In the assessment of kidney failure patients, it is important to try to establish probable cause, duration and whether there has been a life-threatening complication such as pulmonary edema or not.
Kidney Failure Anamnesis
Does the patient have symptoms of kidney failure, such as nausea, vomiting, breathless due to acidosis or pulmonary edema, peripheral edema? Is there any itching, hiccups, peripheral neuropathy, fatigue, malaise, urine output reduction, polyuria or notarial hematuria?
Is there enuresis in childhood?
Are there any associated symptoms: hemoptysis, rash, back pain, fever, and loss weight due to neuropathy?
Is the patient doing treatment for kidney failure, for example, hemodialysis, peritoneal dialysis, kidney transplant?
Previous Disease history
Has the patient been diagnosed of kidney disease?
Has the patient have hypertension or proteinuria?
Are there any complications of kidney disease: hypertension, renal bone disease, or heart disease?
Is there a procedure to allow dialysis, for example, the formation of arteriovenous fistula, peritoneal dialysis catheter (Tenckhoff)?
Drugs
Ask about:
any drug that can cause kidney failure, such as NSAID, angiotensin converting enzyme inhibitor or antibiotics.
any specific therapy for kidney failure e.g erythropoietin.
any drug that can accumulate and cause toxicity in kidney failure e.g digoxin.
Family History
Is there any kidney disease history of your family e.g polycystic kidney disease, reflux nephropathy?
Social History
Is there any symptom or treatment such as dialysis that disrupt life?
Physical Examination of Patients
Does the patient look sick? Kidney failure Complications that are life-threatening, include pulmonary edema, acidosis, and hyperkalemia.
Is there any breathless? Are there any Kussmaul breathing patterns (fast and deep as the result of acidosis)?
Is there cyanosis?
Are there any signs of overload fluid? Crackles in the lungs, gallop rhythm, elevated JVP, peripheral edema, hypertension?
Is there a shortage of liquid or shock? hypotension, postural BP reduction, tachycardia, cold peripheral, peripheral vasoconstriction?
Are there any signs of certain diseases that cause kidney failure, such as polycystic kidney, vasculitic rash, sepsis, pancreatitis, renal artery bruit?
Are there any signs of renal dysfunction effect, for example, anemia, metabolic flap, acidosis, drowsiness, bleeding trend?
Is there evidence of severe hypertension, such as left ventricular hypertrophy, hypertensive retinopathy?
Examine carefully for any signs of obstruction. Is bladder palpable? Is there an enlarged prostate? Is there a pelvic mass?
Check urine with diapstik for searching blood, protein, glucose, leukocytes, and microscopy for cell and cylinder.
