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==
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 examination of patients with [disease name] is usually normal.
*[[Livedo reticularis]]
OR
*Digital [[ischemia]]
*[[Cyanosis]]  
*Butterfly rash
*[[Jaundice]]
*Palpable [[purpura]]  
* [[Pallor]]
*[[Maculopapular rash]]
* Bruises
*Track marks
 
<gallery widths="150px">
 
UploadedImage-01.jpg | Description {{dermref}}
UploadedImage-02.jpg | Description {{dermref}}
 
</gallery>


===HEENT===
===HEENT===
* HEENT examination of patients with [disease name] is usually normal.
*[[Keratitis]]
OR
*[[Iritis]]
* Abnormalities of the head/hair may include ___
*[[Uveitis]]
* Evidence of trauma
*Dry conjunctivae
* Icteric sclera
*[[Jaundice]]
* [[Nystagmus]]  
*Band [[keratopathy]]  
* Extra-ocular movements may be abnormal
*[[Retinopathy]]
*Pupils non-reactive to light / non-reactive to accommodation / non-reactive to neither light nor accommodation
*[[Hearing loss]]
*Ophthalmoscopic exam may be abnormal with findings of ___
*Mucosal or cartilaginous [[ulcerations]]
* Hearing acuity may be reduced
*[[Weber test]] may be abnormal (Note: A positive Weber test is considered a normal finding / A negative Weber test is considered an abnormal finding. To avoid confusion, you may write "abnormal Weber test".)
*[[Rinne test]] may be positive (Note: A positive Rinne test is considered a normal finding / A negative Rinne test is considered an abnormal finding. To avoid confusion, you may write "abnormal Rinne test".)
* [[Exudate]] from the ear canal
* Tenderness upon palpation of the ear pinnae/tragus (anterior to ear canal)
*Inflamed nares / congested nares
* [[Purulent]] exudate from the nares
* Facial tenderness
* Erythematous throat with/without tonsillar swelling, exudates, and/or petechiae


===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===
* Pulmonary examination of patients with [disease name] is usually normal.
*[[Rales]]  
OR
*[[Hemoptysis]]
* Asymmetric chest expansion / Decreased chest expansion
*Lungs are hypo/hyperresonant
*Fine/coarse [[crackles]] upon auscultation of the lung bases/apices unilaterally/bilaterally
*Rhonchi
*Vesicular breath sounds / Distant breath sounds
*Expiratory/inspiratory wheezing with normal / delayed expiratory phase
*[[Wheezing]] may be present
*[[Egophony]] present/absent
*[[Bronchophony]] present/absent
*Normal/reduced [[tactile fremitus]]
 
===Heart===
===Heart===
* Cardiovascular examination of patients with [disease name] is usually normal.
*Irregular rhythms (ie, atrial fibrillation)
OR
*[[Murmurs]]  
*Chest tenderness upon palpation
*[[Pericardial friction rubs|Pericardial friction rub]]  
*PMI within 2 cm of the sternum  (PMI) / Displaced point of maximal impulse (PMI) suggestive of ____
*Increased jugulovenous distention, rales, S3
*[[Heave]] / [[thrill]]
*[[Friction rub]]
*[[Heart sounds#First heart tone S1, the "lub"(components M1 and T1)|S1]]
*[[Heart sounds#Second heart tone S2 the "dub"(components A2 and P2)|S2]]
*[[Heart sounds#Third heart sound S3|S3]]
*[[Heart sounds#Fourth heart sound S4|S4]]
*[[Heart sounds#Summation Gallop|Gallops]]
*A high/low grade early/late [[systolic murmur]] / [[diastolic murmur]] best heard at the base/apex/(specific valve region) may be heard using the bell/diaphgram of the otoscope


===Abdomen===
===Abdomen===
* Abdominal examination of patients with [disease name] is usually normal.
*Pulsatile mass or [[Bruits|bruit]]  
OR
*[[Abdominal]] or [[costovertebral angle]] [[tenderness]]  
*[[Abdominal distention]]  
*Pelvic, rectal masses
*[[Abdominal tenderness]] in the right/left upper/lower abdominal quadrant
*[[Prostatic hypertrophy]]
*[[Rebound tenderness]] (positive Blumberg sign)
*Distended bladder
*A palpable abdominal mass in the right/left upper/lower abdominal quadrant
*Guarding may be present
*[[Hepatomegaly]] / [[splenomegaly]] / [[hepatosplenomegaly]]
*Additional findings, such as obturator test, psoas test, McBurney point test, Murphy test


===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 [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==

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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