Method of palpation of the kidneys in the diagnosis of diseases. Kidney examination What does the examination reveal?

For any pathological condition of the urinary system, the patient’s appointment begins with a visual examination, history taking, auscultation, percussion, and palpation of organs.

The last 2 methods are performed using hands. For clarity of understanding, percussion is tapping, palpation is palpation.

Such methods have been known since ancient times. They do not cause any harm to the patient and are completely painless. With their help, the doctor gets an idea of the state of the body and negative changes in the organs being examined.

Why is bladder percussion performed?

The bladder is an internal part of the body that helps remove fluid from the body, disruption of which leads to the development of diseases. If you notice the following symptoms, you must contact a medical facility to find out the cause:

At the appointment, the doctor will conduct a series of initial studies. The main indicator for percussion is urinary disturbance. In medical practice, this concept implies an examination consisting of tapping certain areas of the body and analyzing the sound that appears during this. The described technique is carried out when there is a large amount of accumulated urine in the urinary reservoir.

Types of palpation

Research can be conducted in several ways. The main condition is an empty bladder. Otherwise, the diagnosis will be incorrect. Palpation methods:

The procedure occurs differently in both sexes:

men– rectally;
women– vaginally.

Examination technique:

The person lies down or gets on all fours.
The doctor presses on the pubic area with one hand, inserts a finger of the other hand into the anus (vagina) and presses on the bladder.

Normal bladder when palpated

In the absence of pathologies, an empty bladder cannot be palpated, since it is located behind the womb. When full, the organ can be felt; its norm is 2-3 cm above the pubic bone. If there is an inflammatory process in the organ, it can be felt outside the womb, and the patient feels pain when pressed.

Technique of the procedure

The palpation method is based on the sensations experienced by the patient when pressing on the corresponding organ. Using this method, you can determine the current condition of the genitourinary organs.

By palpating the lower abdomen, you can clearly determine the strength of the tension in the abdominal muscles. At a time when there were no modern diagnostic devices in medicine (ultrasound, CT, X-ray), this method was quite relevant. However, in modern practice, palpation is still relevant.

Performing percussion step by step:

The patient is placed on his back.
The action is carried out from the navel to the womb (from top to bottom). A finger (pessimeter) is placed on the stomach, and with the other hand the doctor applies light blows to it while gradually lowering it by 2 cm. The bottom of the organ is determined by the occurrence of dullness.

To diagnose certain types of pathologies, a special technique is used - “”. To do this, a person must sit or stand. Method for identifying a symptom: the doctor performs percussion at the site of the 12th rib and moves towards the spinal column. If a patient experiences pain, it can be assumed that there is a bladder pathology.

To examine the internal organs of the genitourinary area, the method of deep palpation is used. When a person's bladder is healthy and empty, it is difficult to palpate, so it must be emptied before the procedure. How is palpation performed:

The patient takes a lying position and relaxes.
The doctor gently presses his hand on the lower abdomen, gradually increasing the pressure in the umbilical area, to feel the contour of the organ.

During the process, the patient must talk about what he feels (localization of the pain syndrome, how it manifests itself).

Features of the female gender

Since the structure of the pelvis in women is special, diagnosis is carried out 2 times:

With a full bladder.
With a devastated organ.

Diagnostics in 2 stages is necessary so as not to confuse the organ being examined with the uterus, which is stretched when carrying a baby, or with a tumor. The method of bimanual vaginal palpation is often practiced. The bottom line is this: one hand is in the woman’s vagina, the other presses on the pubic area.

This technique allows you to detect neoplasms, organ compaction, determine density, and determine a treatment regimen. It should be noted that the appearance of pain does not always indicate the development of pathology.

Palpation of the bladder in young children

In childhood, palpation of the bladder is carried out by a doctor using both hands simultaneously. Before the examination, the child must go to the toilet. In acute, chronic urinary retention, the organ is palpated as a flexible, fluctuating formation, the apex of which sometimes reaches the navel. Normally, a full bladder is palpable in infants.

Palpation of the kidneys in adults and children

The kidneys of a healthy person cannot be palpated; there is no discomfort when palpated. Only organs that are enlarged in size and those that are displaced are subject to examination. The procedure is performed by a doctor when:

However, palpation can be performed in thin people and patients with thin peritoneum. The examination is carried out only on the right side, since the right kidney is lower than the level of the left kidney.

This procedure is also applicable to children. The examination technique is similar to palpation in an adult. In the absence of disease, the kidneys cannot be palpated. Palpation can be carried out in a standing position, lying on your back or side.

Palpation of the kidneys is normal

In a normal state, in the absence of development of pathologies, the organ cannot be palpated, the procedure does not cause pain or any discomfort. In case of pathologies of the urinary organs, the kidneys are palpated. It is important to analyze the flexibility, smoothness of the kidney capsules, consistency, whether there are any seals, or pain. The presumptive diagnosis will depend on the collected data.

