Disorders that suggest or predispose to renal failure: hypertension, diabetes mellitus, human immunodeficiency virus, vascular disease, abnormal urinalyses, family history of renal disease, medication use, toxin or environmental exposure, infection, heart failure, vasculitis, cancer
Disorders that suggest or predispose to volume depletion: vomiting, diarrhea, pancreatitis, gastrointestinal bleeding, burns, heat stroke, fever, uncontrolled diabetes mellitus, diuretic use, orthostatic hypotension, nothing-by-mouth status, nasogastric suctioning Disorders that suggest or predispose to obstruction: stream abnormalities, nocturia, anti-cholingeric medications, stones, urinary tract infections, bladder or prostate disease, intra-abnominal malignancy, suprapubic or flank pain, anuria, fluctuating urine volumes Symptoms of renal failure: anorexia, vomiting, reversed sleep pattern, puritus
Record review Recent events (procedures, surgery) Medications (see Fig. 12-22) Vital signs Intake and output Body weights
Blood chemistries and hemogram
Skin: rash suggestive of allergy, palpable purpura of vasculitis, livedo reticularis and digital infarctions suggesting atheroemboli Eyes: hypertension, diabetes mellitus, Hollenhorst plaques, vasculitis, candidemia Lungs: rales, rubs
Heart: evidence of heart failure, pericardial disease, jugular venous pressure
Vascular system: bruits, pulses, abdominal aortic aneurysm
Abdomen: flank or suprapubic masses, ascites, costovertebral angle pain
Extremities:edema, pulses, compartment syndromes
Nervous system: focal findings, asterixis, mini-mental status examination
Consider bladder catheterization
Urinalysis (see Fig. 12-13)
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