Chronic Kidney Insufficiency: 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 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
    • Auscultation (listening) of the lungs [possible symptoms stage 5:
      • Dyspnea (shortness of breath)
      • Kußmaul’sche breathing (breathing form with even deep breaths (due tohyperacidity in diabetes mellitus and metabolic derailment/diabetic ketoacidosis)).
      • Pulmonary edema (water accumulation in 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
• 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.