1. AM Report 11/4/09 Brandon M. Williams MD
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

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
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