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Kidney function and failure > Approach to patient with renal disease > Flashcards

Approach to patient with renal disease Flashcards

1
Q

Order of vessels at hilum of kidney:

A

Vein: anterior
Ureter: posterior
Artery: middle

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2
Q

Functions of the kidney:

A
  • Excrete waste
  • Fluid and electrolyte balance
  • Acid:base
  • BP
  • EPO
  • Convert 25-hydroxy vitamin D to 1,25 dihydroxy-vitamin D
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3
Q

Calcitriol =

A

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

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4
Q

Upper urinary tract:

A

Kidney, ureters

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5
Q

Common upper urinary tract symptoms:

A
  • Pain

- Haematruia

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6
Q

Kidney pain:

A

Loin pain, may radiate to groin/testicle

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7
Q

Sources of blood:

A
  • Kidney: cysts, tumors, stones, schlerosis, glomerulonephritis
  • Ureters: tumors
  • Bladder: cysts, tumours
  • Urethra
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8
Q

2 broad types of lower urinary tract symptoms:

A
  • Obstructive/voiding

- Storage

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9
Q

Lower urinary tract:

A

Bladder, urethra, prostate

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10
Q

Voiding symptoms:

A
  • Hesitancy
  • Delay in initiation
  • Weak urine stream
  • Straining
  • Incomplete emptying
  • Terminal dribbling
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11
Q

Storage symptoms:

A
  • Urinary frequency
  • Nocturia
  • Urgency
  • Incontinence
  • Bladder pain
  • Dysura
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12
Q

Pain on urination =

A

Dysuria

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13
Q

Types of urine abnormalities:

A

Colour
Odour
Volume
Other

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14
Q

Increase urine production =

A

polyuria

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15
Q

Decrease urine production =

A

oligouria

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16
Q

No urine output =

A

Anuria

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17
Q

Ex causes of polyuria:

A 
Diabetes mellitus (osmotic diuretic)
Early chronic kidney disease 
Post renal obstruction
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18
Q

Ex causes of oliguria:

A

Acute kidney injury

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19
Q

Ex causes of anuria:

A

Severe acute kidney injury

Longstanding end stage renal failure

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20
Q

Normal urine =

A

yellow

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21
Q

Pale urine =

A

Dilute, lots of water

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22
Q

Dark urine =

A

Concentrated, bile pigments

23
Q

Pink/red urine =

A

blood

24
Q

Browny-red urine =

A

myoglobin in muscle breakdown

25
Q

Browny-red urine is a sign of

A

Rhabdomylosis = indirect or direct muscle injury

26
Q

Cloudy urine =

A

Excess WBC

27
Q

Thick urine =

A

Pus from infection

28
Q

Frothy urine =

A

Protein

29
Q

Tool used to determine pathological changes to urine =

A

Urine dipstick

30
Q

Biochemical profile =

A

Combination of lab tests to evaluate an organ system

31
Q

Biochemical profile of renal system:

A
  • Creatinine
  • Urea
  • Albumin
  • Electrolytes
  • Bicarbonate
  • Bone profile
  • Hb and blood film
32
Q

Type of anaemia found in chronic kidney disease =

A

Normochromic

33
Q

Kidneys may look … in chronic disease

A

Small

34
Q

2 types of kidney problem

A
  1. Acute renal injury

2. Chronic renal failure

35
Q

What is used to estimate GFR?

A

Creatinine

36
Q

Link between hypertension and kidney injury

A

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

37
Q

Defining characteristic of nephrotic syndrome:

A

Proteinuria

38
Q

Cause of nephrotic syndrome:

A

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

39
Q

Signs and symptoms of nephrotic syndrome:

A
  • Oedema (periorbital, hands, feet)
  • Frothy urine
  • Increased lipids (liver compensates for albumin)
  • Reduces anti-thrombin II (increased risk of DVT and PE)
40
Q

Why do you get oedema in nephrotic syndrome?

A

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

41
Q

Defining characteristic of nephritic syndrome.

A

Hematuria, proteinuria

42
Q

Pathophysiology of nephritic syndrome:

A

Due to inflammation. e.g. glomerular nephritis

43
Q

Ex cause of glomerular nephritis/nephritic syndrome:

A

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

44
Q

Additional signs/symptoms of nephritic syndrome:

A
  • Blood in urine
  • Sedement in urine
  • White cells in urine
  • Oliguria (glomerulus damage)
  • Increased BP
  • Granular casts in urine
45
Q

What is found in urine of someone with nephritic syndrome?

A

blood, protein, WBC, granular casts

46
Q

Ex of genetic kidney disease:

A

Autosomal dominant polycystic kidney disease

47
Q

Genes associated with PKD

A

PKD1, PKD2

48
Q

Signs and symptoms of PKD:

A 
larger kidneys
compression of blood vessels --> hypertension
Urinary stasis --> stones
Heamaturia
pain 
failure
49
Q

Diagnosis of PKD:

A

Ultrasound (18-21)

Genetic screening

50
Q

Benefits of diagnosing an asymptomatic family member with PDK;

A
  • Monitor BP
  • Monitor renal function
  • Aware of it
  • Pregnancy
51
Q

Problems with diagnosing an asymptomatic family member with PDK:

A
  • Insurance
  • Employment
  • Ethical issue of children
52
Q

2 types of dialysis:

A
  • Hemodialysis

- Peritoneal dialysis

53
Q

Advantages of dialysis:

A
  • Life-saving
  • Contact with medical, nursing and social staff
  • Relief from loneliness
  • Bridge to transplant
54
Q

Impact of dialysis:

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

Kidney function and failure (9 decks)

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