Abdominal Distention and Weight Gain Flashcards
What are the three commonest causes of end stage renal disease in Western countries?
Diabetes, hypertension and glomerular disease.
What is Adult Polycystic Kidney Disease (APKD)?
An inherited condition in which small cysts lined by tubular epithelium develop from infancy or childhood and enlarge slowly and irregularly, causing surrounding normal kidney tissue to be compressed and progressively damaged.
In what pattern is Adult Polycystic Kidney Disease (APKD) inherited?
APKD is an autosomal dominant trait.
What signs on examination are indicative of nephrotic syndrome? (2)
Bilateral limb oedema
High protein on urine dipstick
How does anti-diuretic hormone (ADH) have its effect on the renal system?
ADH acts on the collecting ducts of the kidney to increase the number of aquaporin channels allowing water to be absorbed in the blood.
What hormones does the posterior pituitary release? (2)
ADH and oxytocin.
What is diabetes insipidus?
A rare condition where either too little vasopressin (ADH) is produced by the pituitary (‘cranial diabetes insipidus’) or the kidney becomes insensitive to vasopressin (ADH) and does not make aquaporin channels and reabsorb water from the collecting ducts (‘nephrogenic diabetes insipidus’).
What is Syndrome of Inappropriate ADH Secretion (SIADH)?
A syndrome where various stimuli override osmolality control and cause release of inappropriately high amounts of ADH, resulting in reabsorption of water from collecting ducts and subsequently urine to have high sodium content or osmolality while serum sodium levels drop (hyponatraemia) as water is retained.
What are the six ‘F’s of abdominal distention?
Fat
Faeces (obstruction/constipation)
Flatus (obstruction or pseudo obstruction)
Functional bloating (increased gas in GI tract)
Fluid in peritoneal cavity (ascites)
Foetus (pregnancy)
What are the three common causes of abdominal distention which don’t begin with ‘F’?
Distended bladder
Abdominal mass
Organomegaly
How can you differentiate between an enlarged spleen and an enlarged kidney on examination? (3)
The spleen is smooth and regular in shape whilst kidney will have an irregular surface.
The spleen descends diagonally on deep inspiration whilst the kidneys descend vertically.
The spleen will have a palpable notch on the medial surface whilst the kidneys will not.
Give four causes of ascites.
-Intra-abdominal malignancy with peritoneal spread
-Hepatic cirrhosis with portal hypertension
-Constrictive pericarditis and right heart failure
-Hypoalbuminaemia (nephrotic syndrome)
How can you tell nephrotic and nephritic syndrome apart from a urine dipstick?
Nephrotic syndrome - presence of protein only
Nephritic syndrome - presence of protein AND blood.
What conditions will show presence of blood but no protein, nitrates or leukocytes on a urine dipstick? (3)
Menstrual cycle
Malignancy of kidney, ureter or bladder
Anti-platelet therapy
What conditions will show presence of blood, nitrates and leukocytes but no protein on a urine dipstick? (2)
Urinary Tract Infection
Renal Stones
How is nephrotic syndrome specifically defined? (3)
The presence of heavy proteinuria, hypoalbuminaemia and peripheral oedema.
What is the classical triad of symptoms seen in renal cancer?
Flank pain
Haematuria
Renal mass with abdominal distention
What are the three most common causes of nephrotic syndrome?
Focal segmental glomerulosclerosis (FSGS)
Minimal change disease
Membranous neuropathy
Why is hyperlipidaemia a common association of nephrotic syndrome?
It is a sign of the liver trying to compensate for loss of albumin in the urine.
How may patients with nephritic syndrome present? (3)
Severe kidney injury
Oliguria
Hypertension
What is crescentic glomerulonephritis?
A severe form of inflammation that occurs in nephritic syndrome; requires aggressive treatment with steroids to control the inflammatory process.
What investigations should be requested for a patient presenting with acute kidney injury (AKI) with a suspected renal cause? (5)
Routine blood tests
Ultrasound
Full immunology screen
Full virology profile
Urine PCR/ACR
What is the gold standard investigation for diagnosing nephritic and nephrotic syndrome?
Renal biopsy.
What is Adult Polycystic Kidney Disease (APKD)?
An inherited disorder that usually presents in adulthood, characterised by the development of multiple renal cysts, variably associated with extrarenal (mainly hepatic and cardiovascular) abnormalities.
