Acute kidney injury physical examination: Difference between revisions

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{{Acute kidney injury}}
{{Acute kidney injury}}


{{CMG}}; {{AE}}
{{CMG}}; {{AE}} {{F.K}}


==Overview==
==Overview==
Line 35: Line 35:


===Appearance of the Patient===
===Appearance of the Patient===
*Patients with [disease name] usually appear [general appearance].  
*Patients with acute kidney injury usually appear ill.<ref name="pmid23394211">{{cite journal |vauthors=Kellum JA, Lameire N |title=Diagnosis, evaluation, and management of acute kidney injury: a KDIGO summary (Part 1) |journal=Crit Care |volume=17 |issue=1 |pages=204 |date=February 2013 |pmid=23394211 |pmc=4057151 |doi=10.1186/cc11454 |url=}}</ref><ref name="pmid27670788">{{cite journal |vauthors=Ostermann M, Joannidis M |title=Acute kidney injury 2016: diagnosis and diagnostic workup |journal=Crit Care |volume=20 |issue=1 |pages=299 |date=September 2016 |pmid=27670788 |pmc=5037640 |doi=10.1186/s13054-016-1478-z |url=}}</ref><ref name="pmid14760871">{{cite journal |vauthors=Anderson RJ, Barry DW |title=Clinical and laboratory diagnosis of acute renal failure |journal=Best Pract Res Clin Anaesthesiol |volume=18 |issue=1 |pages=1–20 |date=March 2004 |pmid=14760871 |doi= |url=}}</ref><ref name="pmid18354074">{{cite journal |vauthors=Himmelfarb J, Joannidis M, Molitoris B, Schietz M, Okusa MD, Warnock D, Laghi F, Goldstein SL, Prielipp R, Parikh CR, Pannu N, Lobo SM, Shah S, D'Intini V, Kellum JA |title=Evaluation and initial management of acute kidney injury |journal=Clin J Am Soc Nephrol |volume=3 |issue=4 |pages=962–7 |date=July 2008 |pmid=18354074 |pmc=2440262 |doi=10.2215/CJN.04971107 |url=}}</ref><ref name="pmid28167845">{{cite journal |vauthors=Makris K, Spanou L |title=Acute Kidney Injury: Diagnostic Approaches and Controversies |journal=Clin Biochem Rev |volume=37 |issue=4 |pages=153–175 |date=December 2016 |pmid=28167845 |pmc=5242479 |doi= |url=}}</ref><ref name="pmid26787777">{{cite journal |vauthors=Chen KP, Cavender S, Lee J, Feng M, Mark RG, Celi LA, Mukamal KJ, Danziger J |title=Peripheral Edema, Central Venous Pressure, and Risk of AKI in Critical Illness |journal=Clin J Am Soc Nephrol |volume=11 |issue=4 |pages=602–8 |date=April 2016 |pmid=26787777 |pmc=4822669 |doi=10.2215/CJN.08080715 |url=}}</ref>


===Vital Signs===
===Vital Signs===
 
*[[Bradycardia]] with regular pulse  
*High-grade / low-grade fever
*Low blood pressure with normal pulse pressure
*[[Hypothermia]] / hyperthermia may be present
*[[Tachycardia]] with regular pulse or (ir)regularly irregular pulse
*[[Bradycardia]] with regular pulse or (ir)regularly irregular pulse
*Tachypnea / bradypnea
*Kussmal respirations may be present in _____ (advanced disease state)
*Weak/bounding pulse / pulsus alternans / paradoxical pulse / asymmetric pulse
*High/low blood pressure with normal pulse pressure / [[wide pulse pressure]] / [[narrow pulse pressure]]


===Skin===
===Skin===
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===Neck===
===Neck===
* Neck examination of patients with [disease name] is usually normal.
*Neck examination of patients with acute kidney injury is usually normal.
OR
*[[Jugular venous distension]]
*[[Carotid bruits]] may be auscultated unilaterally/bilaterally using the bell/diaphragm of the otoscope
*[[Lymphadenopathy]] (describe location, size, tenderness, mobility, and symmetry)
*[[Thyromegaly]] / thyroid nodules
*[[Hepatojugular reflux]]


===Lungs===
===Lungs===
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===Genitourinary===
===Genitourinary===
* Genitourinary examination of patients with [disease name] is usually normal.
* Genitourinary examination of patients with acute kidney injury is usually normal.
OR
*A pelvic/adnexal mass may be palpated
*Inflamed mucosa
*Clear/(color), foul-smelling/odorless penile/vaginal discharge