Pasternatsky's symptom

Great importance in the study is given to the definition of Pasternatsky's symptom. The technique is necessary to assess pain. During the session, the medical worker stands behind the patient. Places the left hand in the area of the 12th rib, to the left of the spinal column. Using the edge of the palm of the right hand, he carries out a series of short light blows to the left hand. The severity of pain is characterized by the type of symptom: negative, positive, mild. A positive effect is observed when:

kidney inflammation;

We should not exclude other causes of pain - osteochondrosis, diseases of the ribs, lumbar muscles, gallbladder diseases, pancreatitis.

Examination of organs while lying on your back

Palpation algorithm in a supine position:

The patient lies down on the couch and completely relaxes, breathing deeply.
The doctor stands on the patient’s right side, placing his left hand under the patient’s body in the lumbar area closer to the spine.
The right hand is placed on the stomach under the ribs, perpendicular to the peritoneum.
When the patient exhales, the doctor's right hand gradually sinks, trying to reach the back wall of the abdomen, trying to get closer to the fingers of the left hand.

If the kidney is of normal size, then both hands of the doctor will almost meet, especially for thin people. With an increased size of the organ, its lower edge or the entire kidney can be felt with your fingers.

The procedure for the left kidney is similar. The study helps determine:

the size of the enlarged organ;
shape;
mobility;
consistency;
soreness.

Palpation while lying on your side

For dense patients, palpating while lying on their side is more suitable. To examine the organ on the left, the patient lies on the right side. The procedure technique is the same as lying on your back. The difference is that the doctor sits and the patient lies facing him, the body is slightly tilted, the muscles are completely relaxed.

Palpation of the patient while standing

Standing palpation is suitable for thin people and children. Technique:

The patient faces the doctor and relaxes his abdominal muscles.
The doctor sits on a chair, places his left hand on the patient’s lower back, and the fingers of his right hand in the place of the organ.
When the patient exhales deeply, the doctor's fingers press the abdominal wall towards the back wall, forming a fold.
Then the patient inhales deeply, the kidney descends, becoming accessible for palpation.

The research method helps to analyze:

condition of the kidneys and capsule;
severity of pain;
localization – displacement, omission.

And in conclusion

Physiological methods of examining a patient make it possible to detect various diseases of the urinary system. Thanks to the techniques, it is possible to determine important components indicating the presence of a disease.

In addition to visual examination, percussion and palpation, the doctor prescribes a clinical urine test and, if necessary, other examination methods. Based on the results obtained, a final diagnosis is made.

The upper pole reaches the level of the 11th rib, and its lower edge does not reach the ilium by about 4-5 cm.

The liver puts pressure on the right kidney, so it is 1-1.5 cm lower than the right one

Kidney palpation technique

Superficial palpation is performed over the entire surface of the palm (clockwise or counterclockwise), all movements should be smooth and gentle

If the doctor is not able to examine the patient’s kidneys in a horizontal position, he should begin palpating the kidneys in a standing position

Types of palpation

There are superficial and deep palpation.

Superficial palpation

Superficial palpation of the kidneys is an approximate palpation that allows one to draw preliminary conclusions. The doctor places his hands on the patient’s body and feels the body with symmetrical strokes. Thus, the doctor can:

Determine the temperature, sensitivity, density and humidity of the skin.
Determine the tone of the body muscles, identify their tension.
Detect subcutaneous infiltrates and compactions.

Superficial palpation is carried out with a straightened hand; the doctor does not apply any pressure deep into the body. You can perform a superficial examination with both hands at the same time.

Deep palpation

Deep palpation is used for a detailed examination of internal organs. The doctor performing it must not only have a good understanding of the anatomical projection of the internal organs, but also have sufficient experience in performing the manipulation. Deep palpation of the kidneys and other organs is performed with one or more fingers and involves significant pressure on the body. The method is divided into the following types:

Deep sliding. This is a methodical palpation, which involves feeling the internal organs in a certain sequence. The doctor's fingers penetrate deep inside the body and feel the organ pressed against the back wall.
Bimanual. This is a feeling with both hands of the doctor. The optimal method for examining the kidneys. The doctor's left hand holds the kidney in a certain position, and the right hand, moving towards it, palpates. With bimanual palpation with your left hand, you can, as it were, “hand over” an organ for examination with your right hand.
Jerky. Used to diagnose pathologies of the spleen and liver. This type is not used for renal examination.

Palpation technique

Palpation of the kidneys can be carried out with the patient standing, lying on his back, lying on his side.

The doctor’s left hand is placed with the palm on the patient’s lower back, and the right hand is placed under the costal edge on the abdomen. The patient is asked to relax and breathe deeply. As you inhale, the doctor penetrates deeper with your right hand, and with your left hand slightly “moves” the kidney forward.

If a person has no pathologies, normally the kidneys cannot be palpated. Moreover, both in a standing and lying position. Sometimes the doctor is able to palpate the lower renal border on the right, because it is located lower than the left one. However, even this cannot be done if the patient is overweight.

For obese people, it makes no sense to conduct a manual examination in a vertical position; results will not be achieved. It is possible to feel the lower edge of a healthy right kidney only in patients with a thin build and in children. When palpating in a standing position, the patient is asked to lean forward slightly.

