(SURGICAL).
Diseases of the Kidneys (CoxrusTED).
Movable and Floating Kidney.
The term movable kidney is used to designate those cases of displaced and not fixed kidney in which the movements are entirely subperitoneal. In floating kidney the movements are intra-abdomi nal; the organ is surrounded by peri toneum and has more or less of a meso nephron. The former variety is usually acquired, while the latter is said to be only congenital. This, however, is quite doubtful.
Symptoms. — The subjective signs of movable kidney range from slight dis comfort to intense pain, depending, to some extent, on the amount of mobility. Most commonly the pain is dull, aching, or dragging, located in the loin and ag gravated by exertion, constipation, and often by menstruation. Occasionally it is paroxysmal, not unlike renal colic. Kinking or torsion of the ureter may cause transitory attacks of hydronephro sis. Gastric symptoms and disorders of digestion have also been frequently ob served.
[Edebohls (Centralb. f. Gyn., xxii Jahrg., No. 40) reports fifty-eight cases in which lie believes appendicitis was caused by the venous stasis in the region of the mecum resulting from the pressure of floating kidney. This view seems confirmed by the relief of symp toms in twelve cases by nephropexy. W. W. KEEN and M. B. TINKER.] The chief symptoms of movable kid ney are pains in the back, generally of a changing character, from dull to sharp. Dizziness is also a frequent symptom. Then come those symptoms due to en teroptosis and the gastric symptoms. Those of the circulatory system, consist ing of palpitation, sometimes irregular heart-action, distension of the abdominal aorta, throbbing of this vessel, kinking of the renal artery, and occasionally a Inuit in this place. Then the symptoms from the nervous system; neurasthenia, trembling, dizziness, occipital or frontal headaches, and deep depression. A great many of the symptoms of the movable kidney are doubtless caused by pressure on the solar plexus. Gustav Ffitterer (Amer. Gymec. and Obstet. Jour., Feb.,
'99).
The symptoms of movable kidney in children are very variable; often the affection is absolutely latent. Pain, at times paroxysmal, is sometimes present, and may come on after some unusual fatigue or effort. The kidney may be come twisted and the ureter occluded, causing hydronephrosis, which may be transitory, intermittent, or persistent. Coprostasis, appendicitis, different cystic or solid tumors of the kidney, peri nephritis, and stone are among the con ditions to be excluded. Palpation usually reveals the presence of a smooth, rounded, movable mass. Comby (Amer. Jour. Med. Sei., Mar., '99).
On palpation, a tumor of the size, form, and consistency of the kidney can be usu ally made out; the tumor slips away un der the fingers, generally to the region of the loin. The range of mobility may be slight, but in some cases it is so great that the tumor may be felt near or past the median line or in the inguinal re gion. Manipulation often gives rise to sickening pain, similar to that produced by compression of the testicle or ovary.
The failure of the kidney to ascend after a forced inspiration is a satisfac tory test, even if the kidney only comes down low enough to enable its inferior extremity to be felt. Mansell Moullin (Brit. Med. Jour., i, 566, 1900).
The diagnosis from very mobile, dis tended gall-bladder and tumors of the intestine, especially the large intestine, is sometimes difficult. The kidney is much more deeply located posteriorly, however, and if it is possible to fix the liver it will be impossible to make the gall-bladder disappear as the kidney does. Apart from tumors of the kidney itself, the condition most likely to be mistaken for movable kidney is dis tended gall-bladder.
In differentiating a distended gall bladder, the history, the usually anterior position of the tumor, the difference in the planes of attachments, the constant situation of the gall-bladder, and the variable situation of the kidney are suf ficient to render the diagnosis compara tively easy.