Kidney Palpation

More often than not, neither kidney can be palpated in the adult. The technique, however, is important to know, especially in the evaluation of a newborn.

Palpation of the right kidney is performed by deep palpation below the right costal margin. The examiner stands at the patient's right side and places his or her left hand behind the patient's right flank, between the costal margin and the iliac crest. The right hand is placed just below the patient's costal margin with the tips of the fingers pointing to the examiner's left. The method of kidney palpation is demonstrated in Figure 17-30.

Very deep palpation may reveal the lower pole of the right kidney as it descends during inspiration. The lower pole may be felt as a smooth, rounded mass.

The same procedure is used for the left kidney except that the examiner is on the patient's left side. Because the left kidney is more superior than the right, the lower pole of a normal left

Figure 17-29 Splenomegaly. Note the splenic notch.

Figure 17-29 Splenomegaly. Note the splenic notch.

kidney is rarely palpable. On occasion, the spleen maybe mistaken for an enlarged left kidney. The medial notch of the spleen is helpful in differentiating it from the kidney (see Fig. 17-29).

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