Area of flank below rib cage is the area of kidney. A lump originating from kidney moves moves with respiration and is better felt in the loin than anteriorly, usually ballotable. A band of colonic resonance over the swelling can be felt.
A renal lump can have many causes.
The most common renal mass is a cyst, or fluid-filled sac arising from the kidney, a common diagnosis and without any significant health risks. Renal cysts can be simple cysts or , which don’t need intervention, and may not even need further follow-up or observation.
However, some cysts can be complex.
Solid masses are worrisome for cancer.
History, clinical examination and imaging helps in diagnosis of the renal mass.
Most of the lesion now a days are minimally invasive, kidney-sparing procedures can be offered. In some cases, partial nephrectomy, open or laproscopic are considered.
Cause of Renal Lump
- Cystic fluctuant swelling with typical characteristics of a renal lump
- Pain in the loin if it is very large
- IVP shows clubbing of the minor calyces and dilatation of the pelvis
- All the features of hydronephrosis
- Septicemia: Fever with rigors and sweating, dry furred tongue, leucocytosis and positive blood culture
- Urine examination: Pus cells and white cell casts present
- Cystoscopy: Red and swollen ureteric orifice on the affected side
- Bilateral renal swelling in a man with or without dragging pain in the loin
- Urine: Low specific gravity with albumin and a few casts
- IVP: Attenuated and elongated (spider leg) calyces with terminal clubbing or cupping.
- Fixed, dull aching pain in the renal angle radiating from loin to groin aggravated by movements and relieved by rest
- Tenderness in the renal angle
- Renal lump palpable only if associated hydronephrosis
- Albuminuria, pyuria and hematuria may be present
- Commonly seen in boys below 5 years of age.
- Painless, huge enlargement of kidneys without hematuria (hematuria occurs later when the tumour bursts into the renal pelvis)
- IVP: Filling defect in the renal pelvis or spider leg deformity of the calyces. Plain X-ray abdomen often reveals the tumour
- Common in adult males
- Painless lump in the abdomen
- Painless hematuria
- Development of recent varicocele
- Evidence of metastasis: Spotaneous fracture, hemoptysis
- IVP: Spider leg deformity of the calyces frequently distorted by the tumor. Complete absence of excretion or scattered patches of dye in the kidney areas.
- Evidence of septicemia
- Tenderness and rigidity in the renal angles.
- Scoliosis of the lumbar spine with concavity towards the affected side.
Note: IVP stands for intravenous pyelogram