Abdominal - Renal

Question 1

What are the causes of a unilaterally palpable kidney?

Answer 1

Neoplasma:
- RCC
Congenital:
- PKD with asymmetrical enlargement
Vascular:
- Acute renal vein thrombosis (congestion causes swelling)
Infective:
- Acute pyelonephritis, renal abscess

Solidary kidney (ie post donation), or normal size/ compensatory hypertrophy of one kidney + atrophic other kidney

Question 2

Causes of bilateral palpable kidneys?

Answer 2

Neoplasma:
- RCC bilaterally
Congenital:
- PKD
Infiltrative:
- amyloid, lymphoma
Vascular
- bilateral renal vein thrombosis
Endocrine:
- Acromegally

Other:
- nephrotic syndrome
- Early diabetic nephropathy

Question 3

Suspect adult PKD. What to examine for specifically?

Answer 3

1. Take BP
2. Urinalysis for haemturiua (hemorrhage into cyst) and protiunuria
3. Evidence of anaemia (Due to CKD) or polycythaemia (due to high EPO levels)
4. Hepato or splenomegally (Due to cysts)
5. Tenderness on palpation my indicate infection of cyst

Question 4

How to tell if fistula working or not?

Answer 4

Precence of thrill and bruit indicates working
Look for recent needling