Modified Whitaker test: a novel diagnostic for nephroptosis

A 77-year-old woman presented with right flank pain radiating to the ipsilateral groin and associated nausea, consistent with renal colic. In the emergency department, a non-contrast CT scan revealed severe right-sided hydronephrosis but failed to demonstrate a calculus or ureteropelvic obstruction. The patient improved with fluids and followed up with a community urologist. Initial work-up with cystoscopy and ureteroscopy, voiding cystourethrogram and diuretic renography failed to deduce a diagnosis. At our hospital, we used a modified dynamic (supine and upright) Whitaker test in a novel fashion to diagnose nephroptosis, a rare hypermobility condition of the kidney.

Upper urinary tract obstruction

Obstructive uropathy refers to the clinical sequelae of impairment of free urinary flow in the urological tract. The clinical manifestation of obstructive uropathy depends on the level and duration of obstruction, whether it is partial or complete, and whether infection has supervened. Obstruction may be clinically silent—and incidental radiological, biochemical, or examination findings may suggest the diagnosis. The radiological techniques used to demonstrate obstruction can be divided into anatomical and functional studies. These include ultrasound, urography, cross-sectional imaging, micturating cystourethrography, the Whitaker test, nuclear renography, and urodynamic techniques. Presence of infection with obstruction constitutes a urological emergency and urgent decompression is warranted. The pathophysiological effects of unilateral or bilateral upper tract obstruction differ and have important implications for clinical management of patients. The management of numerous upper urinary tract obstructive conditions is discussed.