PRACTICAL CONSIDERATIONS : THE KIDNEYS. 1889 



left, because of the following conditions, which are of varying relative importance in 

 different cases : (a) the left perirenal fascia is strengthened by some fibrous bands, 

 remnants of the fusion of the descending mesocolon with the primitive parietal peri- 

 toneum (MouUin), the left kidney being thus more firmly bound to the descending 

 colon than is the right to the ascending colon ; {b) the greater size, weight, and 

 density of the liver as compared with the spleen, and its more intimate association 

 with respiratory movements, making the impact of the former on the upper surface of 

 the right kidney both more frequent and more potent than the similar contact of the 

 spleen with the left kidney ; (<:) the greater length of the right renal artery, which has 

 to cross the mid- line to reach the kidney ; although the right vein is similarly shorter 

 than the left vein, it offers less resistance to elongation than does the left renal artery ; 

 {d) the right kidney is usually lower than the left kidney (page 187 1), and therefore 

 more easily loses the support of the parietes at the region where that support is most 

 effective {vide supra) ; (/) the connection of the left suprarenal capsular vein 

 with the left renal vein gives some fixation to the left kidney, as the capsule remains 

 in position and does not follow the kidney in its abnormal movements (Morris, Cru- 

 veilhier) ; {f ) the right renal fossa is more cylindrical — i.e., less narrowed at its 

 lower end — than the left, especially in women, owing to a slight torsion of the lumbar 

 spine (MouUin), or perhaps to the greater width and development of the right side 

 of the pelvis. 



From an anatomical stand-point, the symptoms caused by excessive mobility are : 



1. Those due to traction upon and irritation of the nerves ; as, for example, 

 pain, felt in the loins and often referred to the lower abdomen or genitalia, owing to 

 the association of the renal plexus with the spermatic or ovarian plexus ; the same 

 association gives to the pain produced by pressure upon a movable kidney the sick- 

 ening quality peculiar to testicular nausea (page 1951); 7iausea and vomiti7ig, due to 

 a similar connection with the solar plexus and pneumogastrics ; 7ieurasthenia, which 

 may be either a result of movable kidney — through nerve irritation — or a cause, 

 when it has produced emaciation and muscular weakness. 



2. Those due to traction upon the gastro-intestinal tract, especially upon the 

 duodenum and bile-ducts, as digestive disturbance, flatulence, constipation, and even 

 jatindice. As the second portion of the duodenum is dragged upon through its 

 areolar-tissue connection with the right kidney, its lack of mesentery prevents it from 

 moving downward, it is stretched so that its lumen is diminished, and interference 

 with the digestive current and secondary dilatation of the stomach follow (Bartels) ; 

 at the same time the bile-ducts are elongated and narrowed and the passage of bile 

 through them is interfered with (page 1731)- On the left side similar disturbance of 

 digestion may follow the pull of the kidney on the stomach and colon. 



3. Those due to traction upon the vessels, resulting — as the compressible vein is 

 more readily affected — in congestion of the kidney, sometimes so marked as to give 

 rise to a temporary haematuria. 



4. Those due to traction upon or angulation or twisting of the ureter, causing an 

 acute hydronephrosis, at first intermittent. Tuffier has shown that the bending or 

 kinking of the ureter when a kidney is displaced occurs in more than 50 per cent, 

 of cases at a point a few centimetres below the pelvis, where it is held against the 

 abdominal wall by strong connective tissue and cannot follow the moving kidney 

 (Landau). In some cases, as a result of ureteral stenosis at the point of obstruc- 

 tion, secondary changes occur in the kidney which consist essentially in (a) an 

 atrophy of the renal structure most directly exposed to pressure from the retained 

 urine (Virchow) ; and {b^ interstitial degeneration resulting from interference with 

 nutrition, due to the facts that distention of the pelvis of the kidney takes the direc- 

 tion of least resistance, which is forward, and that the pelvis is placed behind the 

 vessels where they enter the hilum, so that as it distends it stretches, flattens, and 

 obstructs them (GrifTfiths). 



As Morris has pointed out, the increased resonance and diminished resistance in 

 the loin, described as indicating the absence of the kidney from its normal position, are 

 of little value because (a) the ilio-costal space in some positions of the trunk and 

 thigh is somewhat hollow ; {b') the thickness of the loin muscles and of the fat makes 

 the percussion-note dull even when the kidney is displaced ; and {c') in its normal 



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