RENAL SYSTEM EXAMINATION
INTRODUCTION:
- General introduction about the system
GENERAL EXAMINATION:
SYMPTOMS
FEATURES
CONDITIONS OR DIAGNOSIS
Pain
In urinary tract
Renal pain in ank or loin
Chronic ank pain
Severe suprapubic pain
Obstruction, infection, tumour
Stones
PKD
Acute bladder out ow
obstruction
Haematuria
Blood in urine with or without
pain
Stones, tuberculosis, trauma,
acute GN, prostatic
enlargement
Oliguria
Passage of less than 500 ml of
urine per day
Pre-renal, intra-renal and postrenal diseases.
Polyuria
Increased urinary output with
increased frequency of
micturition
DM, CKD, D insipidus
Slow stream, hesitancy, and
terminal dribbling
Slow stream, hesitancy,
terminal dribbling
Prostatic enlargement, bacterial
infection of UT.
TO BE INSPECTED
FEATURES
DIAGNOSIS
Consciousness
Lost
Uraemic encephalopathy
Anaemia
Due to hematuria, bleeding,
coagulation
Decreased erythropoietin in
CKD
Skin changes
Dry, pale, anky
Scratch marks
Uraemia
Pruritis
Oedema
Facial pu ness, pitting edema
of ankles
Nephrotic syndrome
Deformity
Knock-knee or bow legs
Hyperparathyroidism in CKD
Nails
Leukonychia
Half and half nails
Nephrotic syndrome
CRF
SYSTEMIC EXAMINATION:
INSPECTION:
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Saturday, 22 October 2022
1. LEFT KIDNEY:
- Right hand placed anteriorly in the left lumbar while left hand placed posteriorly in the left
loin.
- Ask the patient to take a deep breath, press the left hand forward and lift the right hand
upward and inward.
- Usually left kidney is not palpable unless enlarged.
2. RIGHT KIDNEY:
- Same way as left kidney.
- Right hand - right lumbar region anteriorly
- Left hand - right loin posteriorly
3. URINARY BLADDER:
- Normally UB is not palpable.
- Retention of urine - smooth, rm, regular oval -shaped swelling will be palpated in the
suprapubic region.
- In women, a palpable bladder has to be di erentiated from the uterus.
PERCUSSION:
- To diagnose ascites in nephrotic syndrome.
AUSCULTATION:
- Uraemic pericarditis and pleurisy may be suggested by pericardial and pleural friction
rubs, respectively.
- Their presence points to either advanced uraemia or a multisystem in ammatory disorder
such as systemic lupus erythematosus (SLE), which may have both renal and extrarenal
manifestations.
- Added heart sounds (S3 and S4) suggest, respectively, volume expansion and incipient
heart failure, and ventricular hypertrophy, often as a consequence of hypertension.
- The presence of vascular bruits and/or impairment of the major arterial pulses is an
important nding, raising the possibility of renal vascular disease, which may underlie
hypertension and/or renal failure if bilateral.
Add investigations
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PALPATION: