genitourinary disorders
Evaluation of the Renal Patient
Physical Examination of the Renal Patient
Patients with moderate or severe Chronic Kidney Disease sometimes appear pale, wasted, or ill. Deep (Kussmaul) respiration suggests hyperventilation in response to Pericardial and pleuritic friction rubs may be signs of uremia. Patients can present with lung crackles secondary to pulmonary edema from fluid retention in acute or chronic kidney disease. Visible fullness of the upper abdomen is an unusual, nonspecific finding of Autosomal Dominant Polycystic Kidney Disease (ADPKD) . It may also indicate a kidney or abdominal mass. A soft, lateralizing bruit is occasionally audible in the epigastrium or the flank in renal artery stenosis; presence of a diastolic component increases the probability of Pain elicited by mild striking of the back, flanks, and angle formed by the 12th rib and lumbar spine with a fist (costovertebral tenderness) may indicate Acute pyelonephritis or Transillumination can distinguish solid from cystic renal masses in some children<1 year old if the kidney and mass are manipulated against the abdominal wall. Chronic kidney disease can cause any of the following: Xeroderma due to sebaceous and eccrine sweat gland atrophy Pallor due to anemia Hyperpigmentation due to melanin deposition Sallow or yellow-brown skin due to urochrome deposition Petechiae or ecchymoses due to platelet dysfunction Excoriation due to itching caused by Hyperphosphatemia or uremia Uremic frost, the deposition of white-to-tanureacrystals on the skin after sweat evaporation, is rare. Patients with Acute Kidney Injury (AKI) may be drowsy, confused, or inattentive; speech may be slurred. Asterixis can be detected in handwriting or by observation of outstretched hands maximally extended at the wrists; after several seconds in this position, a hand flap in the flexor direction is asterixis. Asterixis suggests one of the following: Chronic Kidney Disease None Chronic liver failure Carbon dioxide narcosis Toxic encephalopathy 