For overweight people, it is more convenient to palpate while lying on their side. In order to palpate the right kidney, the patient lies on the left side, and on the other to examine the left kidney.

An examination related to palpation, percussion, which is performed in a standing position, is called Pasternatsky's symptom. Normally, the patient does not react in any way to tapping the lumbar region. If this manipulation is painful, kidney disease may be suspected.

When the kidney is palpable

The kidneys are well palpated only with pathological changes in the organ. The doctor can palpate them if they are drooping, if there are cystic or other neoplasms. For pathologies such as hydro- and pyonephrosis, palpation is successfully carried out using the balloting method. These are jerky movements under the lumbar region, which the doctor feels with his second hand through the organ being examined.

It should be noted that normally no organs except the kidneys are running.

Manual examination of the ureteral points is used if pathology in this area is suspected. Normally, the ureters are painless and cannot be palpated. If there is pain in one of the 4 points of projection of the ureters, a pathological process can be suspected.

Child's kidney examination

The same manual examination methods are used in children as in adults. In healthy children, the kidneys cannot be palpated, but in case of pathologies they can be detected. When performing a manual examination in children, the doctor prefers to palpate the kidneys in the supine and lateral decubitus position. Feeling while standing is not always possible, especially if the child is restless.

Why is bladder percussion performed?

Types of palpation

Research can be conducted in several ways. The main condition is an empty bladder. Otherwise, the diagnosis will be incorrect. Palpation methods:

The procedure occurs differently in both sexes:

men - rectally;
women – vaginally.

Examination technique:

The person lies down or gets on all fours.
The doctor presses on the pubic area with one hand, inserts a finger of the other hand into the anus (vagina) and presses on the bladder.

Normal bladder when palpated

Technique of the procedure

Performing percussion step by step:

The patient is placed on his back.
The action is carried out from the navel to the womb (from top to bottom). A finger (pessimeter) is placed on the stomach, and with the other hand the doctor applies light blows to it while gradually lowering it by 2 cm. The bottom of the organ is determined by the occurrence of dullness.

To diagnose certain types of pathologies, a special technique is used - “Pasternatsky’s symptom”. To do this, a person must sit or stand. Method for identifying a symptom: the doctor performs percussion at the site of the 12th rib and moves towards the spinal column. If a patient experiences pain, it can be assumed that there is a bladder pathology.

The patient takes a lying position and relaxes.
The doctor gently presses his hand on the lower abdomen, gradually increasing the pressure in the umbilical area, to feel the contour of the organ.

During the process, the patient must talk about what he feels (localization of the pain syndrome, how it manifests itself).

Features of the female gender

Since the structure of the pelvis in women is special, diagnosis is carried out 2 times:

With a full bladder.
With a devastated organ.

Palpation of the bladder in young children

Palpation of the kidneys in adults and children

Palpation of the kidneys is normal

Pasternatsky's symptom

urolithiasis;
kidney inflammation;
paranephritis.

We should not exclude other causes of pain - osteochondrosis, diseases of the ribs, lumbar muscles, gallbladder diseases, pancreatitis.

Examination of organs while lying on your back

Palpation algorithm in a supine position:

The patient lies down on the couch and completely relaxes, breathing deeply.
The doctor stands on the patient’s right side, placing his left hand under the patient’s body in the lumbar area closer to the spine.
The right hand is placed on the stomach under the ribs, perpendicular to the peritoneum.
When the patient exhales, the doctor's right hand gradually sinks, trying to reach the back wall of the abdomen, trying to get closer to the fingers of the left hand.

The procedure for the left kidney is similar. The study helps determine:

the size of the enlarged organ;
shape;
mobility;
consistency;
soreness.

Palpation while lying on your side

Kidney anatomy

Before proceeding with a targeted examination of an organ, it is necessary to accurately imagine its topical location in the human body, only then can one judge about any violations (for example, their prolapse on one or both sides).

The kidneys are a vital organ; it is a paired formation whose main tasks include the process of formation and excretion of urine. It is thanks to them that the body “gets rid” of unnecessary and harmful products of metabolic processes, waste and toxins.

Anatomically, they are located along the posterior surface of the abdominal cavity on opposite sides of the spine (right and left). The organ occupies the space from the XII thoracic to the II lumbar vertebra, however, the right kidney, as a rule, is located below the left, which is due to the close location of the liver, to which it is adjacent to the upper pole.

Normally, the renal surface is smooth and even throughout its entire length, which is explained by the presence of a dense capsule (fibrous membrane). There is a powerful ligamentous apparatus, thanks to which the organ is fixed in the anatomical bed.

Kidney palpation technique

Palpation examination in medicine is of two types:

superficial (thanks to it, the doctor determines the points of greatest pain sensitivity, and also makes a preliminary assessment of the patient’s general condition);
deep (allows a specialist to directly examine the required organ, determine its main characteristics, location, size, etc.).

Superficial palpation should always precede a deep examination, since in some conditions sharp and intense pressure on the kidneys can cause a severe attack of pain and worsen the patient’s condition. Its implementation consists of uniform and soft palpation of the anterior abdominal wall, without deep immersion.

