Chronic renal failure physical examination

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Aarti Narayan, M.B.B.S [2]

Chronic renal failure causes disturbances in not only the filtration function of the kidney, but also in the normal functioning of virtually every organ in the body. Symptoms and overt signs of kidney disease are often subtle or absent until renal failure ensues. Thus, the diagnosis of chronic renal failure often take the patient by surprise.

• Malaise
• In distress

• Hypertension
• Tachycardia
• Reduced pulse pressure
• Tachypnea
• Hypothermia

• Uremic fetor (foul smell)
• Uremic frost on the face (deposits of tiny, white, friable, crystalline material)^{[1] [2]}
• Poor skin turgor
• Excoriations (scratching)^[3]
• Localized erythema
• Blisters^[3]
• Bruises
• Lindsey’s nails (half and half nails), where proximal half of nails is white (edema) and distal half is pink (normal)

• Abnormal fundoscopic exam with evidence of diabetic retinopathy (among diabetic patients) or hypertensive retinopathy (among hypertensive patients)
• xerostomia (dry mucus membranes)

• Distended neck veins
• Carotid bruit (atherosclerosis)

• Left ventricular heave
• Fourth heart sound S4 (late diastolic low-pitched sound best heart at the apex in left lateral decubitus position)
• Pericardial friction rub (uremic pericarditis)
• Crackles (pulmonary edema)

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