Clinical Presentation Of Kidney Disease Flashcards
Define tubular proteinuria
Low molecular weight proteins which are normally filtered and then reabsorbed by the PCT, but remain in the tubule due to tubulointerstitial disease that impair function
Increased excretion of these smaller proteins
Define glomerular proteinuria
Increase in permeability of glomerulus to proteins - get abnormal filtration and excretion of proteins
Define overflow proteinuria
Increased production of smaller proteins leads to rate of filtration exceeding Tm for reabsorption in PCT.
(Usually occurs with overproduction of monoclonal immunoglobulin light chains in multiple myeloma and plasma cell dyscrasias)
What can cause haematuria?
UTIS Polycystic kidneys Renal stones Renal/bladder tumours Arteriovenous malformations Kidney/glomerular disease
Which patients require a cystoscopy of they have haematuria?
Over 45yrs
If you have haematuria as well as proteinuria and/or hypotension, what are you more likely to have?
Glomerular disease
Causes of red/brown urine? (Macroscopic haematuria)
Glomerular disease
Haemoglobulinuria
Myoglobulinuria
Consumption of food dyes eg beetroot
Investigations if there is haematuria?
FBC (infection, chronic blood loss)
U&Es (renal function)
Midstream urine specimen (MSU - check for infection and parasites)
Cystoscopy if bladder cause is suspected
Autoimmune scan for glomerulonephritis
CT scan/ultrasound if renal cause is suspected
What is nephrotic syndrome?
A non-specific disorder where podocytes are damaged, leaking a large amount of protein into the urine
What are the findings of nephrotic syndrome?
Classical triad
- proteinuria (>3.5g/24hrs)
- hypoalbuminaemia
- oedema (low protein in blood)
Plus
- hyperlipidaemia
- Muehrcke’s bands
How is nephrotic syndrome diagnosed?
Renal biopsy - needle guided by ultrasound
Aimed at bottom of the kidney to ensure cortex is biopsied
Causes of nephrotic syndrome?
Minimal change disease/glomerulonephritis Focal segmenting glomerulosclerosis (scarring) Membranous glomerulonephritis (autoimmune destruction of basement membrane)
What is nephritic syndrome?
A collection of signs associated with disorders affecting the kidneys (specifically glomerular disorders)
Characterised by having pores in the podocytes large enough to permit proteins and RBCs
What is the main difference between nephrotic and nephritic syndrome?
Nephritic has haematuria
Clinical presentation of nephritic syndrome?
Rapid onset Oliguria Hypertension Generalised oedema Haematuria with smoky brown urine Normal serum albumin Variable renal impairment Urine contains blood protein and red cell casts
