Chronic Renal Failure Flashcards
How will someone with chronic renal failure present?
The patient will have
1) Uraemic symptoms: pruritis, fatigue, anorexia, weight loss, pruritis, increased thirst
2) Urinary symptoms: frequency due to loss of concentrating ability, change in volume of urine passed, haematuria
3) Loin pain
4) Fluid overload - dyspnoea, oedema, ascites
Urine dipstick in a patient with chronic renal failure will have…? (1)
Proteinuria
What previous renal history is important in males vs females suspected of chronic renal failure?
For males - was CRF detected during NS check-up
For females - any kidney issues during pregnancy?
What are the commonest causes of chronic renal failure in patients?
- Diabetes
- HTN
- Glomerulonephritis
Glomerulonephritis caused by VITAMIN can lead to chronic renal failure in patients. What are the VITAMIN causes?
V - vascular: HSP I - infectious: hep B/hep C T - toxins: drugs e.g. gold, penicillamine A - autoimmune: SLE M - metabolic: diabetes
How will a patient with HSP causing glomerulonephritis and CRF present?
HSP causes a purpuric rash, joint and abdominal pain.
What will a patient with SLE causing CRF present with?
SLE:
Malar rash, photosensitivity, joint pain, oral ulcers
How to approach the aetiology of a patient with chronic renal failure? (3)
- Common causes e.g. diabetes, HTN, GNNS (glomerular nephrotic and nephritic syndromes)
- Renal causes
- Extrarenal causes
Patient comes in with loin pain, haematuria and headaches, what is a sensible differential?
Capsule stretching (pain), bleeding, HTN > Polycystic kidney disease
What symptoms may a person with pyelonephritis present with?
Fever, loin pain, previous Hx of infection
What are the renal causes of CRF? (acronym STOIC for the general categories, ignoring S)
- Toxins - analgesic nephropathy, interstitial nephritis
- Originating from elsewhere in the urinary tract: obstruction, reflux nephropathy
- Inflammation - pyelonephritis, renovascular disease (vasculitis)
- Cysts - Polycystic kidney disease
Patient has just been diagnosed with CRF. What are the possible extra-renal causes of his CRF?
Myeloma
Systemic sclerosis
Amyloidosis
What history in a patient with CRF points towards reflux nephropathy as the cause?
Patient may have history of enuresis as a child (prolonged bedwetting), history of UTIs, been treated with surgical cytoscopy before.
Give 3 categories of causes of chronic renal failure and some examples in each.
- Common causes - DM, HTN, GNNS (in order of decreasing frequency)
- Renal causes - STOIC acronym e.g. toxins, obstruction, infection, cysts
- Extra-renal causes - myeloma, systemic sclerosis, amyloidosis
What investigations should be carried out to confirm diagnosis of CRF in a patient?
- Urinalysis, urine microalbumin
- Serum creatinine and estimate GFR
- Renal U/S
- Biopsy
Why is a renal ultrasound useful for diagnosing CRF? What should you be looking out for to narrow down the cause of CRF?
Atrophic kidneys suggest CRF
Also, look for evidence of hydronephrosis, which suggests obstruction and stones.
What symptoms and history suggest obstruction as the cause of a patient’s CRF?
Obstruction will cause loin-to-groin pain, haematuria, dysuria, LUTS
History of BPH or stones
Which of the commonest causes of CRF can be diagnosed using renal biopsy?
GNNS - glomerular nephrotic syndrome and nephritis.
What is the definition of chronic kidney disease?
CKD is defined as pathologic abnormality the kidney, or GFR < 60mL/min/1.73m2 for 3 or more months.
What clinical markers are considered as “kidney damage” or “pathologic abnormalities” in the definition of CKD?
- Stuff in the urine - albuminuria (ACR ratio of >30mg/g or 3.4mg/mol), sediments (white or red cell casts)
- Pathology - biopsy reveals disease
- Imaging - atrophic/polycystic kidneys or hydronephrosis
- Previous kidney transplant
What investigations can diagnose CKD? How do these clinical markers relate to definition of CKD?
- Renal biopsy - shows evidence of glomerular/vascular/tubulointerstitial disease > pathologic abnormality as defined in CKD
- Imaging of kidneys - shows hydronephrosis, atrophic kidneys, polycystic kidney > CKD
- Stuff in the urine - red or white cell casts, albumin > CKD
What is the definition of CKD?
CKD is defined as
1) evidence of kidney damage based on lab, radiographic or pathologic abnormalities OR
2) GFR <60 mL/min/1.73m2 for 3 months or more
How many stages are there for CKD?
1 to 5, with 3 broken down into 3a and 3b
What is the GFR defined for each stage of CKD?
Stage 1: normal or increased GFR = 90 or more
Stage 2: slightly decreased GFR = 60 to 89 (30)
Stage 3a: 45 to 59 (15)
Stage 3b: 30 to 44 (15)
Stage 4: 15 to 29 (15)
Stage 5: <15
