THE NERVOUS PHENOMENA ASSOCIATED WITH MOVABLE KIDNEY
Journal of the American Medical Association (JAMA)
It is only within a comparatively recent period that the attention of the profession has been directed to the frequent occurrence of movable or floating kidney, and it is within a still more recent time that the importance of the symptoms arising from this condition has been appreciated. The frequency of movable kidney is a point on which there has been wide diversity of opinion. All authorities agree that movable kidney is much more common in women than in men, and it is also agreed that it
... t frequently occurs between the ages of 25 and 40 years, and is rarely found in girls before puberty. It is also most common in women who have been preg¬ nant. Some writers state that this condition of the kid¬ neys is found in 25 per cent, of women who are examined for pelvic, dyspeptic or other troubles, while others re¬ gard the condition as comparatively rare. Pranks1 in¬ sists on a distinction between floating kidney and mov¬ able kidney. The former, he says, is very rare and is a pathologic curiosity, while the latter is common. Float¬ ing kidney is a congenital condition and the organ is freely movable in the cavity of the abdomen, it is sur¬ rounded by peritoneum and is possessed of a mesonephron. Movable kidney is an acquired condition and the organ is mobile behind the peritoneum. . When looked for in the cadaver, the kidney is not often found displaced, and this is probably due to post¬ mortem conditions, the kidney having a tendency to settle into its normal position, and the fatty capsule surrounding the organ becomes solidified and helps to hold it there. Epstein states that movable kidney was found only five times in 3,658 postmortems, and Landau in an examination of hospital records from 1870 to 1879 found reports of only 4 cases out of 6,999. On the other hand, Lindner2 asserts that in his experience, one out of every five women has a movable kidney, and Mathieu out of 306 women examined in hospitals, found movable kidney in 85, or 25 per cent. There is no doubt that a kidney which is displaced to only a slight extent is overlooked, and in the detection of a movable kidney, much depends on the manner in which the examination is made. It is the experience of every one to have found at one examination that the kidney was so much out of place that its whole outline could be readily traced, while on the next occasion it may have been impossible to feel the organ at all. Lind¬ ner gives the following as his method of examination for displaced kidney : He stands at the right side of the re¬ cumbent patient, places his right hand against the an¬ terior abdominal wall and then presses the left against the back of the lumbar region so as to push the kidney forward. The patient is then placed on her right side with the knees drawn up ; by sharply shaking the body, the kidney, if movable, will fall forward. He says that frequent examinations are sometimes necessary to detect the abnormality.