===Neuromuscular===
===Neuromuscular===
* Neuromuscular examination of patients with [disease name] is usually normal.
* Neuromuscular examination of patients with acute kidney injury is usually normal.
OR
*Patient is usually oriented to persons, place, and time
* Altered mental status
* Glasgow coma scale is ___ / 15
* Clonus may be present
* Hyperreflexia / hyporeflexia / areflexia
* Positive (abnormal) Babinski / plantar reflex unilaterally/bilaterally
* Muscle rigidity
* Proximal/distal muscle weakness unilaterally/bilaterally
* ____ (finding) suggestive of cranial nerve ___ (roman numerical) deficit (e.g. Dilated pupils suggestive of CN III deficit)
*Unilateral/bilateral upper/lower extremity weakness
*Unilateral/bilateral sensory loss in the upper/lower extremity
*Positive straight leg raise test
*Abnormal gait (describe gait: e.g. ataxic (cerebellar) gait / steppage gait / waddling gait / choeiform gait / Parkinsonian gait / sensory gait)
*Positive/negative Trendelenburg sign
*Unilateral/bilateral tremor (describe tremor, e.g. at rest, pill-rolling)
*Normal finger-to-nose test / Dysmetria
*Absent/present dysdiadochokinesia (palm tapping test)


===Extremities===
===Extremities===
* Extremities examination of patients with [disease name] is usually normal.
*[[Edema]] of the lower extremities
OR
 
*[[Clubbing]]
*[[Cyanosis]]
*Pitting/non-pitting [[edema]] of the upper/lower extremities
*Muscle atrophy
*Fasciculations in the upper/lower extremity
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}

Revision as of 19:21, 27 June 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Farima Kahe M.D. [2]

Overview

Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].

OR

Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

The presence of [finding(s)] on physical examination is diagnostic of [disease name].

OR

The presence of [finding(s)] on physical examination is highly suggestive of [disease name].

Physical Examination

Physical examination of patients with [disease name] is usually normal.

OR

Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].

OR

The presence of [finding(s)] on physical examination is diagnostic of [disease name].

OR

The presence of [finding(s)] on physical examination is highly suggestive of [disease name].

Appearance of the Patient

Vital Signs

  • Bradycardia with regular pulse
  • Low blood pressure with normal pulse pressure

Skin

  • Livido reticularis
  • Digital ischemia
  • Butterfly rash
  • Palpable purpura
  • Maculopapular rash
  • Track marks

HEENT

  • Keratitis
  • Iritis
  • Uveitis
  • Dry conjunctivae
  • Jaundice
  • Band keratopathy
  • Retinopathy
  • Hearing loss
  • Mucosal or cartilaginous ulcerations

Neck

  • Neck examination of patients with acute kidney injury is usually normal.

Lungs

  • Rales
  • Hemoptysis

Heart

  • Irregular rhythms (ie, atrial fibrillation)
  • Murmurs
  • Pericardial friction rub
  • Increased jugulovenous distention, rales, S3

Abdomen

  • Pulsatile mass or bruit
  • Abdominal or costovertebral angle tenderness
  • Pelvic, rectal masses
  • Prostatic hypertrophy
  • Distended bladder

Back

  • Back examination of patients with acute kidney injury is usually normal.

Genitourinary

  • Genitourinary examination of patients with acute kidney injury is usually normal.

Neuromuscular

  • Neuromuscular examination of patients with acute kidney injury is usually normal.

Extremities

  • Edema of the lower extremities

References

  1. ↑ Kellum JA, Lameire N (February 2013). "Diagnosis, evaluation, and management of acute kidney injury: a KDIGO summary (Part 1)". Crit Care. 17 (1): 204. doi:10.1186/cc11454. PMC 4057151. PMID 23394211.
  2. ↑ Ostermann M, Joannidis M (September 2016). "Acute kidney injury 2016: diagnosis and diagnostic workup". Crit Care. 20 (1): 299. doi:10.1186/s13054-016-1478-z. PMC 5037640. PMID 27670788.
  3. ↑ Anderson RJ, Barry DW (March 2004). "Clinical and laboratory diagnosis of acute renal failure". Best Pract Res Clin Anaesthesiol. 18 (1): 1–20. PMID 14760871.
  4. ↑ Himmelfarb J, Joannidis M, Molitoris B, Schietz M, Okusa MD, Warnock D, Laghi F, Goldstein SL, Prielipp R, Parikh CR, Pannu N, Lobo SM, Shah S, D'Intini V, Kellum JA (July 2008). "Evaluation and initial management of acute kidney injury". Clin J Am Soc Nephrol. 3 (4): 962–7. doi:10.2215/CJN.04971107. PMC 2440262. PMID 18354074.
  5. ↑ Makris K, Spanou L (December 2016). "Acute Kidney Injury: Diagnostic Approaches and Controversies". Clin Biochem Rev. 37 (4): 153–175. PMC 5242479. PMID 28167845.
  6. ↑ Chen KP, Cavender S, Lee J, Feng M, Mark RG, Celi LA, Mukamal KJ, Danziger J (April 2016). "Peripheral Edema, Central Venous Pressure, and Risk of AKI in Critical Illness". Clin J Am Soc Nephrol. 11 (4): 602–8. doi:10.2215/CJN.08080715. PMC 4822669. PMID 26787777.

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