Chronic renal failure physical examination: Difference between revisions

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Thus, the diagnosis of [[chronic renal failure]] often take the patient by surprise.
Thus, the diagnosis of [[chronic renal failure]] often take the patient by surprise.


==Appearance of the Patient==
===General Appearance===
The patient may have difficulty breathing from complications of [[chronic renal failure]] such as [[pulmonary edema]] and [[pericarditis]].  [[Peripheral edema]] is most often present.
*Malaise
*In distress


==Vitals==
===Vital signs===
===Blood Pressure===
*Hypertension
*[[Hypertension]] may be present and is a potential cause for renal damage
*[[Tachycardia]]
*Reduced [[pulse pressure]]
*Tachypnea
*[[Hypothermia]]


===Respiratory Rate===
===Skin===
*[[Tachypnea]] may be present
*Uremic frost on the face (deposits of tiny, white, friable, crystalline material)<ref name="pmid20696798">{{cite journal |author=Kuo CC, Hung JB, Tsai CW, Chen YM |title=Uremic frost |journal=[[CMAJ]] |volume=182 |issue=17 |pages=E800 |year=2010 |month=November |pmid=20696798 |pmc=2988568 |doi=10.1503/cmaj.091779 |url=}}</ref> <ref name="pmid16707817">{{cite journal |author=Udayakumar P, Balasubramanian S, Ramalingam KS, Lakshmi C, Srinivas CR, Mathew AC |title=Cutaneous manifestations in patients with chronic renal failure on hemodialysis |journal=[[Indian J Dermatol Venereol Leprol]] |volume=72 |issue=2 |pages=119–25 |year=2006 |pmid=16707817 |doi= |url=http://www.ijdvl.com/article.asp?issn=0378-6323;year=2006;volume=72;issue=2;spage=119;epage=125;aulast=Udayakumar}}</ref>
*Poor skin [[turgor]]
*[[Excoriations]] (scratching)<ref name="pmid17898101">{{cite journal| author=Meyer TW, Hostetter TH| title=Uremia. | journal=N Engl J Med | year= 2007 | volume= 357 | issue= 13 | pages= 1316-25 | pmid=17898101 | doi=10.1056/NEJMra071313 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17898101  }} </ref>
*Localized [[erythema]]
*[[Blister]]s<ref name="pmid17898101">{{cite journal| author=Meyer TW, Hostetter TH| title=Uremia. | journal=N Engl J Med | year= 2007 | volume= 357 | issue= 13 | pages= 1316-25 | pmid=17898101 | doi=10.1056/NEJMra071313 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17898101  }} </ref>
*[[Bruise]]s


==Skin==
===HEENT===
*Deposits of tiny, white, friable, crystalline material (called "[[uremic frost]]") may be present on the face.<ref name="pmid20696798">{{cite journal |author=Kuo CC, Hung JB, Tsai CW, Chen YM |title=Uremic frost |journal=[[CMAJ]] |volume=182 |issue=17 |pages=E800 |year=2010 |month=November |pmid=20696798 |pmc=2988568 |doi=10.1503/cmaj.091779 |url=}}</ref> <ref name="pmid16707817">{{cite journal |author=Udayakumar P, Balasubramanian S, Ramalingam KS, Lakshmi C, Srinivas CR, Mathew AC |title=Cutaneous manifestations in patients with chronic renal failure on hemodialysis |journal=[[Indian J Dermatol Venereol Leprol]] |volume=72 |issue=2 |pages=119–25 |year=2006 |pmid=16707817 |doi= |url=http://www.ijdvl.com/article.asp?issn=0378-6323;year=2006;volume=72;issue=2;spage=119;epage=125;aulast=Udayakumar}}</ref>
*Abnormal [[fundoscopic exam]] with evidence of [[diabetic retinopathy]] (among diabetic patients) or [[hypertensive retinopathy]] (among hypertensive patients)
*[[xerostomia]] (dry mucus membranes)


==HEENT==
===Neck===
===Fundoscopy===
*Distended neck veins
*[[Fundoscopy]] is important in evaluating diabetic and hypertensive patients to look for retinal damage as evidence of [[diabetic retinopathy]] or [[hypertensive retinopathy]]
*Carotid bruit (atherosclerosis)


==Heart==
===Cardiothoracic===
===Pre-cordial examination===
*Left ventricular [[heave]]
*Left ventricular [[heave]] may be present
*[[Heart sounds#Fourth heart sound S4|S4]]
===Auscultation===
*[[Pericardial friction rub]] ([[uremic pericarditis]])
*[[Heart sounds#Fourth heart sound S4|S4]] may be heard
*[[Crackles]] ([[pulmonary edema]])
*[[Pericardial friction rub]] from [[uremic pericarditis]] may be present


==Lungs==
===Auscultation===
*[[Rales/Crackles]] from [[pulmonary edema]]


==Extremities==
==Extremities==
*[[Peripheral edema]] may be present.
*[[Peripheral edema]]


==Neurologic==
==Neuromuscular==
*[[Asterixis]]
*[[Asterixis]]
*[[Sensory neuropathy]]
*Reduced sense of smell (CN I dysfunction) and taste (CN VII dysfunction)<ref name="pmid17898101">{{cite journal| author=Meyer TW, Hostetter TH| title=Uremia. | journal=N Engl J Med | year= 2007 | volume= 357 | issue= 13 | pages= 1316-25 | pmid=17898101 | doi=10.1056/NEJMra071313 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17898101  }} </ref>
*Sesorimotor peripheral neuropathy<ref name="pmid17898101">{{cite journal| author=Meyer TW, Hostetter TH| title=Uremia. | journal=N Engl J Med | year= 2007 | volume= 357 | issue= 13 | pages= 1316-25 | pmid=17898101 | doi=10.1056/NEJMra071313 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17898101  }} </ref>
**Reduced pinprick or soft touch sensation in extremities
**Motor weakness in extremities


==References==
==References==

Revision as of 14:41, 3 April 2015

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Aarti Narayan, M.B.B.S [2]

Overview

Chronic renal failure causes disturbances in not only the filtration function of the kidney, but also in the normal functioning of virtually every organ in the body. Symptoms and overt signs of kidney disease are often subtle or absent until renal failure ensues. Thus, the diagnosis of chronic renal failure often take the patient by surprise.

General Appearance

  • Malaise
  • In distress

Vital signs

Skin

HEENT

Neck

  • Distended neck veins
  • Carotid bruit (atherosclerosis)

Cardiothoracic


Extremities

Neuromuscular

  • Asterixis
  • Reduced sense of smell (CN I dysfunction) and taste (CN VII dysfunction)[3]
  • Sesorimotor peripheral neuropathy[3]
    • Reduced pinprick or soft touch sensation in extremities
    • Motor weakness in extremities

References

  1. ↑ Kuo CC, Hung JB, Tsai CW, Chen YM (2010). "Uremic frost". CMAJ. 182 (17): E800. doi:10.1503/cmaj.091779. PMC 2988568. PMID 20696798. Unknown parameter |month= ignored (help)
  2. ↑ Udayakumar P, Balasubramanian S, Ramalingam KS, Lakshmi C, Srinivas CR, Mathew AC (2006). "Cutaneous manifestations in patients with chronic renal failure on hemodialysis". Indian J Dermatol Venereol Leprol. 72 (2): 119–25. PMID 16707817.
  3. ↑ 3.0 3.1 3.2 3.3 Meyer TW, Hostetter TH (2007). "Uremia". N Engl J Med. 357 (13): 1316–25. doi:10.1056/NEJMra071313. PMID 17898101.

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