The following criteria are assessed:

temperature reaction, skin moisture, pain points;
the presence of infiltrates or compactions on the surface of the abdominal wall (under the skin);
severity of protective muscle tension

Of greatest importance for diagnosis is deep palpation of the kidneys, which can be carried out in two positions of the patient: horizontal and vertical.

Deep palpation of the kidneys in the supine position

After the patient takes a horizontal position on the couch or other hard surface, he is asked to relax as much as possible and not strain the muscles of the anterior abdominal wall.

The palpation examination algorithm is presented below:

the doctor takes a position to the right of the patient, after which the left hand is brought under the right lumbar region of the patient;
with the right hand, the specialist begins to slowly plunge into the abdominal cavity of the corresponding side (the fingers should be slightly bent at the phalanges);
on each exhalation of the patient, the doctor makes a deeper dive, trying to reach the posterior wall of the abdominal cavity (the movement goes towards the left hand, which lies under the lower back);
if the patient does not have an enlarged kidney, then almost complete contact of both hands is possible, especially if we are talking about patients with low body weight and the absence of a pronounced fat layer on the anterior surface of the abdomen;
layer on the anterior surface of the abdomen;
when there is an increase in the size of the kidney, its lower edge or the entire organ can be easily identified with your fingertips (at this stage it is very important to palpate very carefully so as not to provoke an attack of severe pain);
thanks to a digital examination, the doctor can determine the approximate size of the enlarged kidney, its shape, consistency, mobility, as well as the presence or absence of pain;
after palpation on the right is completed, I move the hand placed under the lumbar region further until it reaches the left side of the back (projection of the left kidney), the technique for further examination is similar to the previous one.

Deep palpation of the kidneys in a standing position

It is advisable to examine the patient not only in a lying position, but also in a standing position. To do this, the patient is asked to stand on his feet, straighten up and place both hands behind his head. The doctor sits down in front of the patient on a chair and conducts a palpation examination, the course of which is described above.

There are many educational videos that clearly show and explain all stages of palpation (they can be easily found in any Internet search engine).

Conditions in which the kidneys can be palpated

You can identify the kidneys by palpation in the following situations:

an asthenic physique of a person or pronounced thinness (complete absence of fat), as a result of which the lower edge of the organ is easily determined by deep palpation;
prolapse of the kidneys of varying degrees of severity (unilateral or bilateral nephroptosis), in which the kidneys are partially or completely displaced from their anatomical bed, up to their descent into the pelvic cavity;
a significant increase in organ size is possible in a number of diseases.

These conditions include:

cystic kidney disease (replacement of normal tissues with multiple cysts of different sizes);
hydronephrosis (prolonged stagnation leads to a sharp expansion of the collecting apparatus, while progressive atrophy of healthy tissues is observed);
mass formations in the kidneys (for example, an abscess) or oncological processes of benign or malignant origin.

Conclusion

As mentioned above, in the normal state the kidneys of a healthy person are not palpable, however, there are individual structural features of the human body, its constitution and other factors that determine the physiological position of the organ.

If you experience any unpleasant or painful sensations from the organs of the urinary system, you should seek help from a doctor rather than engage in self-diagnosis. Only a qualified specialist is able to correctly conduct palpation, as well as other objective examination techniques.

When palpating the right kidney: the left one is on the lower back, and the right one is on the stomach. When a patient breathes deeply into the stomach, the upper arm gradually sinks deeper as you exhale, moving parallel to the spine and trying to reach the posterior abdominal wall. The lower hand simultaneously lifts the muscles of the lumbar region.

Upon palpation, the impression of contact between the right and left hands is created. After the sensation of the hands touching has arrived (if the kidney is not palpable), it is necessary to ask the patient to take a deep breath - the kidney then descends, and if it is accessible to palpation, its dense consistency is felt. In this case, the kidney is painless. In case of an enlarged kidney or its sharp prolapse, the balloting method (Guyon method) should be used.

There is a method of palpation of the kidney while standing, proposed by S. P. Botkin. The patient stands facing the doctor, leaning forward moderately. The doctor performs the manipulation while sitting on a chair, while the patient’s abdominal muscles must be relaxed. - Pain on palpation of the kidneys or the area where they are located is characteristic of an inflammatory lesion, but can also be observed with acute stretching of the capsule of a different nature - for example, due to swelling of the kidney parenchyma during acute glomerulonephritis (AGN) or when the ureter is blocked by a stone.

However, in most patients the kidney cannot be palpated. Usually it is palpable only in severe asthenics when it subsides, in people who have lost weight sharply and quickly, and in multiparous women (asthenic physique). If the kidney is clearly palpable, the question of kidney prolapse or dystonia (this is a condition when the kidney does not rise completely from the pelvis during embryonic development) should be considered. If an organ can be clearly palpated, it should be evaluated. Usually the kidney is painless, its surface is flat, smooth, bean-shaped, elastic. If the kidney is enlarged, it is easily palpable, and then it is necessary to find out the reasons for the enlargement (polycystic disease, tumor, etc.).

