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Gastro Exam

Examination of the Kidneys

November 26th, 2019


The kidneys are often missed during examination of the abdomen, though the presence of ballotable or tender kidneys can provide a significant amount of information about the cause of their presentation.

Renal Percussion

Flank tenderness to percussion is a relatively sensitive sign for renal pathology, especially pyelonephritis and perinephric abscess.
  • How to Perform

  • With the patient sitting, place one palm over the costovertebral angle and use the ulnar aspect of the other hand (in a fist) to gently percuss the kidneys.

Renal Palpation

The kidneys are not palpable in most normal patients, though may be palpable in thin patients and children.
  • How to Perform

  • With the patient supine, place one hand on the abdomen over the kidney and the other hand over the flank posteriorly. Attempt to ballot the kidney between the two hands. Repeat on both sides.
  • Causes of Palpable Kidney

  • Hydronephrosis - kidney stone, ureteric clot, tumour, stricture
  • Congenital - horseshoe kidney, nephroblastomatosis
  • Cysts - benign cyst, polycystic kidney disease, Von-Hippel-Lindau disease
  • Malignancy - renal cell carcinoma, lymphoma
  • Renal hypertrophy - single kidney, contralateral reduced renal function

Flank Tenderness

  • Causes of Flank Tenderness

  • Infection - pyelonephritis, perinephric abscess
  • Malignancy - renal cell carcinoma, transitional cell carcinoma
  • Renal infarction
  • Trauma
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