A comprehensive clinical examination is the basis for selecting further diagnostic steps:
- General physical examination – including blood pressure, pulse, body weight, height; further:
- Inspection (viewing).
- Skin and mucous membranes [possible symptom stage 5: yellowish skin color].
- Oral cavity [possible symptom stage 5: stomatitis (inflammation of the oral mucosa)]
- Throat [possible symptom stage 5: parotitis (parotid gland inflammation)]
- Extremities [possible symptom from stage 3: peripheral edema (water retention, eg, lower leg)]
- Auscultation (listening) of the heart [possible symptoms stage 5:
- Cardiac arrhythmias
- Pericarditis (inflammation of the pericardium)]
[due topossible sequelae:
- Heart failure (heart failure) – patients with heart failure and kidney disease have a particularly high mortality.
- Hypertension (high blood pressure)
- Coronary artery disease (CAD) (narrowing of the coronary arteries caused by atherosclerosis (arteriosclerosis, hardening of the arteries).
- Left ventricular hypertrophy (LVH; enlargement of the left ventricle (heart chamber)).
- Pericarditis (inflammation of the pericardium)]
- Examination of the lungs
- Palpation (palpation) of the abdomen (abdomen) (tenderness?, knocking pain?, coughing pain?, defensive tension?, hernial orifices?, kidney bearing knocking pain?).
- Palpation of the renal region
- Inspection (viewing).
- If necessary, gynecological examination [possible symptom stage 5: secondary amenorrhea (absence of menstrual bleeding (longer than 3 months, after an already regular cycle))] [due topossible sequelae:
- Amenorrhea (absence of menstrual bleeding).
- Infertility (inability to carry a pregnancy to term)]
- Neurological examination [possible symptom from stage 3:
- Neuropathy (diseases of the peripheral nervous system).
possible symptoms stage 5:
- Seizure
- Restless legs syndrome]
[due topossible secondary diseases:
- Neuropathy (nervous diseases of the peripheral nervous system).
- Restless legs syndrome]
- Orthopedic examination [possible symptoms from stage 3:
- Fractures (broken bones)
- Bone pain
- Osteomalacia (softening of the bones)
possible symptoms stage 5:
- Myopathy (muscle pain)
- Osteoporosis (bone loss)]
- Urological/nephrological examination [due todifferential diagnosis: acute renal failure] [due topossible causes:
- Abacterial chronic interstitial nephritis – chronic inflammation of the connective tissue (tissue between glomeruli (renal corpuscles) and tubules) of the kidney.
- Glomerulonephritis – kidney disease with inflammation of the glomeruli (renal corpuscles).
- Hemolytic uremic syndrome (HUS) – triad of microangiopathic hemolytic anemia (MAHA; form of anemia in which erythrocytes (red blood cells) are destroyed), thrombocytopenia (abnormal reduction in platelets/platelets), and acute kidney injury (AKI); Mostly occurring in children in the context of infections; most common cause of acute renal failure requiring dialysis in childhood.
- HIV nephropathy – kidney disease caused by HIV infection.
- Obstructive nephropathies – kidney disease due to narrowing or obstruction of the urinary tract.
- Pyelonephritis (inflammation of the renal pelvis).
- Vascular nephropathy – kidney disease due to changes in the renal vessels, usually atherosclerosis (arteriosclerosis, hardening of the arteries)]
- Health check
Square brackets [ ] indicate possible pathological (pathological) physical findings.