Clinical overview Flashcards
possible presentation of kidney disease
asymptomatic loin pain/ urinary symptoms haematuria - microscopic - painless macroscopic haematuria proteinuria hypertension - asymptomatic - accelerated acute kidney injury chronic kidney disease nephrotic syndrome nephritic syndrome
what are the systemic effects of loss of kidney function?
if significant loss in renal function: uraemia - pericarditis, encephalopathy, neuropathy, asterixis, gastritis fluid retention and oedema hyperkalaemia and arrhythmia metabolic acidosis and Kussmaul's respiration renal bone disease vascular calcification anaemia drug toxicity - digoxin and gabapentin
renal function may or may not be impaired:
proteinuria
nephrotic syndrome
the functions of the kidney
excretion of nitrogenous waste (urea) fluid balance electrolyte balance acid-base balance vitamin D metabolism/ phosphate excretion production of erythropoietin drug excretion barrier to loss of proteins
how is asymptomatic kidney disease identified?
dipstick microscopic haematuria and/or proteinuria reduced eGFR on biochemical screen raised BP incidental finding on abdominal imaging screening because of FHx
local/ renal presentations
loin/abdominal pain
macroscopic haematuria
UTI
systemic relating to disease
DM
CTD - connective tissue disease
vascular disease
relevant drug history
ACEi, ARB, diuretics NSAIDs antibiotics - gentamicin, trimethoprim, penicillin PPIs radiology contrast over the counter/ herbal remedies
systemic signs relating to disease
pyrexia skin rash heart murmurs consolidation ENT retinopathy (DM & HBP) neuropathy arterial bruits rheumatoid
systemic signs relating to loss of kidney function
pallor arrhythmia pericardial rub raised JVP lung creps oedema gut
general examination findings
leukonychia - hypoaluminaemia
gouty tophi
splinter haemorrhages - vasculitis, endocarditis
vascular skin rash - systemic vasculitis, acute glomerulonephritis, HSP
malar rash - SLE
what is accelerated hypertension
dBP >120mmHg - emergency! - papilloedema - end organ decompensation encephalopathy fits cardiac failure acute renal failure
blood pressure indications of kidney disease
hypotension
hypertension >140/90
accelerated hypertension - emergency
urinalysis
specific gravity - urine concentration haematuria - haemoglobin (RBC, free Hb/myoglobin) proteinuria pH (4.5-7) - distal RTA, UTI leukocyte esterase/nitrites
Urine protein quantification
24hr urine collection - normal <150mg/24hrs
urine protein/Cr ratio - 50mg/mmol (=0.5G/24hr)
asymptomatic low grade - <1g/day
heavy proteinuria - 1-3g/day
nephrotic range - >3g/day
urine microscopy
check for UTIs
urinary casts
- precipitation of mucoprotein secreted by renal tubule cells
- formation pronounced in environments favouring protein denaturation & precipitation - low urine flow, low pH
- hyaline - usually benign
- red cell - pathological, nephritic syndrome
- leukocyte - infection/inflammation
- granular - indicative of chronic disease
urinary crystals - identify cause of renal stones
- calcium oxalate
- uric acid
- phosphate
- cysteine
