AM Report 11/4/09 Brandon M. Williams MD Dietl’s Crisis AM Report 11/4/09 Brandon M. Williams MD

Jozef Dietl 1804-1878 Polish physician Pioneer of balneology Mayor of Krakow 1866-1874

Dietl’s Crisis First described by Dietl in 1864 JAMA in 1909 Mostly in children and females

Signs and Symptoms Intermittent with periods of normality between spells Often abrupt in onset Renal colic pain Nausea and vomiting Hematuria, proteinuria Acute renal failure Associated with alcohol ingestion, overhydration, diuresis

Mechanisms 2 mechanisms Causing INTERMITTENT URETEROPELVIC JUNCTION OBSTRUCTION “free floating” kidney (nephroptosis), worse when standing or with inspiration Osler ‘the mental kidney more often than abdominal is the one that floats’ Kinking of ureter over vessels

UPJ Obstruction

Diagnosis Needs to be evaluated during acute crisis Ultrasound CT Retrograde pyelogram Furosemide-assisted renogram

Treatment Manual manipulation of kidney

Treatment Cont Surgical Pyeloplasty Previously with open procedures now many done laproscopic Surgical results generally good, usually with resolution of pain

References Mergener et al. Dietl’s Crisis: A syndrome of Episodic Abdominal Pain of Urologic Origin that May present to a Gastroenterologist. Am J of Gastroenterology. Vol 92, Issue 12. Dec 1997. Barber et al. Nephroptosis and Nephropexy—Hung up on the Past? European Urology. October 2004 428-433 Up to date Medcyclopaedia Google images