Why is the left kidney not palpable?

From the Guidelines

The left kidney is not palpable due to its anatomical position, being located higher in the abdominal cavity and partially protected by the lower ribcage, as well as being obstructed by the stomach and spleen 1. When attempting to palpate the kidneys, the left kidney's location makes it more challenging to feel through the abdominal wall. In contrast, the right kidney is usually easier to palpate because it sits lower in the abdomen and is not obstructed by as many organs. Some key points to consider when trying to palpate the kidneys include:

• The use of a bimanual technique, placing one hand on the patient's back and the other on the abdomen, trying to feel the kidney between their hands
• The location of the liver above the right kidney, which can help push it down slightly, making it more accessible during examination
• The importance of considering alternative methods for assessing kidney health, such as ultrasound, CT scans, or blood tests, as kidney palpation is not always necessary or reliable. It's also worth noting that imaging techniques, such as those described in the emergency ultrasound imaging criteria compendium 1, can provide more accurate and detailed information about kidney structure and function.

From the Research

Kidney Position and Palpability

The left kidney is not palpable due to several reasons related to its position and surrounding structures.

• The left kidney is located higher than the right kidney in the retroperitoneal space, which makes it less accessible for palpation 2.
• The left kidney is also more deeply embedded in the surrounding tissues and organs, such as the spleen, stomach, and colon, making it more difficult to palpate 3, 4.
• Additionally, the left kidney has a more variable position due to its mobility and the presence of accessory renal vessels, which can affect its palpability 5, 6.

Anatomical Variations

Anatomical variations, such as the presence of accessory renal vessels or congenital anomalies like L-shaped kidney, can also affect the position and palpability of the left kidney.

• Accessory renal vessels can be present at the upper or lower poles of the kidney, which can alter its position and relationship with surrounding structures 5.
• Congenital anomalies like L-shaped kidney can result in an abnormal position of the kidney, making it less palpable 6.

Positional Changes

Positional changes, such as supine to prone position, can also affect the position and palpability of the left kidney.

• The left kidney displaces ventrally and medially in the prone position, which can make it less palpable 3.
• The prone position can also shorten the distance from the skin to the renal calix, making the kidney less accessible for palpation 3, 4.