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Dietl’s Crisis

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.

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Dietl’s Crisis

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

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

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

  4. 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

  5. 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

  6. UPJ Obstruction

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

  8. Treatment • Manual manipulation of kidney

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

  10. 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

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