Ureteral points are determined by pressing in the back and abdomen; they can be painful during inflammatory processes in the pelvis and ureters.

Palpation of the bladder (UB) is possible only when it is filled with urine or if there is a tumor process in it. In the filled state, the MP is palpated in the form of an oval formation, the bottom of which is located at one or another level above the symphysis pubis, which depends on the degree of its filling. The latter also determines the position of the researcher’s right hand. Therefore, it is customary to precede palpation of the bladder with percussion.

With inflammatory damage to the bladder, palpation of the organ or its location is painful. With a tumor of the bladder, a dense, painless, sometimes lumpy formation is determined by palpation.

Percussion is not used when examining the kidneys due to the deep location of the organs.
Above the pubis, a full bladder can be detected, which is confirmed by the presence of dullness. Percussion of the MP is performed along the white line of the abdomen in the direction from the navel to the pubic symphysis. When the bottom of the bladder is reached, instead of a tympanic sound, a dull sound is detected.

Laboratory and instrumental methods for studying the urinary organs. After an objective examination of the kidneys and ureters, as well as other organ systems, they proceed to laboratory and instrumental diagnostics, which are carried out in the following sequence:

performing a urine test, and in controversial cases, conducting several similar tests to ensure their reliability;
conducting basic functional tests;
X-ray examination;
ultrasound diagnostics;
conducting a radiological study using drugs excreted primarily by the kidneys, but labeled with isotopes (carried out if necessary);
performing a kidney biopsy, carrying out light, electron and immunofluorescence microscopy - to clarify the diagnosis and choose treatment tactics (carried out as necessary).

When performing laboratory tests of the kidneys, it is necessary to remember the basic elements of their functioning. In pathological extremes they may manifest themselves in the form of certain symptoms.

Sources

http://2pochki.com/diagnostika/tehnika-palpacii-pochek
http://DvePochki.com/diagnostika/palpaciya-pochek.html
https://UroHelp.guru/diagnostika/metod/palpaciya-pochek-i-mochevogo.html
https://pochki5.ru/other/palpatsiya-pochki.html

One of the main diagnostic procedures for kidney diseases is palpation. This is a manual examination method in which a specialist palpates the kidney area and, based on indicators such as density, consistency and position of the kidney, can make initial conclusions about a possible disease.

This is an old method for diagnosing kidney diseases, but it does not allow for an accurate diagnosis and is used only during the initial examination to determine further direction of the examination.

Difference from percussion

Palpation (or palpating) is a method in which the kidney area is felt.

Along with palpation, the percussion method can also be used, but it performs other tasks. Percussion is tapping area of the kidneys, which is important if it is necessary to determine the presence of neoplasms or compactions in the kidneys, and in the event of the appearance of such pathological compactions, the sound will be dull and dense.

If there are no neoplasms, but the patient has pathologies that lead to fluid accumulation in the kidneys, the sound will be louder. Percussion also allows you to accurately determine whether the tumor is located on the organ itself or in close proximity to it in the abdominal cavity.

Unlike percussion, palpation has a wide range of applications and allows you to identify not only disorders in the pathological organ, but also determine its location(displacement of the kidneys is a deviation from the norm, which indicates possible diseases and injuries).

In general, palpation is used for:

determining the direction in which the kidney is displaced;
determining its mobility or immobility;
identifying the size of the kidney;
obtaining information about the consistency and shape of the organ.

General rules of palpation prescribe the examination while the patient is in a supine relaxed position.

The doctor uses one hand as a support, placing it behind the patient’s lower back in the area of the kidney being examined. The second hand is slowly inserted into the abdominal cavity, and if there are no pathologies, the specialist can feel the organ with both hands without causing any pain to the patient.

Types of palpation

Palpation can be superficial or deep.

In the first case it is done superficial palpation kidney area, which allows you to detect seals located close to the surface of the skin, as well as evaluate muscle tone and determine indicators of humidity, density, temperature and sensitivity of the skin.

There is no direct contact through the skin with the organ itself, and the specialist does not apply pressure to the abdominal cavity.

For a more detailed examination, use deep palpation method, when the doctor uses either several fingers or the entire hand, exerting noticeable physical pressure on the body. Deep palpation is in turn divided into the following types:

Deep sliding. In this case, the goal is to press the organ to the back wall and examine its entire surface in detail.
Bimanual. In this case, one of the specialist’s hands is used not only as a support, being placed behind the patient’s lower back, but also participates in the examination, holding the kidney in the required position.
Push-like (balloting). A push-like pressure is applied to the organ lowered to the abdominal wall with the finger of one hand, while the second hand palpates this organ.

This method is not used to examine the kidneys and is used only if it is necessary to palpate the liver or spleen.

Technique and normal indicators

Depending on the expected diagnosis and anatomical features of the patient, different palpation techniques.

According to Botkin

In case of kidney problems The Botkin palpation method is used, while people with moderate body weight can be examined while standing, and for overweight people, palpation of the kidney using this method is possible only if the person is lying down.

During the examination, the patient stands in front of the doctor and bends forward slightly. The specialist, sitting in front of the subject on a chair, places his left hand behind his lower back, and with the half-bent fingers of his right hand, probes the area where the kidney is located on the front side of the peritoneum.

