21
Physical Examination
Findings Screening Tests Confirmatory Tests
Obesity, large neck size
(eg, >17 inches [men];
>16 inches [women],
Mallampati class 3–4;
loss of normal nocturnal
BP fall
STOP-Bang Questionnaire;
Berlin Questionnaire;
overnight oximetry
Referral for
polysomnography or home
sleep apnea testing if no
suspicion of nonrespiratory
sleep disorders (eg,
narcolepsy)
Abdominal mass or
large palpable kidneys
(polycystic kidney
disease); skin pallor
Electrolytes, including
sodium, potassium, chloride,
and bicarbonate, serum
creatinine, urinalysis, urine
microalbumin, serum
cystatin C, renal ultrasound
Tests to evaluate cause of
CKD
Arrhythmias (with
hypokalemia); especially
AF
Electrolytes, including
sodium and potassium,
plasma aldosterone/renin
activity ratio (correction of
hypokalemia and withdrawal
of MRA for 4–6 wk)
Oral sodium loading
test (with 24-h urine
aldosterone) or IV
saline infusion test with
plasma aldosterone at 4
h of infusion or captopril
suppression test (in patients
not on ACEi or ARB
treatment), adrenal CT
scan, adrenal vein sampling
Fine tremor, tachycardia,
sweating (cocaine,
ephedrine, MAO
inhibitors); acute
abdominal pain
(cocaine)
Urinary drug screen (illicit
drugs)
Response to withdrawal of
suspected agent
Abdominal systolic-
diastolic bruit; bruits
over other arteries
(carotid, femoral)
Electrolytes, including
sodium, potassium, chloride,
and bicarbonate, renal
duplex Doppler ultrasound;
magnetic resonance
arteriography; abdominal CT
arteriography
Bilateral selective renal
intra-arterial angiography
