27. Nephrology Presentations

Question 1

Outline the pathophysiology of haematuria

Answer 1

Gross = blood that you can see
- 10% chance of finding cancer

Microscopic = blood that can only be seen under the microscope
- 3% chance of finding cancer

Question 2

Outline the aetiology of haematuria

Answer 2

UTI

Pyelonephritis

Bladder/kidney stone

BPH

Prostatitis

Glomerulonephritis – IgA nephropathy

Cancer

Sickle cell anaemia

Kidney injury

Medication = anti-cancer drug cyclophosphamide, penicillin, aspirin, heparin

Strenuous exercise

Question 3

What are the symptoms of haematuria?

Answer 3

Pink/red coloured urine

Passing clots = pain

UTI = persistent urge to urinate, pain and burning with urination, and extremely strong-smelling urine, fever

Pyelonephritis = fever, flank pain

Anaemia = pallor

Question 4

How is haematuria investigated?

Answer 4

Urine dipstick

Urine analysis

Urine culture = suspected infection

Bloods = FBC, U+Es, coag

Imaging = CT, MRI, US

Cystoscopy

Abdo exam = assess for palpable kidneys

Genitalia exam

Kidney biopsy = in cases of: significant haematuria, abnormal renal function, recurrent persistent haematuria, serologic abnormalities, recurrent gross haematuria, FH of end-stage renal disease

Question 5

How would you manage haematuria?

Answer 5

Asymptomatic = generally doesn’t require treatment

Abx = UTI

Medication to shrink prostate

Shock wave therapy to break up stones

Tumour/cancer = surgery

Question 6

Outline HTN in children

Answer 6

No UK def

Aetiology = renal parenchymal disease, renal vascular disease, aortic coarctation, endocrine causes, essential HTN, iatrogenic

Mx = weight loss, low salt, exercise, avoid smoking/alcohol, ACEi, BB, CCB, thiazide diuretic

Question 7

What is Acute renal failure, how does it present and what is its DDx?

Answer 7

Acute decline in renal function characterized by an increase in blood urea nitrogen (BUN) and serum creatinine values, often accompanied by hyperkalaemia, metabolic acidosis, and hypertension

S+S = haemorrhage, fever, rash, abdo pain, pale skin, swelling, abdo mass

DDx =

• prerenal (most common) = sepsis, D+V, dehydration, DI, diuretics, adrenal insufficiency, shock burns, pancreatitis
• intrinsic = haemolytic uraemic syndrome (HUS)
• postrenal = stones, posterior urethral valves

Question 8

What is Chronic renal failure, how does it present and what is its DDx?

Answer 8

S+S = poor appetite, bone pain, vomiting, headache, stunted growth, recurrent UTI, tissue swelling, poor muscle tone

DDx =

• Prolonged obstruction
• Alport syndrome = deafness, progressive kidney damage, and eye defects.
• Nephrotic syndrome = proteinuria, low protein in the blood, high cholesterol levels, oedema
• Polycystic kidney disease = growth of numerous cysts
• Cystinosis = amino acid cystine accumulates within lysosomes in the kidney

Question 9

What is Glomerulonephritis, how does it present and what is its DDx?

Answer 9

Glomeruli become inflamed and impair the kidney’s ability to filter urine

S+S = HTN, dark brown urine, sore throat, diminished urine output, fatigue, lethargy, increased breathing effort, headache, seizures, rash, weight loss, joint pain, pale, oedema

DDx = strep, Alport syndrome, SLE, polyarteritis nodosa group, Wegener vasculitis

Question 10

What are the Urinary tract abnormalities, how do they present and what is its DDx?

Answer 10

Posterior urethral valves, hydronephrosis and hydroureters, severe vesico-ureteric reflux, duplex kidney, ureteropelvic junction obstruction, megaureter

S+S = recurrent UTI, anatomical abnormality, nonsyndromic