Acute Renal Failure: Examination

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, mucous membranes and sclerae (white part of the eye).
    • Auscultation (listening) of the heart[due todifferential diagnoses or possible causes of prerenal acute renal failure:
      • Heart failure (cardiac insufficiency).
      • Myocardial infarction (heart attack) with heart failure (cardiac insufficiency).
      • Myocarditis (inflammation of the heart muscle) with heart failure (heart failure).
      • Thromboembolism (occlusion of a blood vessel by a detached blood clot)]

      [due topossible sequelae:

      • Cardiac arrhythmias
      • Hypertension (high blood pressure)
      • Pericarditis (inflammation of the pericardium)]
    • Examination of the lungs (due topossible secondary diseases):
      • Auscultation (listening) of the lungs.
      • Bronchophony (checking the transmission of high-frequency sounds; the patient is asked to pronounce the word “66” several times in a pointed voice while the doctor listens to the lungs)[increased sound conduction due to pulmonary infiltration/compaction of lung tissue (e.g., in pneumonia) the consequence is, the number “66” is better understood on the diseased side than on the healthy side; in the case of reduced sound conduction (attenuated or absent: e.g., in pleural effusion). The result is, the number “66” is barely audible to absent over the diseased part of the lung, because the high-frequency sounds are strongly attenuated]
      • Vocal fremitus (checking the conduction of low frequencies; the patient is asked to pronounce the word “99” several times in a low voice while the physician places his hands on the patient’s chest or back)[increased sound conduction due to pulmonary infiltration/compaction of lung tissue (e.g. e.g. in pneumonia) the consequence is, the number “99” is better understood on the diseased side than on the healthy side; in case of reduced sound conduction (attenuated: e.g. atelectasis, pleural rind; strongly attenuated or absent: in case of pleural effusion). The result is, the number “99” is barely audible to absent over the diseased part of the lung, because the low-frequency sounds are strongly attenuated]
    • Palpation (palpation) of the abdomen (abdomen) (pressure pain?, knock pain?, cough pain?, defensive tension?, hernial orifices?, kidney bearing knock pain?)
  • If applicable, cancer screening[due topossible cause of intrarenal renal failure:
    • Plasmocytoma (multiple myeloma) – malignant tumor disease from the group of non-Hodgkin’s lymphomas. Its origin is in the lymphoid tissue, as in all lymphomas]

    [due toPossible causes of postrenal acute renal failure:

    • Tumors of the reproductive organs, unspecified.
    • Tumors of the retroperitoneal space, unspecified (space between the peritoneum and the posterior abdominal wall)
    • Tumors of the genitourinary tract, unspecified]

    [due todifferential diagnoses:

    • Plasmocytoma (multiple myeloma) – malignant tumor disease from the group of non-Hodgkin’s lymphomas. Its origin is in the lymphoid tissue, as in all lymphomas.
    • Tumors of the reproductive organs, unspecified.
    • Tumors of the retroperitoneal space, unspecified (space between the peritoneum and the posterior abdominal wall)
    • Tumors of the genitourinary tract, unspecified]
  • If necessary, neurological examination [due topossible sequelae: encephalopathy (pathological, unspecified brain changes)]
  • Urological/nephrological examination[due topossible cause of prerenal acute renal failure:
    • Adrenocortical insufficiency]

    [due topossible causes of intrarenal renal failure:

    • Acute interstitial nephritis (kidney inflammation).
    • Glomerulonephritis (kidney disease caused by inflammation of the renal corpuscles).
    • Adrenocortical insufficiency]

    [due topossible causes of postrenal acute renal failure:

    • Benign prostatic hyperplasia (benign enlargement of the prostate gland).
    • Ureteral stenosis (ureteral stricture)
    • Urethrastenosis (urethral narrowing)
    • Urolithiasis (urinary stone disease)]

    [due todifferential diagnoses:

    • Acute interstitial nephritis (inflammation of the kidneys).
    • Benign prostatic hyperplasia (benign enlargement of the prostate gland).
    • Glomerulonephritis (kidney disease caused by inflammation of the renal corpuscles).
    • Adrenocortical insufficiency
    • Ureteral stenosis (narrowing of the ureter)
    • Urethrastenosis (urethral narrowing)
    • Urolithiasis (urinary stone disease)]

Square brackets [ ] indicate possible pathological (pathological) physical findings.