Bệnh thận liên quan (Nephropathy)

Mô tả: With the patient supine, one hand is placed over the flank, and the other on the anterior aspect of the costophrenic angle. The hand underneath ‘ballots’ (from the French ‘to toss’) the kidney upwards. The kidney is ballotable if felt by the anterior hand during this manoeuvre.

Nguyên nhân: More common • Polycystic kidney disease Less common • Renal cell carcinoma • Wilm’s tumour • Amyloidosis • Lymphoma • Ureteric obstruction – hydronephrosis

Cơ chế: An enlarged kidney, from whatever cause (e.g. tumouramyloid infiltration or aberrant cystic expansion), is closer in proximity to the anterior abdominal wall and is more likely to come into contact with the wall and thus be felt when pushed upwards.

Ý nghĩa lâm sàng: There is little or no evidence on the value of the ballotable kidney. In general, they are unlikely to be palpable, so if they are felt investigation is needed. However, a non-ballotable kidney by no means excludes pathology in the kidneys.