Systemic

Examination
of
Renal System

Group No. 5
 outLINE
• Introduction to anatomy and physiology of
renal system
• Purpose of assessment
• Terminology
• Preparation of the patient
• Explanation and positive findings of the
four steps of physical assessment
• Abnormalities in disease condition like CKD
and kidney stone
urpose
• General examination to establish
baseline information or provide
data, to establish a tentative
diagnosis and determine weather
further studies are to be ordered.
• To detect renal or peri-renal masses
• To detect areas of tenderness by
lethargy costovertebral angle
fatigue stomatitis
bruises
Terminology
bruit excoriations
bimanual examination
P atient
reparation
• Stand at the right side of the client.
• Greet the client and introduce yourself.
• Arrange for convenient area to perform the
examination.
• Explain the purpose of examination and
develop a suitable relationship.
• Make sure that the client is comfortable.
• Explain to the client & expose the area to be
examined.
• Maintain privacy and comfort of the patient.
SYSTEMIC
Examination
1 Inspection
• Look for supra-pubic region distension, mass
and scar
• We should assess for changes in the following:
-Skin pallor, excoriations, changes in turgor, bruises,
texture
-Mouth stomatitis, ammonia breath odor
-Face and Extremities edema, masses
-Abdomen midline mass in urinary retention, unilateral
mass in enlargement of either of the kidneys
-Weight gain in edema, loss in renal failure
-General state of health fatigue, lethargy, diminished
alertness
2
•
Palpation
Palpate both kidneys in lumber region
Kidney Landmark: (CVA) Costovertebral Angle
Kidney: Right(palpable) & Left(rarely palpable)
Bimanual
Examination
of Kidney
To palpate the right
kidney, your left
hand is placed
behind and supports
the patient’s right
side between the rib
cage and the iliac
crest while your left
hand on top. (vice
versa)
After Palpation Observations:
Tenderness: Present/Absent
Bimanually: Palpable/Not Palpable
Surface: Smooth

For palpation of urinary bladder, use flat of

the right hand and start to palpate from the
umbilicus region towards supra-pubic
region
3 Percussion
Supra-pubic region: Normally
tympanitic. Dullness present in
presence of an excessive amount of
urinary retention.

Percussing left kidney; Procedure

strike right hand fist
Percussing right kidney;
against dorsal part of
strike the left hand fist
the left hand simply
against dorsal part of
placed flat on CVA
the right hand simply
landmark.
placed flat on CVA
landmark.
Percussing left kidney;
strike right hand fist
Percussing right kidney;
against dorsal part of
strike the left hand fist
the left hand simply
against dorsal part of
placed flat on CVA
the right hand simply
landmark.
placed flat on CVA
landmark.
4 Auscultation
The bell of the stethoscope is placed over both
CVAs and in the upper abdominal quadrants.
With this technique the abdominal aorta and
renal arteries are auscultated for a bruit.
 Positive Systemic Examination
findings in CKD and UTI
Method Normal Abnormal
Used
Inspection Uniform color and Yellowish skin and mild
pigmentation, moist lower extremities edema.
pink lips, no discharge,
scar or pain on any
part.

Palpation Non palpable kidney Enlarged palpable kidney.

Percussion No tenderness or pain The flank area will elicit

at the flank area. pain.

Auscultation No bruit. Bruit.

Thank
You
References

Lewis, S. L., Dirksen, S. R., Heitkemper, M. M., Bucher, L., & Camera, I.

M. (2011). Problems of urinary function. Medical-surgical

nursing: Assessment and management of clinical problems (pp.

1104-1198). USA: Elsevier Mosby.