What is the physical examination approach for Acute Kidney Injury (AKI)?

From the Guidelines

The physical examination approach for Acute Kidney Injury (AKI) should include a thorough evaluation to identify the underlying cause, which can be prerenal, renal, or postrenal.

Key Components of Physical Examination

• Vital signs: Assessing blood pressure, pulse, and temperature to identify potential hypovolemia, hypotension, or sepsis 1
• Volume status: Evaluating for signs of fluid overload or depletion, such as edema, jugular venous distension, or dry mucous membranes 1
• Abdominal examination: Checking for tenderness, masses, or bladder distension to identify potential postrenal causes 1
• Cardiovascular examination: Assessing for signs of cardiac dysfunction, such as murmurs or gallops, which can contribute to prerenal AKI 1

Additional Evaluation

• Laboratory analysis: Including serum creatinine, blood urea nitrogen, complete blood count, and differential, as well as urine microscopy, chemistry, and biomarkers 1
• Imaging studies: Such as renal ultrasound, to evaluate for structural abnormalities or obstruction 1 By combining these physical examination components with laboratory and imaging studies, clinicians can accurately diagnose and manage AKI, and identify the underlying cause to guide treatment.

From the Research

Physical Examination Approach for Acute Kidney Injury (AKI)

The physical examination approach for AKI involves a thorough evaluation to categorize the underlying cause as prerenal, intrinsic renal, or postrenal 2. The physical examination should include:

• Determination of fluid volume status 3
• Evaluation of vital signs, weight, and other conventional parameters to assess hemodynamics, although these parameters have limitations 4
• Point-of-care ultrasonography (POCUS) as an extension of physical examination to answer focused clinical questions at the bedside 5, 6, 4

Role of Point-of-Care Ultrasonography (POCUS)

POCUS can be used to:

• Exclude hydronephrosis 5
• Provide real-time insights into hemodynamics 5, 4
• Evaluate the efficacy of decongestive therapy in real-time using venous Doppler (VExUS) evaluation 4
• Aid in accurate diagnosis of fluid overload state 4

Key Components of Physical Examination

The physical examination should focus on:

• Risk factors, including nephrotoxic drugs 3
• Urinalysis with microscopy to narrow the differential diagnosis 3
• Assessment of the patient's volume status to guide treatment with fluid resuscitation or diuresis 3