Clinical 🏥 Flashcards
What are the renal functions?
• 1. Excretory function and production of urine
• 2. Regulation of the acid-base balance of the body
• 3. Hemopoietic function
• 4. Endocrine functions of the kidney
What is clinical presentation in kidney diseasess?
1- Fluid retention
2- Problem in Excretory Function
3- Disturbance of acid base balance (metabolic acidosis)
4- Hemopoietic function
5- Hypertension
6- Clinical presentation related to micturition and urine output
What is the effect of fluid retention?
A. Buffy face (swollen face)
B. Edema lower limbs and pulmonary edema due to fluid retention in alveoli
C. Decreased urine output
D. In severe cases:
Shortness of breath
Generalized anasarca
Pulmonary oedema
What is the effect of problem in excretory function of kidney?
Retention of toxin and products of metabolism Such as ammonia, urea, uric acid, creatinine in renal failure result in ammonia smell (halitosis), urea frost “skin”.
“Ammonia smell due to retention of urea”
What is the effect of disturbance of acid base balance?
METABOLIC ACIDOSIS
• Headache
• Decreased BP
• Hyperkalemia
• MUSCLE TWITCHING
• Warm, Flushed Skin (Vasodilation)
• Nausea, Vomiting and Diarrhea
• Changes in LOC (Confusion, T drowsiness)
•KUSSMAUL RESPIRATIONS Compensatory Hyperventilation.
• Causes:
DKA
Severe Diarrhea
Renal Failure
Shock
What is the effect of problem in hemopoitic function of the kidney?
Anemia due to :
1- Decreased erythropiotin production “MCQ”
2- Malnutrition
3- Blood loss in patient with hemodialysis causes iron deficiency anemia
4- Toxins that depress bone marrow
What is a clinical presentation related to micturition and urine output?
1- Volume:
Normal:1.2-2L/day
Polyuria>2000ml/day
Oliguria<500ml/day
Anuria: total suppression of urine , < 100ml/day
2- Color :
Red urine seen mainly in hematuria , hemoglobinuria which could be differnitated by microscopic examination which can demonstrate RBCs in case of hematuria but not in case of hemoglobinuria.
“The Presence of red urine doesn’t necessarily indicate blood”
3- Dysuria : “التهاب”
Painful urination
Urinarytractinfectionsareacommoncause.
4- Frequency .
What are the systemic manifestations of chronic kidney diseaes?
Cutaneous manifestations
CVS manifestations
Respiratory manifestations
Gastrointestinal manifestations
Neurolmuscular manifestations
What are the cutenous manifestations related to chronic kidney disease?
- Pale & yellow (sallow face)
- Dry skin
- Bruises.
- Pruritis.
- Purpura.
- Urea frost.
What are the CVS manifestations related to chronic kidney disease?
“HUC”
- Hypertension.
- Uremic pericarditis
- Cardiac tamponade “blood in pericardium - must be evacuated”
What are the Respiratory manifestations related to chronic kidney disease?
“PRPA”
a. Acidotic breathing
b. Pleural effusion
c. Recurrent infection. “Immunocomprimised”
d. Pleurisy
What are the GIT manifestations related to chronic kidney disease?
“NHAG”
- Anorexia, nausea, vomiting “persistent”
- Hiccough
- Ammoniacal smell
- Coated tongue “brown”
- GIT hemorrhage “due to stress and toxins”
What are the Neuromascular manifestations related to chronic kidney disease?
- Muscle fatigue, wasting
- Bone aches, fractures, deformity in children
- Headache, intellectual deterioration
- Drowsiness , coma
What is pericardial Rub?
Hallmark of pericardial inflammation
What causes pericardial rub?
- Due to moving of parietal & visceral surfaces of pericardium against each other.
What are the investigations done to kidney?
Biochemical Investigations
Renal Function Tests
Radiologic Examination
Renal Biopsy
What are the biochemical investigations done to the kidney?
- Examination of urine = urine analysis :
Physical
Chemical
Microscopic - Tests for kidney functions
- Microbiologic and immunologic tests
What are the renal function tests done to the kidney?
“Creatinine, bun & PU and GFR”
1- Serum creatinine : normally .6-1.2 mg/dl
2- Serum Plasma urea and Blood Urea Nitrogen (BUN) : urea normally 15-40 mg/dl , while BUN 8-13 mg/dl
“Not very Acc.”
3- Glomerular Filtration Rate (GFR) :
- Best measure for kidney function
- Calculated by serum creatinine
- No direct way to calculate GFR
What are radiologic examination of the kidney?
- Of the kidney and the urinary tract by ultrasound
What is the normal range of proteins in urine?
- Urine normally contain only small amount of protein (<150 mg/24 h)
“Less than tenth gram”
What are the grades of proteinuria?
1- Micro-albuminuria : 30-300 mg/day = 20=200 ug/min
2- Mild proteinuria : < 1000 mg/day
3- Moderate proteinuria : 1000-2000 mg/day
4- Heavy proteinuria : >2000 mg/day
5- Nephrotic range proteinuria : > 3500 mg/day
What are the types of hematuria?
a) Microscopic hematuria : diagnosed by urine dipstick, color of urine not changed
b) Macroscopic hematuria : blood is visible in urine , usually originate from lower urinary tract dse. as stone , carcinoma of bladder.
What is the definition of acute kidney injury?
- rapid deterioration of parenchymal renal function , may cause uremia.
What are the characteristics of acute kidney injury?
- Usually but not invariably reversible
- Usually but not invariably cause oliguria
What is the definition of chronic kidney disease?
- deterioration of kidney function for more than 3 months
What are the stages of chronic kidney disease?
Kidney damage with normal or increased GFR
Kidney damage with mildly decreased GFR
Moderately decreased GFR
Severely decreased GFR
Kidney Failure
≥ 90
60-89
30-59
15-29
<15
What are the characteristics of nephrotic syndrome?
Edema
Proteinuria
Hyper-lipidemia
Hypo-albuminuria
What are the characteristics of nephritic syndrome?
Hematuria
Proteinuria
Hypertension
Azotemia
Oliguria (low urine output < 400 mL/day)
