Approach to patient with renal disease Flashcards
Order of vessels at hilum of kidney:
Vein: anterior
Ureter: posterior
Artery: middle
Functions of the kidney:
- Excrete waste
- Fluid and electrolyte balance
- Acid:base
- BP
- EPO
- Convert 25-hydroxy vitamin D to 1,25 dihydroxy-vitamin D
Calcitriol =
Active form of vitamine D (1,25 dihydroxy-vitamin D)
Upper urinary tract:
Kidney, ureters
Common upper urinary tract symptoms:
- Pain
- Haematruia
Kidney pain:
Loin pain, may radiate to groin/testicle
Sources of blood:
- Kidney: cysts, tumors, stones, schlerosis, glomerulonephritis
- Ureters: tumors
- Bladder: cysts, tumours
- Urethra
2 broad types of lower urinary tract symptoms:
- Obstructive/voiding
- Storage
Lower urinary tract:
Bladder, urethra, prostate
Voiding symptoms:
- Hesitancy
- Delay in initiation
- Weak urine stream
- Straining
- Incomplete emptying
- Terminal dribbling
Storage symptoms:
- Urinary frequency
- Nocturia
- Urgency
- Incontinence
- Bladder pain
- Dysura
Pain on urination =
Dysuria
Types of urine abnormalities:
Colour
Odour
Volume
Other
Increase urine production =
polyuria
Decrease urine production =
oligouria
No urine output =
Anuria
Ex causes of polyuria:
Diabetes mellitus (osmotic diuretic) Early chronic kidney disease Post renal obstruction
Ex causes of oliguria:
Acute kidney injury
Ex causes of anuria:
Severe acute kidney injury
Longstanding end stage renal failure
Normal urine =
yellow
Pale urine =
Dilute, lots of water
Dark urine =
Concentrated, bile pigments
Pink/red urine =
blood
Browny-red urine =
myoglobin in muscle breakdown
Browny-red urine is a sign of
Rhabdomylosis = indirect or direct muscle injury
Cloudy urine =
Excess WBC
Thick urine =
Pus from infection
Frothy urine =
Protein
Tool used to determine pathological changes to urine =
Urine dipstick
Biochemical profile =
Combination of lab tests to evaluate an organ system
Biochemical profile of renal system:
- Creatinine
- Urea
- Albumin
- Electrolytes
- Bicarbonate
- Bone profile
- Hb and blood film
Type of anaemia found in chronic kidney disease =
Normochromic
Kidneys may look … in chronic disease
Small
2 types of kidney problem
- Acute renal injury
2. Chronic renal failure
What is used to estimate GFR?
Creatinine
Link between hypertension and kidney injury
Hypertension can cause kidney injury, kidney injury releases renin which increases BP
Defining characteristic of nephrotic syndrome:
Proteinuria
Cause of nephrotic syndrome:
Podocytes or basement membrane not filtering properly. Damage to glomeruli.
Signs and symptoms of nephrotic syndrome:
- Oedema (periorbital, hands, feet)
- Frothy urine
- Increased lipids (liver compensates for albumin)
- Reduces anti-thrombin II (increased risk of DVT and PE)
Why do you get oedema in nephrotic syndrome?
Albumin acts as a sponge keeping fluid in vessels. When lost in urine fluid is redistributed.
Defining characteristic of nephritic syndrome.
Hematuria, proteinuria
Pathophysiology of nephritic syndrome:
Due to inflammation. e.g. glomerular nephritis
Ex cause of glomerular nephritis/nephritic syndrome:
SLE (antigen-antibody complexes) which activate the complement system
Additional signs/symptoms of nephritic syndrome:
- Blood in urine
- Sedement in urine
- White cells in urine
- Oliguria (glomerulus damage)
- Increased BP
- Granular casts in urine
What is found in urine of someone with nephritic syndrome?
blood, protein, WBC, granular casts
Ex of genetic kidney disease:
Autosomal dominant polycystic kidney disease
Genes associated with PKD
PKD1, PKD2
Signs and symptoms of PKD:
larger kidneys compression of blood vessels --> hypertension Urinary stasis --> stones Heamaturia pain failure
Diagnosis of PKD:
Ultrasound (18-21)
Genetic screening
Benefits of diagnosing an asymptomatic family member with PDK;
- Monitor BP
- Monitor renal function
- Aware of it
- Pregnancy
Problems with diagnosing an asymptomatic family member with PDK:
- Insurance
- Employment
- Ethical issue of children
2 types of dialysis:
- Hemodialysis
- Peritoneal dialysis
Advantages of dialysis:
- Life-saving
- Contact with medical, nursing and social staff
- Relief from loneliness
- Bridge to transplant
Impact of dialysis:
- Frequent admission
- Depression common
- Time burden
- Travel limitation
- Fluid and diet restrictions
- Employment
