Approach to patients with Kidney Disease

Question 1

What are the common symptoms of renal disease?

Answer 1

Loin pain
Shortness of breath
Fluid retention
Muscle cramps: due to electrolyte imbalances
Oliguria, anuria
Voiding issues
Diarrhoea and vomiting

Question 2

What does tachypnoea indicate?

Answer 2

Pulmonary oedema

Question 3

What is bradypnoea indicate?

Answer 3

Uraemic encephalopathy (accumulation of toxins)
Opioid toxicity

Question 4

What does low BP in kidney examination indicate?

Answer 4

Sepsis and dehydration

Question 5

What is Kussmaul breathing?

Answer 5

Rapid deep breathing indicated by severe metabolic ketaoacidosis due to diabetes.

Question 6

What are the signs in renal disease?

Question 7

What are the biochemical tests to measure urine?

Answer 7

Potassium, bicarbonate, haemoglobin, calcium and phosphate

Dipstick test

Question 8

What does the dipstick test measure?

Answer 8

Blood in urine

Question 9

What are the features to look for in urine?

Answer 9

Cloudiness, thick pus
Protein

Question 10

How is protein detected in urine?

Answer 10

Bromophenol blue which is sensitive to albumin

Question 11

What does frothiness indicate?

Answer 11

Excess protein

Question 12

What does gravel in urine indicate?

Answer 12

Stone fragments

Question 13

What does air in urine indicate?

Answer 13

Vesico-colic fistula

Question 14

What does debris in urine indicate?

Answer 14

Infection
Vesico-colic fistula

Question 15

What are the measures of renal structure?

Answer 15

Contrast Enhanced CT
Angiogram: renal artery stenosis
Venogram

DMSA

Question 16

What is the DMSA scan?

Answer 16

Diagnostic test for renal structure and function

Question 17

What are the measures of renal function?

Answer 17

Serum creatinine
Serum urea
GFR
eGFR
Protein: creatinine ratio

Question 18

What are the issues for patients with familial renal disease?

Answer 18

Affects health insurance
Ethical issues with passing on conditions

Question 19

What is the impact of chronic renal dialysis?

Answer 19

Frequent hospital admissions
Depression and Psychological illness
Restrictions on food and diet

Question 20

What do creatinine levels indicate?

Answer 20

Renal clearance.

Question 21

What does eGFR indicate?

Answer 21

Renal function.

Question 22

What do nitrites in urine indicate?

Answer 22

UTI.

Question 23

What does a high urine pH indicate?

Answer 23

Alkaline urine indicates infection.
Renal tubular acidosis where acid is not removed into urine but remains in the bloodstream, due to kidney damage.

Question 24

What does a low urine pH indicate?

Answer 24

Acidic urine due to:
Diabetic ketoacidosis
Renal tubular acidosis

Question 25

What does bilirubin in urine indicate?

Answer 25

Post-hepatic jaundice.

Question 26

What is the ideal method to image the kidneys?

Answer 26

Ultrasound which is cheap and non-invasive.

Question 27

Why should CT scans be avoided in kidney disease?

Answer 27

Contrast is required to view the kidneys but this is nephrotoxic.

Question 28

Why is MRI avoided in kidney imaging?

Answer 28

Uses the contrast agent gadolinium which can be nephrotoxic.

Question 29

What is autosomal dominant polycystic kidney disease?

Answer 29

Formation of cysts which fill with fluid in the tubules to become nonfunctional that leads to reduced gFR function over time. Patients will have excessive RAAS activation so hypertension, haematuria, poyluria. There are two subtypes which are APKD1 and APKD 2.

Ultrasound scanning and genetic screening is important.

Question 30

What are the features of APKD 1?

Answer 30

Typically more severe renal disease and affects people in their 30’s to 40’s.

Question 31

What are the features of APKD 2?

Answer 31

Milder form of renal disease which affects people in their 70’s.

Question 32

What are the disadvantages to genetic screening?

Answer 32

Difficulty with employment
Difficulty with insurance
Ethical issues arise with family planning.