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Is the patient unwell? Life-threatening complications of renal failure include pulmonary oedema, acidosis and hyperkalaemia.

Are they breathless? Is there a Kussmaul pattern of respiration (deep and sighing due to acidosis)?

Is there cyanosis?

Is there evidence of fluid overload? Crackles in the lungs, gallop rhythm, elevated JVP, peripheral oedema, hypertension?

Is there fluid depletion or shock? Hypotension, postural fall in BP, tachycardia, cool peripheries, peripheral vasoconstriction?

Any signs of specific diseases causing renal failure (e.g. poly-cystic kidneys, vasculitic rash, sites of sepsis, pancreatitis, renal arterial bruit)?

Any evidence of effects of renal dysfunction (e.g. anaemia, metabolic flap, acidosis, drowsy, bleeding tendency)?

Or any evidence of severe hypertension (e.g. left ventricular hypertrophy, hypertensive retinopathy)?

Examine carefully for any signs of obstruction. Palpable bladder? Enlarged prostate? Pelvic mass?

Examine the urine with dipstick for blood, protein, glucose, leucocytes and microscopy for cells and casts.

Renal failure 147

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