The patient needs to completely relax the abdominal muscles and exhale deeply, and at this time the specialist presses the peritoneum with his right hand, after which the patient inhales and the doctor’s fingers move further, gaining access to the kidney.

In this way you can diagnose prolapse of the organ () and its swelling due to pressure from accumulated fluid (hydronephrosis).

In the first case, palpation is painless, the size of the kidney does not change, and the organ itself remains elastic and soft. With hydronephrosis, painful sensations appear due to increased sensitivity of the organ, but the pain is usually tolerable. To the touch, the pathological organ is very dense and can be easily palpated.

In both diseases, the surface of the kidney is even and smooth, but if the structure of the surface is disturbed (tubercles, irregularities and depressions are found), this indicates the development of tumors and neoplasms.

According to the Obraztsov-Strazhesko method

The second option of palpation - according to the Obraztsov-Strazhesko method, refers to deep sliding palpation. This method involves sequential palpation of all organs located in the kidney area, as well as partially the intestines. The specialist’s hand “slides” along the internal cavity, moving from organ to organ.

This examination is carried out according to a certain algorithm:

The patient lies on his back and stretches his arms along the body.
The doctor inserts the fingers of his right hand into the patient’s abdominal area, as with the Botkin method.
Next, the examination is carried out by sliding the fingertips from organ to organ towards the back wall.

From the point of view of nephrology, this method most effective in determining the degree of kidney prolapse, and in this case such pathology can be expressed in one of three degrees.

With first-degree nephroptosis, a specialist can only feel the lower part of the organ. In the second degree, the entire organ can be palpated and even have mobility, but when moving, the kidney does not go beyond the line of the spine: this is typical for third-degree nephroptosis.

According to Glenar

Much less often The Glenard palpation method is used. This examination is performed in the following sequence:

The patient lies on his back, and the doctor clasps the patient's side with one hand so that the thumb rests on the hypochondrium, and the other four fingers rest on the back of the lower back.
The doctor places the thumb of the second hand next to the first in the hypochondrium area.
The patient is asked to take a deep breath, as a result of which the kidney moves just to the place where the doctor's thumbs are located.
At this moment, the specialist applies light pressure with his fingers, feeling the organ.

This method is used for the primary diagnosis of neoplasms, and also allows determine kidney enlargement.

Palpation, despite the availability of the technique, can only be used for primary diagnosis.

And only by qualified doctors who know the anatomical structure of the area being examined well and can determine by touch whether there are pathological changes in the organs in a particular case.

Regardless of the results of such an examination, for the final diagnosis and appropriate treatment for the patient subsequently It is imperative to undergo instrumental diagnostics.

How to palpate the kidneys while lying down - watch the video:

The kidneys are one of the most important organs of the urinary system. They are responsible for cleansing the blood of toxic products and harmful impurities and removing processed substances. In recent years, the number of kidney diseases, which are accompanied by a violation of the shape and size of the organ, has sharply increased. For primary diagnosis, many doctors resort to the palpation method, which helps to establish signs of various pathologies.

What is kidney palpation?

Palpation of the kidneys is one of the methods for the initial examination of these organs of the urinary system by palpating them through the anterior and posterior abdominal wall. This method is carried out by a doctor of any specialty in order to determine existing violations of the shape, sensitivity or position of the organ.

Palpation of the kidneys is carried out mainly by senior medical personnel

Palpation is carried out as a preliminary diagnosis and requires mandatory confirmation of the results obtained using laboratory or instrumental studies.

Table: advantages and disadvantages of the technique

Pros	Cons
The procedure can be performed by a doctor of any specialty	A certain amount of experience is required on the part of the doctor to suspect a particular pathology.
The duration of palpation takes no more than 10 minutes and does not harm the body	During the procedure, discomfort may occur (increased pain)
This technique can also be performed on bedridden, paralyzed patients.	With a large amount of fat deposits or highly developed muscles, it is not possible to obtain reliable data
No special equipment required	Minor structural changes may be missed
The location of the organ is revealed	It is impossible to assess functional disorders of the organ

Diagnostic value of this study

Palpation is not a particularly sensitive method, and a lot depends on the care and experience of medical personnel, but it is thanks to this method that the presence of certain diseases can be determined. It is not recommended to neglect primary diagnosis: it is relatively reliable and can often provide the necessary information.

What pathologies can be identified by palpation of the kidneys:

nephroptosis (prolapse of an organ on one side or the other) and excessive mobility;
hydronephrosis (expansion of the collecting system);
nephrocalcinosis (deposition of calcifications in soft tissues) and urolithiasis;
inflammatory process (pyelonephritis, glomerulonephritis);
an increase in the size of the kidney due to edema;
change in the surface of the organ (appearance of tuberosities, protrusions or pits);
malignant or benign neoplasm.

