Chronic Kidney Disease also called (CKD) is a long-standing disease of Kidneys. In CKD, Kidney function may worsen gradually and fail eventually. CKD not only affects the functioning of the Kidney but also has an effect on the functioning of every other organ in the body. CKD often doesn’t show any symptoms until in its advanced stages. CKD patients may have the following signs during physical examination.
General Appearance
- Malaise
- Depressed
Vital signs
- Hypertension
- Tachycardia (Heart Rate over 100 BPM)
- Reduced pulse pressure
- Tachypnea (Rapid Breathing)
- Hypothermia (Chillness)
Skin
- Dry Skin
- Uremic fetor (Urine like odour in breath)
- Uremic frost on the face, beard and other areas (due to deposits of urea crystals)
- Pigmentary alterations
- Poor skin turgor
- Excoriations (scratching)
- Localized erythema
- Blisters
- Bruises
- Lindsey’s nails (half and half nails), where the proximal half of the nails is white (edema) and the distal half is pink (normal)
HEENT (Head, ears, eyes, nose, and throat)
- Abnormal fundoscopic exam with evidence of diabetic retinopathy (among diabetic patients) or hypertensive retinopathy (among hypertensive patients)
- xerostomia (dry mucus membranes)
- Tinnitus (Ringing noise in ear)
- Coated tongue
Neck
- Distended neck veins
- Carotid bruit (atherosclerosis)
Cardiothoracic
- 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)
Chronic Kidney Disease Physical Examination