2: Presentation of renal disease Flashcards
What type of pain is seen in kidney disease?
Loin pain
posterior flanks
What are some urinary symptoms of kidney disease?
Oiligouria
Polyuria
Haematuria
What may be detected in the urine?
Blood - haematuria
(Myoglobin - same colour, sign of rhabdomyolysis)
Protein - proteinuria
Urea - uraemia, sign of serious disease
Glucose - sign of diabetes
Ketones - signs of DKA
What is a common cardiovascular presentation of kidney disease?
Hypertension
Kidney disease can be ___ or ___.
primary
secondary (as in systemic disease)
Kidney disease can present ___ or ___.
acutely
chronic
What symptoms are produced by the failure of the kidneys to control fluid balance?
Fluid retention
Oedema
What signs are produced by the failure of the kidneys to control acid base balance?
Metabolic acidosis
Kussmaul breathing
What types of disease are caused by the failure of the kidney to metabolise Vitamin D?
What is the active form of Vitamin D called?
Bone disease
Calcification of vessels (e.g digital arteries, renal arteries, aorta…)
Calcitriol
What hormone, produced by the kidneys, causes anaemia if it is deficient?
Erythropoeitin
What causes proteinuria?
Loss of barrier to proteins of kidneys
What is a vital sign which should always be checked in people with renal disease?
BP
What investigation analyses the urine of people with suspected kidney disease?
Urinalysis
What are some systemic diseases which can cause nephropathy?
Diabetes (complications)
Connective tissue diseases e.g SLE
Vasculitis
CVD (e.g renal artery stenosis)
What drugs can cause kidney disease?
Anti-hypertensives (ACEIs, ARBs, diuretics)
NSAIDs
Antibiotics (gentamicin, trimethoprim, penicillins)
PPIs
What substances, used in MRI and CT scans, can cause nephropathy?
Contrast
What does trimethoprim cause, mimicking kidney disease?
Raised creatinine
What should always be asked about in a drug history?
OTC drugs
Herbal remedies
What acute arthropathy can be caused by chronic kidney disease?
Gout
Above which BP is someone hypertensive?
140 / 90 mmHg
People with chronic kidney disease must maintain good control of what?
BP
What type of hypertension can kidney disease cause?
What is it associated with?
Accelerated hypertension (diastolic > 120)
Papilloedema, organ failure
___ hypertension due to kidney disease must be treated urgently.
Accelerated
What nail sign is seen in chronic kidney disease?
Leukonychia
What sign is seen in the skin in gout?
Tophi
What nail sign may be seen in patients with haematuria and is also seen in infective endocarditis and vasculitis?
Splinter haemorrhages
What type of vasculitis is seen on the extensor surfaces of the thighs and buttocks?
What symptoms is it associated with?
Henoch-Schonlein purpura
Abdominal pain, joint pain (is the big one according to peer tutor)
What is a significant indicator of renal disease on urinalysis?
Proteinuria
What might suggest a UTI on urinalysis?
Elevated white blood cells
What is the gold standard for classifying proteinuria?
24h urine collection
What test is not gold standard but gives an indication of proteinuria?
Protein/creatinine ratio
What can be done with urine to see if there is bacterial infection?
Microscopy
What is a urinary cast?
Protein mould of urinary tract
What types of urinary cast are associated with:
a) nephritic syndrome
b) infection or inflammation
c) chronic disease?
a) Red cells
b) Leukocytes
c) Granular
What type of crystal makes up renal calculi?
Calcium oxalate
What ECG changes are seen in
a) LVH
b) Hyperkalaemia?
a) Increased voltage (i.e taller waves)
b) Tall, tented P waves & shortened QT interval
Why do crush injuries or skeletal muscle death in general cause hyperkalaemia?
Rhabdomyolysis
Acute kidney injury
Can’t filter potassium
Hyperkalaemia
How is kidney disease staged?
GFR
What is acute kidney injury?
Rapid (<48h) increase in creatinine (either by 26.4 or >50% of original)
or
Rapid decrease in urine output
Levels of which metabolite increase in AKI?
Creatinine
What is nephrotic syndrome?
Syndrome due to glOmerular damage
What are the triad of symptoms seen in nephrotic syndrome?
Proteinuria (>3g/day)
Hypoalbuminaemia
Oedema
O because patient swells up
What does a patient with nephrotic syndrome look like?
Swollen peripheries (if severe enough, arms and orbits, which isn’t seen in heart failure)
Why don’t you get periorbital oedema in heart failure?
Orthopnoea
patient won’t lie flat
What is nephritic syndrome?
Glomerulonephritis
What are the signs of nephritic syndrome?
AKI (proteinuria, increased creatinine, decreased GFR)
Oliguria
Oedema
Hypertension
Sediment in urine
