Unilateral palpable kidney

Published on 02/04/2015 by admin

Filed under Internal Medicine

Last modified 22/04/2025

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124 Unilateral palpable kidney

Instruction

Examine this patient’s abdomen.

Salient features

History

• Nephrectomy

• Congenital absence of kidney

• History of azotaemia, dialysis.

Examination

• One kidney is palpable (bimanually ballottable; there is a transverse band of colonic resonance on percussion and you will be able to insinuate your fingers between the mass and costal margin).

Proceed as follows:

• Look carefully for arteriovenous fistulae in the arms, haemodialysis catheters in the subclavian region.

Diagnosis

This patient has a unilateral palpable kidney (lesion), which may be caused by either polycystic kidney disease or renal neoplasm (aetiology).

Questions

What are the common causes of a palpable kidney?

• Polycystic kidney disease

• Renal carcinoma

• Hydronephrosis

• Renal cyst

• Hypertrophy of the solitary functioning kidney.

What changes can occur in a kidney when the other is removed?

Long-term renal function remains stable in most patients with a reduction in renal mass of >50%. However, these patients are at increased risk for proteinuria, glomerulopathy and progressive renal failure. Hence it is important to monitor patients with remnant kidneys. Problems are most frequent in those in whom the amount of renal tissue removed is greatest and who have survived the longest (N Engl J Med 1991;325:1058). Survival and the risk of end-stage renal disease in carefully screened kidney donors appear to be similar to those in the general population. Most donors who were studied had a preserved glomerular filtration rate, normal albumin excretion and an excellent quality of life (N Engl J Med 2009;360:459). Renal failure has gradually developed in a small proportion of donors, and according to the United Network for Organ Sharing, 56 of >50 000 previous kidney donors have ultimately been listed for transplants themselves. Although some donors develop hypertension over time, hypertension is common in the general population. Occasionally, microalbuminuria develops in donors, and it is worth considering whether renoprotective therapy might be tailored to prevent this complication (N Engl J Med 2005;353:447).

What are the short-term risks of donation?

• The short-term physical risks are small: the death rate is 0.03%, which is similar to or lower than that for any operation involving the use of general anaesthesia

• The risk of bleeding during or after the procedure

• The risks of infection or other perioperative problems

• Donors will lose time from work. Most return to work within 4–5 weeks

• It can take a few weeks to recover fully from surgery, although the increasing use of laparoscopic donation means that a donor may now be released from the hospital in just a few days.

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