Investigations

Renal function tests (most appropriate for the general practitioner):

• plasma creatinine

• creatinine clearance (more precise)

Plasma electrolytes

Anaemia lethargy pallor

HaematoEogical anaemia bruising epistaxis

Respiratoi y dyspnoea tachypnoea

Shin pruritus scratch marks pigmentation purpura

Nail changes proximal leuccmychia dista brownish d molorahon

Musculoskeletal muscle weakness bone pain

Periphery pe n p he raí ne .jropathy oedema

Fig. 27.1 Clinical features of chronic renal disease

Anaemia lethargy pallor

HaematoEogical anaemia bruising epistaxis

Respiratoi y dyspnoea tachypnoea

Shin pruritus scratch marks pigmentation purpura

Nail changes proximal leuccmychia dista brownish d molorahon

Musculoskeletal muscle weakness bone pain

Periphery pe n p he raí ne .jropathy oedema

• sodium, potassium, chloride, bicarbonate

• calcium and phosphate

Consider:

• magnesium, urate, glucose

• prescribed drug level

• cardiac studies

Determination of underlying cause

• imaging of urinary tract—ultrasound

• immunological tests

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