| | Signs | Implications/comments |
| Growth | Serial measures of: - Height
- Weight
- Head circumference (for children <3 years)
| - Children with CKD are at risk for growth impairment
- Plot results on standard growth curves to monitor growth deficit and growth velocity
|
| BP | - Measure BP at each visit
- Interpret by comparing with normative BP percentiles based on age, sex, and height
| - CKD is often associated with elevated BP due to underlying kidney pathology, hypervolemia due to impaired salt and water excretion, or certain medications
- The combination of elevated BP and hematuria strongly suggests glomerulonephritis
|
| Chest | Signs of hypervolemia: - Pericardial rub (suggests uremic pericarditis)
- Diminished heart sounds (suggests pericardial effusion)
| - Signs of hypervolemia appear late in the course of CKD because >5% body weight fluid retention is needed for these signs to appear
- Pericardial effusion can be caused by hypervolemia and/or uremic pericarditis
- A severe pericardial effusion can cause cardiac tamponade
|
| Extremities | | - Edema can be caused by hypoalbuminemia (eg, due to protein loss in nephrotic syndrome) or fluid retention (eg, due to impaired kidney function)
|
| Skin | | - Suggests anemia
- Best appreciated where capillary beds are visible through the mucosa (eg, conjunctiva, palmar creases, and nail beds)
|
| Skeletal deformities | Changes of rickets/CKD-MBD: - Parietal and frontal bossing
- Widening of the wrists
- Bow-legs (genu varum) or knock-knees (genu valgum)
| - Suggests CKD-MBD
- Physical and radiographic signs are similar to those of nutritional rickets
- Manifestations depend on the age of the child and weightbearing status
- Syndromic CKD should be considered in children with skeletal anomalies
- Screen for VACTERL in children with vertebral anomalies (missing/extra ribs, hemivertebrae)
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