Unilateral Enlarged Kidney

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.

The patient has evidenced of chronic renal failure of which he is receiving

hemodialysis. There is presence of a sallow appearance. I did not notice any pruritic
scratch marks or bruises on the ULs or LLs and he is not cachexic looking. There are
no signs of leukonychia or Terrys nails. There is no conjunctival pallor to suggest
anaemia and he does not have features of polycythemia. Patient is not in fluid
overload, has no uremic fetor or flapping tremor of the hands and no Kussmauls
breathing.

Patient is undergoing hemodialysis via a left arterio-venous fistula. There is a strong

thrill felt over the fistula with recent needle injection marks. There are no
complications of aneurysm of the fistula. There are no abdominal scars to suggest
previous TK insertion or renal transplant.

I would like to complete my examination by

Temperature chart for fever
Blood pressure for hypertension
Fundoscopy for hypertensive changes
(dont mention urine analysis if ESRF on RRT!)
Cardiovascular examination for MVP and AR
Neurological examination for III nerve palsy of stroke
FHx of stroke or aneurysm

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

See Bilateral enlarged Kidneys for other questions.