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


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


==Overview==
==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].
Patients with acute kidney injury usually appear ill. Physical examination of patients with acute kidney injury is usually remarkable for [[hypotension]], [[edema]] of the lower extremities, [[maculopapular rash]] and [[rales]] on chest ausculatation.  
 
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==
Physical examination of patients with [disease name] is usually normal.
Physical examination of patients with acute kidney injury is usually remarkable for [[hypotension]], [[edema]] of the lower extremities, [[maculopapular rash]] and [[rales]] on chest ausculatation.<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>
 
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===
===Appearance of the Patient===
*Patients with [disease name] usually appear [general appearance].  
*Patients with acute kidney injury usually appear ill.


===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===
* Skin examinat
*[[Livedo reticularis]]
*Digital [[ischemia]]
*Butterfly rash
*Palpable [[purpura]]
*[[Maculopapular rash]]
*Track marks


===HEENT===
===HEENT===
*Keratitis, iritis, uveitis, dry conjunctivae  
*[[Keratitis]]
*Jaundice  
*[[Iritis]]
*Band keratopathy  
*[[Uveitis]]
*Atheroemboli
*Dry conjunctivae  
*Hearing loss  
*[[Jaundice]]
*Mucosal or cartilaginous ulcerations
*Band [[keratopathy]]
*[[Retinopathy]]
*[[Hearing loss]]
*Mucosal or cartilaginous [[ulcerations]]


===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===
*Rales  
*[[Rales]]
*Hemoptysis
*[[Hemoptysis]]
 
===Heart===
===Heart===
* Cardiovascular examination of patients with hydronephrosis is usually normal.
*Irregular rhythms (ie, atrial fibrillation)
*S1
*[[Murmurs]]
*S2
*[[Pericardial friction rubs|Pericardial friction rub]]
*Increased jugulovenous distention, rales, S3


===Abdomen===
===Abdomen===
*costovertebral angle tenderness may be present.
*Pulsatile mass or [[Bruits|bruit]]
*Distended bladder may be palpable.
*[[Abdominal]] or [[costovertebral angle]] [[tenderness]]
*Pelvic, rectal masses
*[[Prostatic hypertrophy]]
*Distended bladder


===Back===
===Back===
* Back examination of patients with [disease name] is usually normal.
* Back examination of patients with acute kidney injury is usually normal.
OR
*Point tenderness over __ vertebrae (e.g. L3-L4)
*Sacral edema
*Costovertebral angle tenderness bilaterally/unilaterally
*Buffalo hump


===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 hydronephrosis is usually normal.
* [[Neuromuscular]] examination of patients with acute kidney injury is usually normal.


===Extremities===
===Extremities===
* Extremities examination of patients with hydronephrosis may show edema.
*[[Edema]] of the lower extremities


==References==
==References==

Latest revision as of 16:41, 26 July 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 acute kidney injury usually appear ill. Physical examination of patients with acute kidney injury is usually remarkable for hypotension, edema of the lower extremities, maculopapular rash and rales on chest ausculatation.

Physical Examination

Physical examination of patients with acute kidney injury is usually remarkable for hypotension, edema of the lower extremities, maculopapular rash and rales on chest ausculatation.[1][2][3][4][5][6]

Appearance of the Patient

  • Patients with acute kidney injury usually appear ill.

Vital Signs

Skin

HEENT

Neck

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

Lungs

Heart

Abdomen

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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