History and Physical for Kidney Disease
The clinical exam assessing for kidney disease is very important, as kidney disease often goes undiagnosed.
- history
- physical exam
History
Medications
Prescription and over-the counter drugs, street drugs, herbs can also lead to acute or chronic interstitial nephritis.
Past medical history
Diabetes and/or hypertension, along with other complications such as retinopathy or neuropathy, can suggest the cause of kidney disease.
Recurrent urinary tract infections can cause reflux nephropathy.
Recurrent renal calculi can result in chronic obstruction.
Systemic disorders:
- arthralgias and skin rash in autoimmune disease
- fever and pharyngitis in postinfectious glomerulonephritis
Family History
Alport's syndrome
Physical Exam
Retina: look for signs of diabetes, hypertension, bacterial endocarditis, and cholesterol emboli
Skin: look for presence of edema, rash, and purpura. Assess sacral edema if patient is supine.
Joints: signs of arthritis
Rectal/pelvic exam to exclude protstate/gynecological causes of urinary obstruction
Volume Satus
Assessing volume status is critical in nephrology. Look for:
- blood pressure, especially orthostatic blood pressure
- JVP
- ankle or sacral edema
- crackels on the lungs
- fluid intake and urine output (often chart review)
- skin turgor (forehead or sternum good areas)
Dehydration in infants and children