18) Clinical Presentations of Kidney Disease Flashcards
What symptoms are related to impaired excretion?
think of what remains in body
Hyperkalemia
Oedema and hypertension - retaining Na+ and H2O
Acidosis - Kussmaul breathing (deep and laboured)
TATT
Uraemic syndrome
What are the symptoms of impaired glomerular selectivity?
Proteinuria
Haematuria
What are the symptoms of impaired tubular functions?
Impaired concentrating ability - increased frequency and nocturia (can’t concentrate over night)
Acidosis
Glycosuria - lower tubular threshold
What are the symptoms of impaired hormone secretion?
Metabolic bone disease - Vit D not activated
Anaemia - no erythropoietin
Hypertension - renin secretion
How is kidney disease often detected?
Opportunistic screening (dipstick) of at risk populations: hypertension, heart disease, diabetes, UT obstruction
What do you see in macroscopic haematuria?
Brown or smoky coloured urine
What does urine microscopy of haematuria show?
Dysmorphic red cell
Red cell cast - red cells stick to Tamm-Horsfall protein, secreted by TAL
What symptoms does proteinuria cause?
Frothy urine
Oedema - reduced oncotic pressure
Infection - loss of Ig
Thromboembolic risk - imbalanced regulators of coagulation cascade
What is the classic triad of findings in nephrotic syndrome?
Proteinuria (>3.5g/day)
Hypoalbuminemia
Oedema
(+hyperlipidemia)
How is a renal biopsy carried out?
Ultrasound guided needle to cortex of kidney
How does nephrotic syndrome present in patients?
Swelling
Xanthelasma
Fat bodies in urine
Muehrcke’ bands (white lines on nails)
How does nephritic syndrome present?
Rapid onset
Hypertension
Haematuria
How does rapidly progressive glomerulonephritis present microscopically?
Cresenteric glomerulonephritis
Systemic vasculitis
Antibodies against GBM and ANCA
(Cavitating lesion in lung)
When do symptoms begin to occur in CKD?
eGFR < 30ml/min
What are some symptoms of advanced CKD?
Tiredness Breathlessness Nausea Nocturia Pallor Pruritus rash
