Renal Patient Examination Guide

Essentially you need to know:

  • the causes of chronic renal failure
  • the forms of renal replacement therapy
  • some other points

Causes of CRF Related to Clinical Findings

DiseaseBedside FindingsComments
Hypertension↑ BP, Retinopathy, history of proteinuria, anti hypertensives round the bed.Hypertension and DM are the commonest causes
DiabetesFinger prick blood glucose scars. Bruising around abdominal insulin injection sites. Lipohypertrophy 
GlomerulonephritisDipstick evidence of blood and protein 
Reflux NephropathyNone!Childhood infection history
VasculitisVasculitic rash may be evidente.g. Henoch Schonlein Purpura
Wegener’sHistory of nosebleed/ evidence of respiratory signs.cANCA positive, granulomas on biopsy
Rheumatoid related vasculitis/ drug therapySigns of RA.Renal impairment could be due to NSAIDs/ DMARDs/  Vasculitis/ Infection/ Glomerulonephritis
SLEPhotosensitive rash Arthritis Interstitial lung disease Serositis elsewhere 
Tuberous SclerosisDevelopmental Delay Epilepsy Adenoma sebaceous. Cutaneous manefestations also include: subungal fibromas, shagreen patch: thickened leathery patches of skin often around the neck.Hamartomas can occur anywhere
Goodpasture’sPulmonary Haemorrhage and Renal Failure. You may get a history of respiratory disease: think Wegener’s Goodpasture’sAnti – GMB antibodies

RRT= Renal Replacement therapy

Form Of RRTExamplesComments
CAPD: DAILY   (Continuous ambulatory peritoneal dialysis)Scars in the abdomen centrally from the dialysis      Many renal patients “further down” their illness e.g. who’ve had a transplant or been on dialysis for many years have had previous CADP. The little scars are there centrally, so look for them.    
Haemodialysis 3x a weekFistula (e.g. ARM/ LEG)   Tunnelled lines   Central Venous Catheters  Fistula sites are either working and being used: in which case they will have VISIBLE puncture marks in them Working and not being used either a.) they’re not needed yet or b.) the patient has had a transplant and the fistula is a remnant of previous treatment  
TransplantE.g. Right iliac fossa/ left iliac fossaThese are either Working fine Not working fine (may have been biopsied-look for a needle puncture over the kidney) Not Working at all: sign of other RRT (see above)   Normally you “leave the other kidneys in” unless the failed kidneys are causing problems through Size (ADAPKD) Infection (Cyst disease) Cancer   Remember to look / comment on signs of ciclosporin use i.e. gingival hypertrophy and Hypertension and peripheral neuropathy. This will impress the examiners.
Remember to also look for Features of nephrotic syndrome (oedema/ hypercholesterolaemia) Enlarged kidneys/ liver/ cerebral aneurysms of the Autosomal Dominant Adult Polycystic Kidney disease Anaemia of Renal disease (patients may be taking subcutaneous erythropoetin)