4.4: Presentation of Renal Disease

Question 1

List the way that renal diseases can present? (The Symptoms)

Answer 1

Asymptomatic

Haematuria

Loin Pain

Proteinuria

Hypertension

Acute Kidney Injury

Chronic Kidney Disease

Nephrotic Syndrome

Nephritic Syndrome

Question 2

Describe what happens when the kidney is unable to excrete urea?

What is the value for uraemia?

Answer 2

Uraemia

Causes pericarditis, encepalopathy, gastric problems

Urea >40

Question 3

What happens if there is a failure of erthyropoietin production?

Answer 3

Anaemia

Question 4

Describe the presentation of asymptomatic patients? (Eg: Why would they be referred to renal clinic?)

Answer 4

• Proteinuria
• Microscopic Haematuria
• Hypertension
• Reduced estimated GFR
• Incidental findings on abdominal imaging
• Family History

Question 5

Describe accelerated hypertension?

Answer 5

This is a medical emergency

Diastolic over 120mmHg

There is papilloedema and end organ decompensation (Encephalopathy, Seizures, acute renal failure)

Question 6

What is Leukonychia?

What does it suggest?

Answer 6

Whiteness of the nails

Suggests hypoalbuminaemia

Question 7

What is a gouty tophus?

What does it suggest?

Answer 7

Small lumps on skin caused by urate crystal deposits

Chronic Kidney Disease

Question 8

What are splinter haemorrhages?

What do they suggest?

Answer 8

Tiny Blood Clots under the nails

Subacute bacterial endocarditis or vasculitis

Question 9

A vasculitis skin rash may suggest what renal condition is going on?

Answer 9

Acute Glomerulonephritis

Question 10

What is the upper limit of normal for proteinuria?

What is heavy protineuria?

What is nephrotic ranges?

GIVE ANSWERS IN GRAMS/DAY

Answer 10

Upper limit of normal = 0.5G/day

Heavy Proteinuria = 1-3g/day

Nephrotic = >3g/day

Question 11

Describe how hyperkalaemia presents on ECG?

Answer 11

Tented T Waves

Question 12

Give the GFR ranges for all of the CKD stages?

Answer 12

Stage 1 = >90 (Normal)

Stage 2 = 60-89 (mild)

Stage 3 = 30-59 (Moderate)

Stage 4 = 15-29 (Severe)

Stage 5 = <15 (Failure)

Question 13

Describe acute kidney injury?

Answer 13

This is decline in GFR over a period of hours/days/weeks

With or without oligoruia (<400ml/day)

In a patient with normal or impaired baseline renal function

Question 14

Describe nephrotic syndrome?

Answer 14

Kidney disease characterized by:

• Proteinuria (>3g/day)
• Hypoalbuminaemia
• Oedema

Question 15

Describe nephritic syndrome?

Answer 15

Haematuria

Red Cell Casts

Small amount of proteinuria

Hypertension

Decreased urine output

Question 16

Periorbital oedema suggests:
- Nephritic syndrome?

• Nephrotic Syndrome?

Answer 16

PERIORBITAL OEDEMA SUGGESTS NEPHROTIC SYNDROME