Approach
- Expose abdomen
- Start with the hands
- Inspection
- Likely to be normal
- Palpation
- May be supraclavicular lymphadenopathy
- Presence of mass in Left / right loins / upper quadrants
- Distinguish from other masses
- Enlarged kidney descends with inspiration as it is pushed down the diaphragm
- Percussion
- Auscultation
Differential diagnoses
- Congenital
- Cystic disease (including polycystic disease)
- Horseshoe kidney
- Hypertrophic single kidney
- Acquired
- Disease specific to kidney - solitary cysts, (RCC) tumours, hydronephrosis, perinephric abscess, renal vein thrombosis
- Systemic disease - diabetes, amyloidosis, SLE
Polycystic kidney disease
| Adult | Infantile | |
| Inheritance | Autosomal dominant | Autosomal recessive |
| Incidence | 1 / 500 | 1 / 5000 - 40,000 |
| Genetics | Chromosome 4,16 | 6 |
| Age of presentation | 30 - 50s | Perinatal |
| Pattern of presentation |
Hypertension |
Oligohydramnios Large liver and kidneys Chronic renal failure |
| Pattern of enlargement | Asymmetrical | Symmetrical |
| Liver involvement | Adult liver cysts common | Always congenital hepatic fibrosis |
| Other systemic involvement | Incracranial aneurysms (Berry) Colonic diverticulae Mitral regurgitation |
|
| Prognosis | Often require dialysis but good prognosis | All die by age 20 |
Presentation of Renal Cella carcinoma
- Usually in over 50s
- Triad of - haematuria, loin pain, mass
- Other presentations
- Incidental
- PUO
- Anaemia of chronic disease
- Polycythaemia (from EPO)
- Raised ESR
- Hypercalcaemia
- Left sided varicocoele
- Tumour
- Mass - direct pain, compression left renal vein giving varicocoele
- Haematuria
- Loin pain
- Function - calcium, erythropoesis
- Distant spread
- Paraneoplastic syndrome
- Incidental on investigations
- Thick, irregular wall
- Extensive calcification within cavity or wall of cyst
- Multilocular cysts
Management of renal cysts
- History
- Examination
- Investigations
- Blood tests - usually normal
- Renal USS: cyst with smooth outline; sharply defined thin wall and no internal echoes
- Treatment
- Major differential diagnoses would be with a renal tumour and adult polycystic kidney disease