13. Signs And Symptoms

Question 1

Name 3 general common causes of kidney disease.

Answer 1

Infection/sepsis.
Hypovolaemia.
Nephrotoxins.
Inflammatory conditions.

Question 2

What 2 initial investigations will be abnormal in a patient presenting with CKD?

Answer 2

Abnormal blood result.

Abnormal urine dipstick.

Question 3

Give 3 presenting symptoms of a patient with CKD.

Answer 3

No symptoms.
Fatigue/malaise.
Loss of appetite/weight.
Acute illness/recent infection.
Ankle swelling.
Haematuria/nocturia.

Question 4

Give 4 presenting symptoms of a patient with AKI.

Answer 4

Preceding illness/infection.
Inter-current illness.
History of volume depletion.
Fatigue/malaise.
Ankle swelling/SOB.
Nausea and vomiting.
Pain (suprapubic/loin/joints).
Change in urine.
Dysuria.
Fever.

Question 5

Give two questions about past medical history that you should ask young patients presenting with renal problems.

Answer 5

Enuresis in childhood.

Problems in pregnancy.

Question 6

Name 2 conditions you should ask about in past medical history when you suspect a patient has a renal problem.

Answer 6

Diabetes mellitus.
Hypertension.
Ischaemic heart disease.
Cerebrovascular disease.

Question 7

Name 3 conditions you should ask about when taking a patients family history, if you suspect they have a renal problem.

Answer 7

Kidney disease - inherited or CKD.
Diabetes mellitus.
Hypertension.
Ischaemic heart disease.
Cerebrovascular disease.
Auto-immune disease.
UTIs.

Question 8

What needs to be particularly thorough in a patient with kidney disease when taking a history/examining?

Answer 8

Systems review.

Question 9

What 2 vital examinations should always be done in a patient with suspected renal disease?

Answer 9

Blood pressure.

Urine dipstick.

Question 10

What is uraemia?

Answer 10

Raised level of urea and other nitrogenous waste compounds in the blood. Can cause a change to skin tone.

Question 11

Name 2 things that can cause inaccuracies on dipsticks.

Answer 11

Extreme exercise - causes proteinuria and haematuria.
Mestruation - proteinuria and haematuria.
Indwelling catheters - leukocytes, nitrites, haematuria.

Question 12

When is it best to do a dipstick in terms of proteinuria and why?

Answer 12

Early origin as removes orthostatic and exercise effect.

Question 13

What does the level of proteinuria depend on?

Answer 13

Concentration of urine.

Question 14

Name 2 non-glomerular causes of proteinuria.

Answer 14

UTI.
Inflammation.
Kidney tubule damage (CKD, AKI).
Bence Jones Protein.
Myoglobin and haemoglobin.

Question 15

Name 2 glomerular causes of proteinuria.

Answer 15

Glomerulonephritis.
Amyloidosis.
Physiological - fever and exercise.

Question 16

What does a dipstick detect to indicate haematuria? So what can give false positives?

Answer 16

Detects haemoglobin.

But myoglobin and intravascular haemolysis give false positives.

Question 17

Name 2 causes of haematuria.

Answer 17

Renal - pyelonephritis , glomerulonephritis, renal calculi etc.
Ureteric - stones, carcinoma.
Bladder - cystitis, trauma, stone, carcinoma.
Urethra - benign prostatic hypertrophy, trauma, stone, carcinoma of prostate.

Question 18

Name 2 things that can give positive leukocytes on a urine dipstick.

Answer 18

Infection.
Glomerulonephritis.
Interstitial nephritis.
Cystitis.
Neoplasms.
Stones.

Question 19

What can give a false positive reading of leukocytes on a urine dipstick?

Answer 19

Contamination with vaginal secretions.

Question 20

Name 2 things you might look for on a urine microscopy.

Answer 20

Infection (culture).
Crystals - gout and pseudogout.
Casts.
Red cell casts.