Chronic renal failure physical examination: Difference between revisions
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==Overview== | ==Overview== | ||
[[Chronic renal failure]] causes disturbances in not only the filtration function of the kidney, but also | [[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. | |||
==Physical Examination== | |||
===General Appearance=== | |||
*Malaise | |||
*In distress | |||
== | ===Vital signs=== | ||
*Hypertension | |||
*[[Tachycardia]] | |||
*Reduced [[pulse pressure]] | |||
*Tachypnea | |||
*[[Hypothermia]] | |||
===Skin=== | |||
*Uremic fetor (foul smell) | |||
*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 | |||
*Lindsey's nails (half and half nails), where proximal half of nails is white (edema) and distal half is pink (normal) | |||
===HEENT=== | |||
*Abnormal [[fundoscopic exam]] with evidence of [[diabetic retinopathy]] (among diabetic patients) or [[hypertensive retinopathy]] (among hypertensive patients) | |||
*[[xerostomia]] (dry mucus membranes) | |||
===Neck=== | |||
*Distended neck veins | |||
*Carotid bruit (atherosclerosis) | |||
===Cardiothoracic=== | |||
*Left ventricular [[heave]] | |||
*Fourth heart sound [[Heart sounds#Fourth heart sound S4|S4]] (late diastolic low-pitched sound best heart at the apex in left lateral decubitus position) | |||
*[[Pericardial friction rub]] ([[uremic pericarditis]]) | |||
*[[Crackles]] ([[pulmonary edema]]) | |||
==References== | ==References== | ||
Latest revision as of 15:05, 3 April 2015
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Chronic renal failure Microchapters |
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Chronic renal failure physical examination On the Web |
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Risk calculators and risk factors for Chronic renal failure physical examination |
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.
Physical Examination
General Appearance
- Malaise
- In distress
Vital signs
- Hypertension
- Tachycardia
- Reduced pulse pressure
- Tachypnea
- Hypothermia
Skin
- Uremic fetor (foul smell)
- Uremic frost on the face (deposits of tiny, white, friable, crystalline material)[1] [2]
- Poor skin turgor
- Excoriations (scratching)[3]
- Localized erythema
- Blisters[3]
- Bruises
- Lindsey's nails (half and half nails), where proximal half of nails is white (edema) and distal half is pink (normal)
HEENT
- Abnormal fundoscopic exam with evidence of diabetic retinopathy (among diabetic patients) or hypertensive retinopathy (among hypertensive patients)
- xerostomia (dry mucus membranes)
Neck
- Distended neck veins
- Carotid bruit (atherosclerosis)
Cardiothoracic
- Left ventricular heave
- Fourth heart sound S4 (late diastolic low-pitched sound best heart at the apex in left lateral decubitus position)
- Pericardial friction rub (uremic pericarditis)
- Crackles (pulmonary edema)
References
- ↑ 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) - ↑ 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.
- ↑ 3.0 3.1 Meyer TW, Hostetter TH (2007). "Uremia". N Engl J Med. 357 (13): 1316–25. doi:10.1056/NEJMra071313. PMID 17898101.