APPROACH TO THE PATIENT WITH RENAL DISEASE



The patient with renal disease often comes to die attention of a physician because of mild, non­specific signs and symptoms but may also present with severe, life-threatening manifestations of renal dysfunction. Certain signs and symptoms should alert the physician to the possibility that renal disease is present. Complaints of flank pain, dysuria, gross hematuria, or the passage of a renal stone are directly referable to the urinary tract. Other findings such as hypertension, edema, congestive heart failure, or constitutional symp­toms of lethargy, anorexia, or pruritus are non­specific but may reflect the impact of reduced renal function on other organ systems. The ap­proach to the patient with suspected renal disease begins with a careful history and physical ex­amination. Table 31-1 outlines some of the im­portant features of the history and physical ex­amination that should not be overlooked. A particular renal syndrome such as chronic renal failure, glomerulonephritis, urinary tract infec­tion, or urinary tract obstruction is often sug­gested by the constellation of presenting signs and symptoms. This initial impression can then be used in the formulation of a differential diagnosis and in the design of a diagnostic evaluation.