Medical student and Medical Doctor skills for a Chronic Renal Failure Medical Examination.

Chronic Renal Failure Medical Examination

Chronic Renal Failure (CRF)

WIPE - Wash hands, Introduce yourself, Position and Expose.

For positioning, the patient position is similar to an abdominal examination. This position is where the patient is lying comfortably, ideally lying flat on the bed with arms by her side. If the patient is in pain in this position, an alternative position is where the patient is lying with one pillow and legs bent.

Also ensure good lighting and proper exposure of the patient.

General Appearance of Patient in Chronic Renal Failure Examination

• Assess if the patient appears comfortable?
• Is the patient distressed?
• Is there any obvious pain?
• Is there any pallor, jaundice?
• Is there any cachexia (low weight)?
• Any obvious masses or scars?

Determine Patients Mental State in the Chronic Renal Failure Examination

• Is the patient able to respond?
• Is the patient coherent?
  

Hand Examination in CRF

• Examine the hands for clubbing
  
• Metabolic flap (asterixis)?
• Anemia signs including Koilonychia and pale palmar creases
• skin pigmentation changes?
• scratch marks?
• 
  

Assess Fluid Status in the Patient with CRF

• Assess skin turgor (pinch skin - should go back down in less than 2 seconds - if slow then possibly dehydration)
• Are mucous membranes wet? Tongue wet?
  
• Are the eye orbits sunken ?
• Examine wrist pulse - weak pulse? fast pulse?
• Take blood pressure supine then standing - low blood pressure? any signs of postural hypotension?
• Check for axillary dryness (a good sign of dehydration)
• Assess JVP
• Auscultate for heart sounds - Normal? dual no murmur?
• Auscultate the chest for edema or lung problems
• Assess Sacral edema?
• Examine for pedal Edema

Abdominal Examination for CRF

• Inspection
• Kidneys are examined by ballottement
• The kidneys are compared from each side
• To examine the kidneys place the left hand in the left lumbar region below the 12th rib (above the iliac crest)
• The right hand is placed anteriorly above the ASIS (anterior superior iliac spine)
• The left hand is then lifted towards the right hand
• Normally the kidney is not felt by the right hand (unless the person is very thin)
• Note that the right kidney lies lower than the left and is more likely to be palpated
• One can also auscultate the kidney area and aorta 
• Percuss for shifting dullness if any ascites
• 
  

 Peripheral Nerves and Neurological Examination for CRF

(if time do Neurological Examination)

• Assess for any peripheral neuropathy

• Ask if body weight known and any changes.

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