Chapter 8 Clinical presentation of abnormal renal funciton

Question 1

What is the tool used to screen pts for renal disease (also urinary tract infections)?

Answer 1

dipstick

Question 2

Why might there be protein in urine?

Answer 2

damage to glomerular filtration barrier overwhelming tubular capacity for reabsorption

Question 3

Why might there be haemauria?

Answer 3

false read i.e. form myoglobinuria

positive= UTI, bladder, inflammation, renal stones, interstitial kidney disease and cancer

Question 4

What is nephritic syndrome?

Answer 4

The nephritic syndrome comprises: ▪▪ Oliguria. ▪▪ Smoky or Coca‐Cola‐coloured urine due to haematuria. ▪▪ Oedema. ▪▪ Hypertension due to salt and water retention
Acute renal dysfunction

due to pathologies damaging glomerular filtration barrier e.g. immune-mediated inflammation and glomerulonephritis.

Question 5

Symptoms:
comprises: ▪▪ Oliguria. ▪▪ Smoky or Coca‐Cola‐coloured urine due to haematuria. ▪▪ Oedema. ▪▪ Hypertension due to salt and water rention
finally: acute rental dysfunction
What is it?

Answer 5

nephritic syndrome

Question 6

what is oliguria?

Answer 6

low urine output

less than 400 mL or 500 mL per 24h in adults

Question 7

what could cause the following symptoms:
oedema
hyperlipidaemia
hypoalbuminaemia
significant proteinuria (uACR>250mg/,mmol or uPCR> 350mg/mmol)
initially urine dipstick shoes well preserved levels but with significant proteinuria

Answer 7

nephrotic syndrome
(this is different to nephritic syndrome as it is more to do with protein leakage than inflammation at glomerular filtration barrier)

Question 8

Acute kidney injury affect on GFR?

Answer 8

rapid decline = reduced elimination of nitrogenous waste products and toxins, resulting in impaired fluid and electrolyte homeostasis

Question 9

Who is at risk of acute kidney injury?

Answer 9

elderly
pre-exsisting kidney injury disease
co-morbidities e.g. diabetes, CVD
nephrotoxic medications
hypovolaemia/dehydration
those with sepsis

Question 10

What are the symptoms of Acute kidney injury?
RIFLE criteria adapted by acute kidney injury network say it is…
2) What are the different stages?

Answer 10

RIFLE criteria adapted by acute kidney injury network say it is less then 0.5ml/Kg body weight per hour for 12 hours, serum creatinine increase by 2 fold and GFR 50% decrease. It is a reult of a sudden decline in GFR, mutliple causes and can occur over hours or days.
2) 1-3, 1 being least severe (creatine increase of 1.5-2 fold (baseline is 26micromol/L), urine output less than 0.5ml/kg body weight per hour for 6 hours), 3 is creatine over 3 fold increase (more than 354) , o.3ml/Kg body weight per hour for 24 hours or anuria for 12 hours.