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How to do palpation of kidney?

  • Lower Pole of right kidney is normally palpable.
  • Left kidney is usually not palpable unless either low in position or enlarged 
  • Though kidney is retroperitoneally situated, it moves with respiration as it is related to the crus of the diaphragm posteriorly, the movement of the diaphragm is reflected to kidney producing restricted movement during respiration.
  • Use bimanual technique to palpate the kidneys.
How to palpate the kidneys?
  • The lower pole of right kidney is commonly palpable in thin patients for obvious reasons. Previously it was told that left kidney is palpated best from left side but nowadays no such dogma is present.
  • Both the kidneys are palpated from right side of the patient. The method of palpation goes like this :
  • Preliminary preparations of the patient are the same as done during palpation of liver. Always sit on a stool for palpation of kidneys.
  • To palpate the right kidney, place the right hand horizontally in the right lumbar region anteriorly and the left hand is placed posteriorly in the right loin region (bimanual palpation)
  • Push the right hand in a backward, upward and inward direction, and ask the patient to take deep inspiration. A firm mass may be felt in between the two hands (if kidney is enlarged).
  • Next, a sharp tap is given by the left hand placed in the loin region. The anteriorly placed right hand now feels the kidney and the kidney then falls back (by gravity) on the posterior abdominal wall which is felt by the left hand. This is ballottement. Firm pressure is exerted by both hands at the height of inspiration to trap the palpable kidney between the two hands, otherwise it will prevent the descend of kidney by the diaphragm
  • The left kidney is then palpated by placing the right hand anteriorly and the left hand posterior- the left loin.