Introduction:

A comprehensive history and physical examination are pivotal in the evaluation of acute kidney injury (AKI), offering valuable insights into underlying etiologies, risk factors, and clinical severity. This article delineates the key components of AKI assessment through history-taking and physical examination.

History:

• Medication History: Inquire about recent medication use, particularly nephrotoxic agents (e.g., nonsteroidal anti-inflammatory drugs [NSAIDs], contrast agents, aminoglycosides), herbal supplements, and over-the-counter medications.
• Medical History: Assess for pre-existing conditions predisposing to AKI, including chronic kidney disease, diabetes mellitus, hypertension, heart failure, liver cirrhosis, and autoimmune disorders.
• Fluid Status: Evaluate fluid intake, urine output, and symptoms suggestive of volume depletion (e.g., vomiting, diarrhea, decreased oral intake), volume overload (e.g., edema, dyspnea), or fluid shifts (e.g., burns, ascites).

Physical Examination:

• Vital Signs: Measure blood pressure, heart rate, temperature, and respiratory rate to assess hemodynamic stability and signs of systemic illness, such as sepsis or shock.
• Fluid Status: Evaluate for signs of volume depletion (e.g., dry mucous membranes, decreased skin turgor), volume overload (e.g., peripheral edema, pulmonary rales), or fluid shifts (e.g., ascites, pericardial effusion).
• Cardiovascular Examination: Auscultate for murmurs, assess jugular venous pressure, and palpate for peripheral pulses to identify cardiac abnormalities contributing to AKI, such as heart failure or valvular disease.
• Abdominal Examination: Palpate for abdominal tenderness, organomegaly (e.g., enlarged kidneys suggestive of obstructive uropathy), or masses (e.g., renal tumors).
• Skin Examination: Look for signs of dermatologic conditions associated with AKI, such as purpura (vasculitis), petechiae (thrombotic microangiopathy), or rash (drug-induced interstitial nephritis).

Clinical Clues:

• Oliguria: Document urine output to assess for oliguria (<0.5 mL/kg/hour) or anuria, suggestive of AKI and renal hypoperfusion.
• Edema: Peripheral edema may indicate volume overload and impaired fluid balance, common in AKI secondary to heart failure or nephrotic syndrome.
• Altered Mental Status: Neurological symptoms, including confusion, lethargy, or seizures, may result from uremia or electrolyte disturbances accompanying AKI.
• Septic Features: Fever, hypotension, tachycardia, and signs of systemic infection suggest sepsis-induced AKI, a common cause of renal dysfunction in critically ill patients.

Conclusion:

A thorough history and physical examination are essential in the evaluation of acute kidney injury, providing critical clues for diagnosing underlying etiologies, assessing clinical severity, and guiding management decisions. Integration of clinical findings with laboratory tests and imaging studies facilitates timely intervention and optimization of patient outcomes.

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