Physical examination

General inspection of the patient with CRF will usually reveal a sallow complexion with yellow-brown pigmentation in the skin, which is often dry and pruritic. The patient's mental state should be noted. The respiratory and pulse rates are usually rapid because of anaemia and metabolic acidosis. Other findings may include bruising, uraemic foetor, reduced mental status, pericarditis and peripheral neuropathy. The abdomen should be carefully palpated especially in the renal areas. A rectal examination is indicated to detect prostatomegaly or other rectal or pelvic pathology. Ophthalmoscopic examination may show hypertensive or diabetic retinopathy. Urinalysis should test glucose, blood and protein. Proteinuria should be confirmed with a 24-hour urine protein estimation.

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