Physical exam in Kidney

Disease
Andree Kurniawan
Symptoms associated with renal problems
•  Dysuria, frequency, and urgency •  Edema
•  Hematuria •  Colicky pain
•  Polyuria •  Hypertension
•  Nocturia •  Mass
•  Oliguria and anuria •  Weakness
Dysuria, frequency, and urgency
•  Urinary tract infecCons
•  Frequency and urgency: lower UT-bladder, prostate, and urethra
•  Tumors, urinary calculi or urinary tract obstrucCon
•  Dysuria: infecCons in urethra
•  Frequency: anxiety, overacCve bladder
•  Urgency: pregnancy, weakness of pelvic floor muscles, extrinsic
pressure in bladder, neurogenic
Dysuria
Hematuria
•  Bleeding from urinary tract
•  ContaminaCon?, Hburia, myoglobinuria
•  Painless: UTI, tuberculosis, schistosomiasis, urogenital tumor,
glomerulonephriCs, renal cysCc disease, hypertension, chronic renal
vascular disease
•  Painful: Renal calculi, UTI, reflux nephropathy, renal papillary
necrosis, embolism
Polyuria
•  Increase in urine volume
•  High fluid intake, psychogenic polydipsia
•  Increase solute, osmoCc diuresis
•  Impaired ADH
•  Reflux nephropathy
•  Chronic adrenal inssuficiency
Nocturia
•  Insomnia, polyuria and prostaCc obstrucCon
•  Cardiac failure
Anuria
•  Urine retenCon
•  True anuria
•  Acute Kidney Injury
•  Pre renal
•  Renal
•  Post renal
•  Chronic Kidney Disease (CKD)
•  Acute on CKD
Edema

AAFP
AAFP
Drug induced edema

AAFP
Abdominal pain

AAFP
Hypertension
Weakness
Abdominal Exam
•  InspecCon
•  Scars, distended, scrotum for masses and genital edema
•  PalpaCon
•  Renal mass, enlarged kidney, renal tenderness, hepatomegaly, abdominal
aorCc aneurysm, enlarged bladder
•  BalloCng
•  Percussion
•  Ascites, enlarged bladder
•  AuscultaCon
•  Renal bruit
Physical ExaminaDon
•  General inspecCon à drowsy to coma, hypervenClaCon, cingultus,
bronze color skin, twitching
•  Vital signs à blood pressure, temperature
•  Face à anemia, Band keratopathy, fundi, palpebra edema, mouth
(uremic fetor), rash
•  Neck à jugular vein pressure, caroCd artery bruit, lymphe-
adenopathy, scar
•  Chest exam à congesCve heart failure, pulmonary oedema,
pericardial rub, lung infecCon
Physical ExaminaDon (2)
•  Abdominal exam
•  Rectal exam à enlarged prostate
•  Back à bone tenderness, Murphy kidney punch, sacral edema
•  ExtremiCes exam à ulcer, edema, purpura, livedo reCcularis,
peripheral neuropathy and myopathy, tophi
•  Hand à skin nodule, arthropathy

History
•  Familial renal disease: polycysCc kidney disease, hereditary nephriCs,
renal calculi
•  Systemic disease: SLE, DM, hypertension, sickle cell anemia
•  Toxic exposure: heavy metals, radiographic contrast material, drugs:
analgesics, anCbioCcs, NSAIDS
•  Associated symptoms:
•  General: fever, weight loss, faCgue, skin rash, pruritus, sore throat
•  Cardiovascular: dyspnea, chest pain, edema
•  GastrointesCnal: anorexia, nausea, vomiCng
•  Genitourinary: polyuria, dysuria, flank pain, hematuria, passage of renal stone
Physical exam
•  Cardiovascular: hypertension, cardiac failure, pericardial rub, edema
•  Genitourinary: palpable kidneys or bladder, prostaCc enlargement
•  Neurological: peripheral neuropathy, asterixis, encephalopathy
•  Funduscopic: sign of diabetes, SLE, hypertension
Thank you