Palpation of kidneys

Definition: To palpate or ballot the kidneys the examiner should place one hand under the patient in the flank region and the other hand on top just below the borders of the costal margin.

Test procedure: Note the kidneys cannot be palpated normally even in a slim person. To feel for the kidneys you need to use both hands. With the left hand on the back of the patient under the 12th rib pushing upwards and the right hand pushing down just below the costal margin.

Ask the patient to take a deep breath to help descend the kidney as you attempt to trap it between your two hands. The examiner is required to somewhat firmly push his/her hands together as the patient inhales air with a deep breath. The enlarged kidney may be felt as you try to capture it between your two hands in conjunction with the commencement of inspiration.

On inspiration one may feel the lower pole of the kidney moving down
between the hands in response to this the examiner can ballot or push the kidney forwards and backwards between the hands

Test findings: An easily palpable and/or tender kidney is abnormal.
If you are able to palpate the kidneys try to describe its texture and size. It is usually tender in hydronephrosis or when acutely infected in pyelonephritis. Another method for assessing kidney tenderness is to percuss over them.

Considerations:
The right kidney is often palpable in very thin patients and sometimes in the case of children. This is not considered pathologic usually and can be normal a normal finding in those with less adipose tissue.