RENAL SYSTEM EXAMINATION NOTES

• Introduction, Wash Hands, Consent,
• Expose Patient & General Inspection:
  • Alert & Orientated? (Uraemic Encephalopathy, UTI in Elderly)
  • Acute pain or distress (Renal Colic, Pyelonephritis)
  • Signs of Fluid Overload (Ascites, Peripheral Oedema)
  • Signs of Dehydration (Causing Pre-Renal Failure)
  • Facial Oedema (Nephrotic Syndrome)
  • Obesity
  • Scars
  • In-Dwelling catheter
  • Uraemic Fetor/Tinge (Ammonia Smell from Hyperuricaemia)
  • Easy bruising on Arms, Legs & Trunk
• Vital Signs:
  • Pulse:
    • Tachycardia (If Infection, Hypovolaemia, Anaemia)
  • Blood Pressure:
    • Hypertension (Nephritic, Fluid Overload, Polycythaemia, Polycystic Kidney)
    • Postural Hypotension (Anaemia, Hyponatraemia, Addisons, Diabetic Neuropathy)
  • Respiratory Rate:
    • Tachypnoea (if Renal Acidosis)
    • Bradypnoea (if Renal Alkalosis)
  • Temperature:
    • Fever (Infection, Malignancy)
• Hands:
  • Peripheral Perfusion + CRT
  • Mee’s Lines [single horizontal bands] (Arsenic/Heavy metal Poisoning)
  • Muercke’s Lines [paired horizontal bands] & Leukonychia (Hypoalbuminaemia due to Nephrotic Syndrome)
  • Palmar Crease Pallor & Pale Nails (Anaemia, Nephritic Syndrome)
  • Palmar Crease Pigmentation (Addisons Disease ➔ Hyponatraemia & Hypovolaemia)
  • Xanthomata (Diabetes, Obesity, Metabolic Syndrome)
  • Gouty Tophi (Hyperuricaemia)
  • Vasculitic Changes (Eg. Digital Infarcts – Sign of Autoimmune Glomerulonephritis)
• Arms:
  • Uraemic Tinge/Uraemic Frost (Hyperuricaemia)
  • Scratch Marks (Uraemia)
  • AV-Fistulae (ESRD – Dialysis)
  • Scars
  • Asterixis (Uraemic Encephalopathy)
• Face:
  • Butterfly Malar Rash of SLE (Cause of Renal Failure)
  • Periorbital Oedema (Nephrotic Syndrome)
  • Conjunctival Pallor (Anaemia, Nephritic Syndrome)
  • Central/Peripheral Cyanosis
  • Mouth Infections:
    • (Strep Pharyngitis can ➔ PSGN Nephritic Syndrome)
    • (Also Immunocompromise from Nephrotic Syndrome)
    • Thrush (Immunocompromise from diabetes)
  • Xanthelasma (Diabetes, Nephrotic Syndrome)
  • Band Keratopathy (calcification of cornea due to 2^o Hyperparathyroidism due to Vit D Deficiency)
  • Dehydration (Nephrotic Syndrome)
  • +Fundoscopy (Diabetic Retinopathy)
  • Gum Hyperplasia (Methotrexate – Transplant Medication)
• Neck:
  • • Carotid Bruits (Hypercholesterolaemia, PVD, Diabetes)
    • Vas Cath (Haemodialysis)
    • Parathyroidectomy Scars (due to 2^o Hyperparathyroidism due to VitD Deficiency)
    • Acanthosis Nigricans (Diabetes, Metabolic Syndrome, Obesity)
• Chest:
  • • • CCF & Pulmonary Oedema (Due to Fluid Overload – Ie. Nephrotic Syndrome, CKD, ESRD)
• Abdomen:
  • • • Inspection:
        • Distension (Ascites in Nephrotic, Nephritic, Peritoneal Dialysis)
        • Surgical Scars
        • Peritoneal Dialysis Port
        • Visible Masses
      • Palpation:
        • Renal masses (Polycystic Kidneys, Carcinoma)
        • Insulin Injection Sites
        • Polycystic Liver ➔Hepatomegaly (Polycystic Kidneys)
        • Abdominal Aorta (Aneurysm ➔ Pre-Renal Failure)
        • Enlarged Bladder (Obstructive Uropathy)
      • Auscultation:
        • Renal Bruits (Renal Artery Stenosis, Pre-Renal Failure)
        • Bowel Sounds Present
      • Percussion:
        • Shifting Dullness (Ascites – Nephrotic, Nephritic, CKD)
• Back:
  • • • Surgical Scars
      • Costovertebral Angle Tenderness (Murphey’s Kidney Punch) – (Pyelonephritis/Stones)

• • Bony Tenderness
  • Sacral Oedema
• Legs:
  • Pitting Oedema (Nephrotic, Nephritic, CKD, Diabetes, PVD)
  • Scratches/Uraemic Frost (Hyperuricaemia)
• Feet:
  • Xanthomata (Hypercholesterolaemia)
  • Gouty Tophi (Hyperuricaemia)
  • Mee’s Lines (Arsenic/Heavy metal Poisoning)
  • Meurkhe’s Lines & Leukonychia (Hypoalbuminaemia – Nephrotic Syndrome)
  • Peripheral Perfusion + CRT
  • Peripheral Pulses
  • (+ Diabetic Neuropathy & Foot Examination)
  • + Urine Dipstick
  • Blood (Nephritic, Pyelonephritis, Renal Stones)
  • Protein (Nephrotic, Nephritic)

• Signs of Intra-Renal Failure (Nephrotics & Nephritics):
  • Nephrotic (Less Serious) (Autoimmune [adults] or Post-URTI [child]):
    • Polyuria
    • Massive Proteinuria ➔ Hypoalbuminaemia, Oedema & Periorbital Oedema
    • Compensative Hyperlipidaemia (Xanthomata/Xanthelasma)
    • Immunosuppression (Loss of IgG in Urine)
    • Hypercoaguability (Loss of AT3 in Urine)
    • No Haematuria
  • Nephritic (More Serious) (Post URTI [Adults] or Post Strep-Pharyngitis [Children]):
    • Anuria/Oliguria (↓GFR)
    • Modest Proteinuria (NB: NORMAL ALBUMIN) ➔ Oedema
    • Anaemia (PainLESS Haematuria)
    • Hypertension

Thank You so Much. Happy Learning!!