Approach to patients with Kidney Disease Flashcards
What are the common symptoms of renal disease?
Loin pain
Shortness of breath
Fluid retention
Muscle cramps: due to electrolyte imbalances
Oliguria, anuria
Voiding issues
Diarrhoea and vomiting
What does tachypnoea indicate?
Pulmonary oedema
What is bradypnoea indicate?
Uraemic encephalopathy (accumulation of toxins)
Opioid toxicity
What does low BP in kidney examination indicate?
Sepsis and dehydration
What is Kussmaul breathing?
Rapid deep breathing indicated by severe metabolic ketaoacidosis due to diabetes.
What are the signs in renal disease?
What are the biochemical tests to measure urine?
Potassium, bicarbonate, haemoglobin, calcium and phosphate
Dipstick test
What does the dipstick test measure?
Blood in urine
What are the features to look for in urine?
Cloudiness, thick pus
Protein
How is protein detected in urine?
Bromophenol blue which is sensitive to albumin
What does frothiness indicate?
Excess protein
What does gravel in urine indicate?
Stone fragments
What does air in urine indicate?
Vesico-colic fistula
What does debris in urine indicate?
Infection
Vesico-colic fistula
What are the measures of renal structure?
Contrast Enhanced CT
Angiogram: renal artery stenosis
Venogram
DMSA
What is the DMSA scan?
Diagnostic test for renal structure and function
What are the measures of renal function?
Serum creatinine
Serum urea
GFR
eGFR
Protein: creatinine ratio
What are the issues for patients with familial renal disease?
Affects health insurance
Ethical issues with passing on conditions
What is the impact of chronic renal dialysis?
Frequent hospital admissions
Depression and Psychological illness
Restrictions on food and diet
What do creatinine levels indicate?
Renal clearance.
What does eGFR indicate?
Renal function.
What do nitrites in urine indicate?
UTI.
What does a high urine pH indicate?
Alkaline urine indicates infection.
Renal tubular acidosis where acid is not removed into urine but remains in the bloodstream, due to kidney damage.
What does a low urine pH indicate?
Acidic urine due to:
Diabetic ketoacidosis
Renal tubular acidosis
What does bilirubin in urine indicate?
Post-hepatic jaundice.
What is the ideal method to image the kidneys?
Ultrasound which is cheap and non-invasive.
Why should CT scans be avoided in kidney disease?
Contrast is required to view the kidneys but this is nephrotoxic.
Why is MRI avoided in kidney imaging?
Uses the contrast agent gadolinium which can be nephrotoxic.
What is autosomal dominant polycystic kidney disease?
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.
What are the features of APKD 1?
Typically more severe renal disease and affects people in their 30’s to 40’s.
What are the features of APKD 2?
Milder form of renal disease which affects people in their 70’s.
What are the disadvantages to genetic screening?
Difficulty with employment
Difficulty with insurance
Ethical issues arise with family planning.
