Physical

• Obtaining a thorough physical examination is extremely important when collecting evidence about the etiology of AKI.

• Skin

• • Examination of the skin for petechiae, purpura, ecchymosis, and livedo reticularis provides clues to inflammatory and vascular causes of AK
  • Infectious diseases, thrombotic thrombocytopenic purpura (TTP), disseminated intravascular coagulation (DIC), and embolic phenomena can present with typical cutaneous changes.

• Eyes

• • Evidence of uveitis may indicate interstitial nephritis and necrotizing vasculitis.
  • Ocular palsy may indicate ethylene glycol poisoning or necrotizing vasculitis.
  • Findings suggestive of severe hypertension, atheroembolic disease, and endocarditis may be observed after a careful examination of the eyes.

• Cardiovascular system

• • The most important part of the physical examination is the assessment of cardiovascular and volume status.
  • The physical examination must include pulse rate and blood pressure recordings measured in both the supine position and the standing position; close inspection of the jugular venous pulse; careful examination of the heart, lungs, skin turgor, and mucous membranes; and assessment for the presence of peripheral edema.
  • Accurate daily records of fluid intake and urine output and daily measurements of patient weight are important.
  • Blood pressure recordings can be important diagnostic tools.
  • Hypovolemia leads to hypotension; however, hypotension may not necessarily indicate hypovolemia.
  • Severe congestive cardiac failure (CHF) may also cause hypotension. Although patients with CHF may have low blood pressure, volume expansion is present and effective renal perfusion is poor, which can result in AKI.
  • Severe hypertension with renal failure suggests renovascular disease, glomerulonephritis, vasculitis, or atheroembolic disease.

• Abdomen

• • Abdominal examination findings can be useful to help detect obstruction at the bladder outlet as the cause of renal failure, which may be due to cancer or an enlarged prostate.
  • The presence of an epigastric bruit suggests renal vascular hypertension.