History and Physical for Kidney Disease

History

 

Medications

Prescription and over-the counter drugs, street drugs, herbs can also lead to acute or chronic interstitial nephritis.

 

Past medical history

Diabetes and/or hypertension, along with other complications such as retinopathy or neuropathy, can suggest the cause of kidney disease.

Recurrent urinary tract infections can cause reflux nephropathy.

Recurrent renal calculi can result in chronic obstruction.

Systemic disorders:

• arthralgias and skin rash in autoimmune disease
• fever and pharyngitis in postinfectious glomerulonephritis

 

Family History

Alport's syndrome

 

Physical Exam

 

Retina: look for signs of diabetes, hypertension, bacterial endocarditis, and cholesterol emboli

 

Skin: look for presence of edema, rash, and purpura. Assess sacral edema if patient is supine.

 

Joints: signs of arthritis

 

Rectal/pelvic exam to exclude protstate/gynecological causes of urinary obstruction

 

 

Volume Satus

Assessing volume status is critical in nephrology. Look for:

• blood pressure, especially orthostatic blood pressure
• JVP
• ankle or sacral edema
• crackels on the lungs
• fluid intake and urine output (often chart review)
• skin turgor (forehead or sternum good areas)

Dehydration in infants and children