Nephrology Tutorial


Pericardial Friction Rub

A pericardial friction rub is the sound that is generated as a result of an inflamed pericardium. Rubs consist of one to three sounds that may be mistaken for murmurs. However, the quality of the sound(s) is different and distinctive, often scratchy or creaky. Classically there are three components to a pericardial rub that correlate with atrial contraction (so you may hear it just before S1), during ventricular systole (between S1 and S2) and during the rapid filling phase of diastole (right after S2). A rub is diagnosed exclusively through physical examination. 

Uremic frost

A complication of severe azotemia, characterized by the presence of white-yellow crystalline material visualized on the skin. It occurs when urea and other nitrogenous waste that accumulate in sweat crystallize on the skin after evaporation


Describes jerking movements of the hand when the wrist is in full extension (also known as a “flap”). Usually associated with hepatic encephalopathy or uremia.


Cutaneous vasculitis

IgA nephropathy


Arteriovenous fistula

Causes a continuous (systolic and diastolic) murmur. Can be heard over the chest, which is often confused for a murmur of cardiac origin. Follow the sound out to the periphery, where it will become louder as you reach the actual site of the fistula.