Professional Documents
Culture Documents
1. Sir, this patient has an enlarged left kidney and is on hemodialysis. There is
presence of an enlarged left kidney as evidence by a left flank mass that is bimanually
palpable and ballotable with a nodular surface. I am able to get above the mass and
there was no palpable notch. Percussion note is resonant above the mass and it moves
inferiorly with respiration. It is non tender and not associated renal bruit.
2. Sir, this patient has an enlarged right kidney and is on hemodialysis. There is
presence of a right flank mass that is bimanually palpable and ballotable with a
nodular surface. I am able to get above this mass and the mass does not cross the
midline. Percussion note is resonant over the mass and it moves inferiorly with
respiration. It is non-tender and there is no associated renal bruit.
There is no ascites. The liver is not enlarged with a span of 12 cm in the right
midclavicular line. The spleen is also not enlarged. I did not notice any scars.
In summary, this middle age gentleman has an enlarged left sided kidney with
complications of ESRF of which he is undergoing hemodialysis. The most likely
aetiology is asymmetrically enlarged Adult Polycystic Kidney disease.
Questions
What are the causes of a unilaterally enlarged kidney?
Causes of bilateral asymmetrical enlargement
o APCKD, Acromegaly, DM, bilateral HN
o Tuberous sclerosis, VHL, Amyloidosis
Unilateral disease
o RCC
o Acute renal vein thrombosis
o Pyonephrosis
o Hypertrophy of a single functioning kidney