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How to elicit Tenderness over the renal angle?

Patient is asked to sit and the angle formed by the 12th rib and lateral border of erector spinae muscle is pressed by the ball of the thumb—"Murphys kidney punch". This  test is done on both sides.
Renal  angle is tender in the following conditions
  • Acute pyelonephritis
  • Perinephric abscess
  • Nephrolithiasis, 
  • Tuberculosis of kidney