2 - Signs of Renal Disease

Question 1

In general, what are some common presentations of kidney disease?

Answer 1

• Tired
• Trouble sleeping
• Dry and itchy skin (white specks on scalp)
• Nocturia
• Haematuria
• Foamy urine
• Persistent puffiness around the eyes
• Swollen feet and ankles
• Poor appetite
• Muscle cramps

Question 2

What are some different ways that you may discover a patient has kidney disease?

Answer 2

History is really important, e.g may have SLE and think itching etc is due to this but could be masking kidney disease

Question 3

What is important to exam when looking at a patient with renal disease?

Answer 3

Question 4

Why is end stage renal kidney disease dangerous?

Answer 4

Hyperkalemia, which could lead to V Fib

Question 5

What are some symptoms of ESRD (end stage of CKD)

Answer 5

Usually if young may be benign clinical picture, symptoms depend on co-morbidities

Symptoms due to uraemia and the toxins

Question 6

What are some signs of ESRD?

Answer 6

Question 7

What is the definition of ESRD?

Answer 7

Fifth and final stage of CKD where there is irreversible damage to the kidneys, the only cure is dialysis or transplant. 5-10% kidney function

Question 8

What are some of the roles of the kidneys?

Answer 8

Question 9

How does potassium homeostasis occur?

Answer 9

• Some unregulated loss in kidneys
• Can ingest a large excess
• Actual balance controlled by the kidneys. If too high or low >8 or <3, fatal arrhythmias

Question 10

Why are patients with severe CKD vitamin D deficient?

Answer 10

25-hydroxyvitamin d-1 alpha hydroxylase aka enzyme is produced in the proximal tubule of the kidneys, which is needed for activatin of Vitamin D, calcitriol (Active Vit D3)

Question 11

What cells in the kidney produce erythropoietin?

Answer 11

Interstitial fibroblasts in the peritubular capillary and proximal convoluted tubule

PCT and peritubular capillary (fibroblasts)

Question 12

What is a cause and effect relationship involving kidney disease?

Answer 12

Question 13

What is the main issue that can occur involving the kidneys when you have SLE?

Answer 13

• Glomerulonephritis (especially diffuse proliferative) which can lead to renal failure without treatment
• Symptoms often mistake for SLE symptoms

Question 14

Why may someone have musculoskeletal pain with CKD?

Answer 14

Calcium, Phosphorus and Vitamin D deficiency

Question 15

Why do patients with CKD present with the following symptoms:

• Tired?
• Trouble sleeping?
• Dry itchy skin?

Answer 15

• Anaemia and build up of toxins and impurities in the blood
• Toxins in blood. Also co-morbidity of obesity leading to sleep apnea
• Mineral and bone diease as kidney can’t keep the right balance of nutrients

Question 16

Why do patients with CKD present with the following symptoms:

• Nocturia?
• Haematouria?
• Foamy urine?

Answer 16

• Glomeruli damaged increasing urge to urinate (could be UTI or BPH)
• Glomeruli damaged so RBC leak out (could be UTI, malignancy, infection or kidney stones)
• Albumin and proteins in the urine as glomeruli damaged

Question 17

Why do patients with CKD present with the following symptoms:

• Puffy eyes?
• Swollen feet and ankles?
• Poor appetite?
• Muscle cramps?

Answer 17

• Early sign. Due to large amount of protein leaking into urine
• Sodium retention (also due to heart, liver and vein disease)
• Build up of toxins
• Electrolyte imbalances