Approach to patient with renal disease

Question 1

Order of vessels at hilum of kidney:

Answer 1

Vein: anterior
Ureter: posterior
Artery: middle

Question 2

Functions of the kidney:

Answer 2

• Excrete waste
• Fluid and electrolyte balance
• Acid:base
• BP
• EPO
• Convert 25-hydroxy vitamin D to 1,25 dihydroxy-vitamin D

Question 3

Calcitriol =

Answer 3

Active form of vitamine D (1,25 dihydroxy-vitamin D)

Question 4

Upper urinary tract:

Answer 4

Kidney, ureters

Question 5

Common upper urinary tract symptoms:

Answer 5

• Pain

- Haematruia

Question 6

Kidney pain:

Answer 6

Loin pain, may radiate to groin/testicle

Question 7

Sources of blood:

Answer 7

• Kidney: cysts, tumors, stones, schlerosis, glomerulonephritis
• Ureters: tumors
• Bladder: cysts, tumours
• Urethra

Question 8

2 broad types of lower urinary tract symptoms:

Answer 8

• Obstructive/voiding

- Storage

Question 9

Lower urinary tract:

Answer 9

Bladder, urethra, prostate

Question 10

Voiding symptoms:

Answer 10

• Hesitancy
• Delay in initiation
• Weak urine stream
• Straining
• Incomplete emptying
• Terminal dribbling

Question 11

Storage symptoms:

Answer 11

• Urinary frequency
• Nocturia
• Urgency
• Incontinence
• Bladder pain
• Dysura

Question 12

Pain on urination =

Answer 12

Dysuria

Question 13

Types of urine abnormalities:

Answer 13

Colour
Odour
Volume
Other

Question 14

Increase urine production =

Answer 14

polyuria

Question 15

Decrease urine production =

Answer 15

oligouria

Question 16

No urine output =

Answer 16

Anuria

Question 17

Ex causes of polyuria:

Answer 17

Diabetes mellitus (osmotic diuretic)
Early chronic kidney disease 
Post renal obstruction

Question 18

Ex causes of oliguria:

Answer 18

Acute kidney injury

Question 19

Ex causes of anuria:

Answer 19

Severe acute kidney injury

Longstanding end stage renal failure

Question 20

Normal urine =

Answer 20

yellow

Question 21

Pale urine =

Answer 21

Dilute, lots of water

Question 22

Dark urine =

Answer 22

Concentrated, bile pigments

Question 23

Pink/red urine =

Answer 23

blood

Question 24

Browny-red urine =

Answer 24

myoglobin in muscle breakdown

Question 25

Browny-red urine is a sign of

Answer 25

Rhabdomylosis = indirect or direct muscle injury

Question 26

Cloudy urine =

Answer 26

Excess WBC

Question 27

Thick urine =

Answer 27

Pus from infection

Question 28

Frothy urine =

Answer 28

Protein

Question 29

Tool used to determine pathological changes to urine =

Answer 29

Urine dipstick

Question 30

Biochemical profile =

Answer 30

Combination of lab tests to evaluate an organ system

Question 31

Biochemical profile of renal system:

Answer 31

- Creatinine - Urea - Albumin - Electrolytes - Bicarbonate - Bone profile - Hb and blood film

Question 32

Type of anaemia found in chronic kidney disease =

Answer 32

Normochromic

Question 33

Kidneys may look ... in chronic disease

Answer 33

Small

Question 34

2 types of kidney problem

Answer 34

1. Acute renal injury | 2. Chronic renal failure

Question 35

What is used to estimate GFR?

Answer 35

Creatinine

Question 36

Link between hypertension and kidney injury

Answer 36

Hypertension can cause kidney injury, kidney injury releases renin which increases BP

Question 37

Defining characteristic of nephrotic syndrome:

Answer 37

Proteinuria

Question 38

Cause of nephrotic syndrome:

Answer 38

Podocytes or basement membrane not filtering properly. Damage to glomeruli.

Question 39

Signs and symptoms of nephrotic syndrome:

Answer 39

- Oedema (periorbital, hands, feet) - Frothy urine - Increased lipids (liver compensates for albumin) - Reduces anti-thrombin II (increased risk of DVT and PE)

Question 40

Why do you get oedema in nephrotic syndrome?

Answer 40

Albumin acts as a sponge keeping fluid in vessels. When lost in urine fluid is redistributed.

Question 41

Defining characteristic of nephritic syndrome.

Answer 41

Hematuria, proteinuria

Question 42

Pathophysiology of nephritic syndrome:

Answer 42

Due to inflammation. e.g. glomerular nephritis

Question 43

Ex cause of glomerular nephritis/nephritic syndrome:

Answer 43

SLE (antigen-antibody complexes) which activate the complement system

Question 44

Additional signs/symptoms of nephritic syndrome:

Answer 44

- Blood in urine - Sedement in urine - White cells in urine - Oliguria (glomerulus damage) - Increased BP - Granular casts in urine

Question 45

What is found in urine of someone with nephritic syndrome?

Answer 45

blood, protein, WBC, granular casts

Question 46

Ex of genetic kidney disease:

Answer 46

Autosomal dominant polycystic kidney disease

Question 47

Genes associated with PKD

Answer 47

PKD1, PKD2

Question 48

Signs and symptoms of PKD:

Answer 48

``` larger kidneys compression of blood vessels --> hypertension Urinary stasis --> stones Heamaturia pain failure ```

Question 49

Diagnosis of PKD:

Answer 49

Ultrasound (18-21) | Genetic screening

Question 50

Benefits of diagnosing an asymptomatic family member with PDK;

Answer 50

- Monitor BP - Monitor renal function - Aware of it - Pregnancy

Question 51

Problems with diagnosing an asymptomatic family member with PDK:

Answer 51

- Insurance - Employment - Ethical issue of children

Question 52

2 types of dialysis:

Answer 52

- Hemodialysis | - Peritoneal dialysis

Question 53

Advantages of dialysis:

Answer 53

- Life-saving - Contact with medical, nursing and social staff - Relief from loneliness - Bridge to transplant

Question 54

Impact of dialysis:

Answer 54

- Frequent admission - Depression common - Time burden - Travel limitation - Fluid and diet restrictions - Employment