Photo gallery: what ailments can be detected this way

A renal cyst is a fluid-filled mass Hydronephrosis occurs due to overstretching of the pelvis Malignant neoplasm often causes the death of the patient

Indications and contraindications for the procedure

Like any other study, palpation requires justification for its conduct. Indications for its implementation are:

intense pain in the lumbar region;
suspicion of the development of a malignant or benign neoplasm;
differential diagnosis between kidney damage and lumbar osteochondrosis (dystrophic disorder of the integrity of the vertebral discs);
the need to determine the shape and location of the organ.

In some situations, excess pressure on the abdominal wall can lead to undesirable consequences and provoke a deterioration in the patient's condition. Then it is better to abandon palpation and replace it with a more gentle method. Contraindications for the procedure include:

Pregnancy. In this case, it is almost impossible to palpate the kidneys, since almost the entire volume of the abdomen is occupied by the enlarged uterus, which displaces the internal organs. And also pressure on the abdominal wall can negatively affect the condition of the baby and the woman or provoke a premature onset of labor.
Suspicion of the presence of a purulent process in the kidneys. During palpation, an accidental rupture and disruption of the integrity of the capsule may occur, as a result of which the contents of the abscess will enter the pelvic cavity and onto the peritoneum, causing blood poisoning.
The patient is in a state of drug or alcohol intoxication, as well as exacerbation of chronic mental illnesses. In this case, a person can harm not only himself, but also the people around him. It is recommended to wait out the acute period and then palpate the kidneys.
Fractures of the spine, pelvic bones. Even a slight movement in this case can provoke displacement of bone fragments and lead to unwanted complications.

In my practice, I had to deal with the unpleasant consequences of palpation of the kidneys in a patient who was intoxicated. The intern, who pressed too hard on the abdominal wall, provoked an intense attack of nausea in the man, ending in vomiting. To avoid this, it is not recommended to palpate a person under the influence of alcoholic beverages.

How can a patient prepare for palpation of the kidneys?

Such a study is not invasive (does not involve the penetration of medical equipment into the body). This means that it is absolutely not necessary to follow a diet or not drink water or any other liquids. The only thing doctors recommend is not to eat food for 30 minutes before the start of the study. In patients with an extremely sensitive stomach, when it is full, palpation of the abdominal wall can cause heartburn or slight nausea, and is also accompanied by mild discomfort.

Don't forget that if you feel nervous before starting the test, you need to tell your doctor about it. I met one patient who was terrified of tickling and reacted extremely negatively to any touch to the abdominal wall. Since palpation was necessary for differential diagnosis, I tried to reassure the man as much as possible and spoke in detail about how the study was proceeding. The patient relaxed and trusted me, and then we managed to carry out palpation without any funny incidents.

Procedure technique and results

The examination takes place behind a closed door or behind a screen in the doctor's office. The patient needs to remove the upper part of his clothing, exposing the stomach and lower back. Palpation is carried out in the following positions:

The patient lies on his back, there should be no bolsters or pillows under his head, the upper limbs are freely extended along the body. The doctor places his right hand under the costal arch of the organ being examined, and the left hand is placed on the lower back. The patient needs to inhale and begin to exhale slowly. At this time, the doctor brings the palms together and feels the kidney. Then the procedure is carried out on the other side.
Palpation of the kidneys from a supine position is the most effective way of such diagnosis.
Lying on your side. The patient turns over on his side, puts one hand behind his head, and places the other along the body. The doctor places his hands on the anterior abdominal wall and lower back in the same way as in the previous type of examination. As you exhale, slow pressure is applied and the palms are connected to each other.
This position allows you to determine the side of damage
Standing. The patient is asked to bend at an angle of at least 40–45 degrees and take a deep breath. The doctor's hands are located in the same places, and at the exit they begin to come closer together. Using this technique, in 90% of cases a change in the position of the organ is detected.
Palpation of the kidneys from a standing position reveals displacement of the organ

What can be detected during palpation:

Variant of the norm. In the absence of any morphological and functional abnormalities, the kidneys are located in the lower back at the level of the last thoracic and first lumbar vertebrae. The boundaries of a healthy organ can only be felt in people with an extremely thin layer of fat. In other cases, the kidneys are not palpable, and this area is completely painless.
Change of position. The prolapse of an organ is accompanied by its absence in the right place. The kidney may appear higher or lower than its normal level, and sometimes a wandering phenomenon is detected. In this case, the organ can move freely relative to the retroperitoneal space, which serves as a reason for the operation.
Deformation and enlargement of the kidney. These symptoms are characteristic of cysts, malignant neoplasms, purulent processes limited to the capsule, and calcifications. Depending on the dense or soft consistency of the organ, we can make an assumption about the type of disease.
Changing the nature of the surface. A healthy kidney is even and smooth, without pits or protrusions. The appearance of tuberosity indicates cancer, a small-focal pustular process, or polycystic changes.
The occurrence of pain. This symptom accompanies almost all renal pathologies, as a result of which it is used only to differentiate between lesions of the urinary and skeletal systems.

Video: doctor talks about the procedure

Features of palpation of the kidneys in children

Many kids are afraid of people in white coats. To normalize the emotional background and reduce stress, it is necessary that one of his parents be with the child during the kidney examination. If this is impossible, you should distract the baby with toys or songs, and also carry out the procedure in a playful way.

