Renal Assessment: the complete description about system wise examination of a renal patient. edema assessment, fluid status assessment.

1. RENAL ASSESSMENT
RISK FACTOR ANALYSIS
 Hypertension long standing hypertension or DM
 Diabetes Mellitus
 Cardiovascular disorders
 Immunologic disorders/ infections
 Hepatitis, cirrhosis
 Frequent UTIs
 Recurrent kidney stones /urinary stones
 Urinary symptoms related to bladder neck obstructions
 Pyelonephritis/ glomerulonephritis/ hydronephrosis
 Nephrotic syndrome
 Polycystic kidney disease
 Urinary obstructions – stricture, tumors, BPH, malignancy
 Hypovolemia
 Anaphylactic shock
 Sepsis
 Nephrotoxic drugs/agents
 Chemical exposure
 Smoking/alcoholism
 Use of alternative medicines
 Snake bite
 Poisoning
 Family history
(Assess for prerenal / intrarenal / postrenal causes)
SYMPTOM ANALYSIS (onset, duration, characteristics)
Subjective symptoms
 Anorexia
 Nausea/ vomiting
 History of weight loss
 Abdominal/flank pain
 Constipation/ diarrhea
 Hiccups
 Unpleasant taste in mouth
 Stomatitis
 Fatigue
 Dyspnea (Borg scale)
 Pruritis
 Bone or joint pain
 Muscle cramps
 Restless legs
 Muscular twitching
 Sleep disturbances

2. Urinary symptoms:
 Polyuria, anuria, oliguria, nocturia, hematuria, dysuria
 Colour of urine – dark/coffee colour urine
 Foam/ bubbly urine
 Incomplete emptying
 Urinary retention/ incontinence
 Terminal dribbling
 Hesitancy
 Weak stream
 Frequency
 Urgency
Objective symptoms
 Level of consciousness
 Activity level – fully dependent, need assistance, independent
 PICCLE
 TPR
 Integumentary system – skin colour (yello brown skin, hyperpigmentation), texture,
turgor, nail changes, uremic frost, excoriation due to itching, ecchymosis, AV fistula
 Nail changes – colour, nail beds
 Face – facial puffiness, periorbital edema, conjuctiva
 Lips & oral cavity – colour, stomatitis, dry mouth, uremic breath
 Neck – JVD, JVP, lymphnodes
 Chest -
 respiratory rate, SOB, DOE, kussmaul’s respiration
 signs & symptoms of uremic pleuritic, pleural effusion
 auscultation – lung sounds, heart sounds, precardial friction rub in
uremic pericarditis
 Abdomen –
o visible masses
o presence of PD catheter
o ascites – yes/ no
o abdominal girth
o tenderness
o auscultation – bowel sounds (normal/ diminished/ absent), renal bruit
(present/ absent) (1cm superior lateral to umbilicus using bell of stethoscope)
 Extremities –
o Peripheral edema – location, type, grade
o Flapping tremor
o Peripheral pulses
o Capillary refill
o Clubbing – grade
o Renal osteodystrophy
 Daily weight -
o Present weight
o Dry weight
o Considerable changes in weight – present/ absent

3. o If present, ……kg
 Dialysis
o Type : HD/ PD
o Access: temporary/ permanent; details….
o Frequency of dialysis
o Hep B vaccination protocol
o Erythropoietin protocol
o Post dialysis weight
o BP chart: sitting/ standing/ lying
o Fluid restriction
o Intake/ output chart
 Medications
 Investigations – CBC, Hb, RFT, Na, K, Ca, PTH, ultrasound, renal biopsy, urine
analysis, specific gravity
 Renal diet