by abdominal manipulation. A tumor can be felt and rolled about in various directions. The absence of this sign, however, cannot be accepted as indicating that no such abnormality exists. In a stout woman upon whom I operated for symptoms which pointed to a mov able kidney and where, in the absence of relief by abdominal belts and dyspeptic medicine, I made an exploration, on removing the perirenal fat I could move the kidney in almost any direction by the tip of my index finger. I fixed the kidney with sutures and the patient completely recovered and after the lapse of seven years is in excellent health. Hence in the diagnosis of movable kidney we
must to a certain extent be dependent upon symptoms and the ex ploratory proceedings which the continuation of these signs sometimes undoubtedly indicates. Where there are symptoms of a constant nature which threaten to injure the health of the patient, and in the absence of any relief from an abdominal belt or support, the ques tion of operation will have to be entertained.
Nephrorrhaphy, or the fixation of a kidney by suture, is a proceed ing which may be practised with very good result. It consists in ex posing the kidney by an incision from the loin and then securing it by means of strong catgut sutures passed within the fibrous capsule and out through the edges of the parietal wound. It may be urged that this is not possible in the case of kidneys which are rendered movable by reason of a complete mesonephron, and that where there are grounds for the belief, from the obvious mobility of the organ, that this is the case a laparotomy should be proceeded with and the organ removed in this way. I cannot, however, indorse a practice of this kind until the simpler proceeding has first been tried and exploration effected from the loin. Though I have operated several times for a movable kidney and have, on more than one .occasion, met with what appeared to be a fairly constituted mesonephron, I never experienced much difficulty in reaching the surface of the kidney. Failing in a proceeding of this kind, and the pressing symp toms continuing after the healing of the lumbar incision, I should have no hesitation in resorting to a laparotomy and removing the organ entirely. Nephrectomy should, however, not be adopted with out the most careful consideration, as the liability to kidney disease as well as its gravity, so far as the remaining organ is concerned, is, as might be expected, considerably increased.