Before palpation begins, the doctor’s palms must be warm. Exposure to cold, even through rubber gloves, can lead to reflex muscle spasms and disrupt the examination procedure, as one of my colleagues once experienced. As a result, it took about 10 minutes to calm and relax the baby. Only then did it become possible to repeat the procedure.

Palpation of the kidneys in a child does not differ from that in adults

In newborns and infants, palpation of the kidneys is carried out only in the supine position. The hand is placed slightly higher than that of an adult (this is due to the small volume of the chest), and the pressure is exerted not by 4 fingers, but by 2 or 3. For older children, the study is carried out in three positions (lying on the back and on the side, standing) . If the baby behaves restlessly, it is necessary to repeat palpation at least 2 times to obtain the most reliable data.

Palpation of the kidneys is a fairly effective technique, which, in the absence of special technologies, allows the doctor to suspect initial changes in organs and tissues. Often this method helps the therapist decide whether the patient needs a consultation with a nephrologist or urologist. However, palpation data without instrumental confirmation cannot be used to make a diagnosis. That is why you should undergo a full range of examinations before starting treatment.

When a patient comes to see a doctor and presents his complaints, the specialist usually asks clarifying questions and conducts an examination. He feels with his hands where the organ is, how painful it is. The methods of conducting the examination will differ depending on which system of the body the failure occurred.

Palpation of the kidney does not cause pain to the patient if everything is in order with the organ. In addition, if the kidneys are in their place and have a normal size, it is quite difficult to palpate them. Already from these signs it is clear whether there are any deviations.

With pathologies such as nephroptosis, the kidney changes its position - it descends and becomes mobile. With neoplasms or inflammation, the organ becomes uneven, changes shape, enlarging in places where tumors are located.

Below we suggest familiarizing yourself with the pathologies for which it is possible to palpate the kidney:

pyelonephritis;
hydronephrosis;
paranephritis;
urolithiasis;
neoplasms.

There are two ways to palpate organs:

superficial;
more deeply.

In the first option, the doctor receives generalized information about the kidneys. He will understand the body temperature, how tense the muscles are, and whether there are any lumps or infiltrates under the skin. With the deep method, the organ can be felt as accurately as possible. These include the following methods:

palpation with sliding movements;
bimanual method;
jerky palpations.

The bimanual technique is most suitable for examining the kidneys.

Palpation technique

The patient will need to lie on their back or side, and the doctor may ask them to stand up. Sometimes the specialist is able to feel the edge of the right kidney. Usually it is located lower compared to the left. This is only possible in thin people or children.

If the patient is quite obese, then it is completely impossible to palpate the organs even with a pathological picture. In order for the doctor to somehow get to the kidneys, an overweight person must stand.

The doctor asks the patient to stand up and relax as much as possible, even out his breathing. It must be deep. When the patient inhales, the doctor from the back tries to slightly push the kidney forward. With his second hand he will feel it. It is this hand that must penetrate deeply.

Methods of palpation of the kidneys. Source: studopedia.su

Palpation of the kidney can be performed:

according to Obraztsov, when the patient should lie on his back;
according to Botkin, the patient is standing.

Palpation according to Obraztsov. The specialist places the thumb under the patient's front ribs. The remaining fingers are at the back. The doctor places his second hand on the front wall of the abdomen. When the patient inhales, the kidney will descend. The doctor will fix it with one hand and press on the stomach with the other. The organ, caught between the fingers, will slip out. At this moment, the kidney can be carefully palpated.

Palpation according to Botkin. This method of palpation of the kidneys has a similar algorithm to the previous one. The difference is that the patient must stand up and turn sideways towards the specialist. The torso leans slightly forward, and the arms should be folded on the chest.

Both methods are suitable for thin people with weak muscles and a soft stomach.

If the patient has well-developed muscles or is overweight, then the examination is carried out lying on his side.

Palpation of the kidneys in children is similar to the actions that the doctor performs when examining adults. In this case, the characteristics of small patients should be taken into account. Children are not always ready to stand still. That is why their internal organs are often palpated in a lying position.

Percussion

When examining the kidneys, percussion means tapping on the lower back. In this case, they focus on Pasternatsky’s symptom. If the pain is severe, the result is considered positive. Often we are talking about urolithiasis, paranephritis, pyelonephritis. Pathologies such as radiculitis or myositis, which are not related to the urinary system, cannot be excluded. In these diseases, percussion causes increased pain.

Percussion of the kidneys is performed in a sitting or standing position. The patient should fix his hand in the abdomen and lean forward slightly - bend over.

The doctor stands behind. He places his left hand in the area of the 12th rib, and with his right hand he makes gentle blows, but at the same time quite sharp. Then repeats the movements on the other side.

Thanks to this kind of tapping and palpating, a specialist can understand whether there is a pathology or not. To be on the safe side, additional studies will be ordered. Sometimes an ultrasound is enough. If doubts remain, a CT scan or a more in-depth examination will be prescribed. After this, it will be possible to make a diagnosis and begin choosing the optimal treatment option.