Case Launch/ Basics (M1 30/10 and Tutorial)

Question 1

What is reflux nephropathy?

Answer 1

• Kidney damage due to urine flowing backward from the bladder toward the kidneys

Question 2

What is Pyelonephritis?

Answer 2

Inflammation of the kidney, typically due to a bacterial infection.

Question 3

What is diabetic nephropathy?

Answer 3

?

Question 4

What does Chronic Kidney Disease refer to?

Answer 4

• A broad term used in clinical practice covering a range of kidney damage

Question 5

What are the symptoms of a lower (bladder and urethras, that carries urine out of the body) urinary tract infection?

Answer 5

• Dysuria – burning/stinging on passing urine
• Urinary frequency – passing urine more often
• Urgency – patients may experience episodes of incontinence if they are unable to get to a toilet quick enough
• Abdominal discomfort – suprapubic
• Haematuria -passing blood in urine
• Cloudy/smelly urine
• Feeling generally unwell ( often the only symptom in the elderly)

Question 6

What are the symptoms of an upper urinary tract infection (kidneys and ureters, that carry urine to the bladder)?

Answer 6

• a high temperature (fever) of 38C (100.4ºF) or above
• pain in your sides or back
• shivering and chills
• feeling and being sick
• confusion
• agitation or restlessness

Question 7

What causes recurrent UTI’s?

Answer 7

• indwelling catheters,
• neuropathic bladder,
• vesico-ureteric reflux (VUR),
• outflow obstruction ( eg: enlarged prostate)
• anatomical anomalies.( duplex kidneys)
• renal stones

Question 8

What is the most likely cause of LUTI in women and why?

Answer 8

E Coli is the most common organisms for LUTI in women because this is the bacteria than colonises the rectum. The proximity of the rectum, and the short urethral opening in women predispose to UTI compared to men.

Question 9

What is the kidneys role in the regulation of blood pressure? Briefly explain the underlying pathophysiology for raised BP in CKD

Answer 9

• The renin-angiotensin system or RAS regulates blood pressure and fluid balance in the body. When blood volume or sodium levels in the body are low, or blood potassium is high, cells in the kidney release the enzyme, renin. Renin converts angiotensinogen, which is produced in the liver, to the hormone angiotensin I. An enzyme known as ACE or angiotensin-converting enzyme found in the lungs metabolizes angiotensin I into angiotensin II. Angiotensin II causes blood vessels to constrict and blood pressure to increase. Angiotensin II stimulates the release of the hormone aldosterone in the adrenal glands, which causes the renal tubules to retain sodium and water and excrete potassium.
• Together, angiotensin II and aldosterone work to raise blood volume, blood pressure and sodium levels in the blood to restore the balance of sodium, potassium, and fluids. If the renin-angiotensin system becomes overactive, consistently high blood pressure results.
• CKD leads to sodium and water retention, leading to increases of plasma volume and cardiac output. Furthermore, disturbances in the effects of various vasoactive substances – activation/insufficient suppression of vasoconstriction systems (renin–angiotensin–aldosterone, sympathetic system) can increase blood pressure.

Question 10

In the management of CKD, why is it important to monitor the impact on other systems of the body?

Answer 10

Development of CKD is associated with a number of significant complications:including increased incidence of cardiovascular disease, hyperlipidemia, anaemia and metabolic bone disease.

Patients should therefore be assessed for the development of these complications and receive treatment to reduce their morbidity and mortality. A multidisciplinary approach is required to accomplish this goal.

Question 11

Why is it important to consider renal function when prescribing any new drug?

Answer 11

• Reduced kidney function may affect the excretion of certain medications and therefore alter desired effects of certain drugs and increase risk of side effects.
• Certain medications may be harmful to kidneys and therefore prescribing these medications to patients with kidney disease may be detrimental to their condition.

Question 12

Define prognosis

Answer 12

Prognosis can be defined as the likely course of a medical condition; this may be based on based on medical experience or research outcomes.

Question 13

What factors could contribute to peripheral oedema in patients with CKD?

Answer 13

Fluid retention secondary to impaired renal function. Oedema develops because of a limitation in the kidneys’ ability to excrete sodium into the urine. Therefore, patients with kidney failure from whatever cause will develop oedema if their intake of sodium exceeds the ability of their kidneys to excrete the sodium.

Hypoalbuminemia – loss of protein in the urine

Patients may have an element of right sided heart failure – (high risk of CVD) and if has anaemia

Question 14

Difference between symptom and sign?

Answer 14

A symptom is any subjective evidence of disease, while a sign is any objective evidence of disease. Therefore, a symptom is a phenomenon that is experienced by the individual affected by the disease. These are mainly explored in the history taking process.

A sign is a phenomenon that can be detected by someone other than the individual affected by the disease and is what is elicited during examination.

Question 15

What are the symptoms of CKF?

Answer 15

Symptoms of kidney failure:

1. No/minimal symptoms of kidney disease when it’s at an early stage.
2. Later symptoms include weight loss and poor appetite
3. Swollen ankles, feet or hands
4. Shortness of breath
5. Tiredness
6. Haematuria
7. Increased urinary frequency
8. Difficulty sleeping (insomnia)
9. Itchy skin ( pruritus)
10. Muscle cramps
11. Nausea and poor appetite
12. Headaches
13. Erectile dysfunction in men

Question 16

Why can CKD cause raised pottasium?

Answer 16

The kidneys play a major role in maintaining potassium homeostasis by matching potassium intake with potassium excretion. the main regulator is aldosterone in response to serum potassium. Therefore, reduced kidney function due to renal disease results in renal retention of potassium.

Question 17

Why do patients with CKD need to take treatment for their bones?

Answer 17

To protect her from renal bone disease.

The kidneys are a key organ in the regulation of bone metabolism through regulation of calcium, phosphate and vitamin D. People with CKD sometimes find their bones get weaker and thinner – osteoporosis and osteomalacia may result.