23rd June 2023

History and examination

A thorough history and examination of the patient will often provide some clues regarding diagnosis. Some example question and examination points to include below:

History

• Pre-renal – increased fluid losses/decreased fluid intake, cardiac issues, infection +/- sepsis.
• Intrinsic – symptoms of systemic connective tissue disease or vasculitis, full drug history, infections, malignancy, periods of prolonged immobility/trauma/limb ischaemia, source of emboli, cardiovascular disease or endovascular intervention
• Post-renal – abdominal pain, haematuria, lower urinary tract symptoms, history of prostatic symptoms

Examination

• Pre-renal – volume status assessment, urine output
• Intrinsic – signs of cardiovascular/peripheral vascular disease, rash, synovitis, mouth ulcers, uveitis, nail changes, epistaxis, pulmonary haemorrhage, signs of connective tissue disease
• Post-renal – palpable bladder, enlarged prostate, abdominal masses