Dietl's crisis

(Jozef Dietl, 1804-1878, Polish physician), a syndrome characterized by violent paroxysms of colicky flank pain, nausea, chills, tachycardia, oliguria, transient haematuria or proteinuria, and a palpable enlarged tender kidney. Dietl's crisis was attributed to acute hydronephrosis due to kinking or vascular obstruction of the ureter of a floating kidney (see nephroptosis). The treatment of Dietl's crisis was based on gentle manual reduction of the kidney into the renal fossa while the patient was supine. At the turn of the century the diagnosis of nephroptosis was based on history and physical examination.

The described findings at intravenous urography (IVU) include ptosis, delayed emptying of the involved kidney and renal pelvic dilatation during expiration. IVU and retrograde pyelography may be performed during expiration with the patient supine and during inspiration with the patient upright. Flow impairment, abnormal tubular secretion, irregular distribution of activity and reduced glomerular filtration rate during isotopic imaging are also said to be typical of the condition. Ultrasonography is said to be helpful by demonstrating intermittent hydronephrosis. The existence of Dietl's crisis as a true pathological condition, separate to ureteropelvic junction obstruction, is very controversial.

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