Clinical presentation of renal disease Flashcards
How to diagnose renal disease?
- History
- Examination
- Fluid overload
- Pallor
- Rash
- Blood and Urine tests
- Urea and creatinine elevated
- Dipstick protein/blood
- Imaging
- USS renal tract or CT Kidneys Ureter Bladder or nuclear medicine scans (DMSA and MAG3)
What is acute renal disease?
- Acutely ( called Acute Kidney Injury or AKI)
- Patient unwell
- Oliguria/anuria (passing less urine than normal/ no urine)
- Disturbances of acid base balance or electrolytes or fluid balance
What is chronic kidney disease?
- Patient often asymptomatic
- BP might be high
- Often have other conditions like diabetes or vascular disease
Which patients are more likely to have renal disease?
- Renal disease can affect all age groups
- More common as get older
What is the common presentation of renal disease?
- Patients might be asymptomatic for a long time as there is significant extra capacity
- >50% fall in GFR before kidney function tests become abnormal
- Symptoms only really start when GFR<20 (normal is GFR 120 and GFR 10 is when you need to start dialysis)
- History: 25 year old man usually fit and well, works at local gym as PT.
- Sudden onset leg swelling over 1 week getting worse and now up to mid thighs
- Bit tired…interfering with training
- Doesn’t take any medications and hasn’t tried anything for this.
- Noticed his urine has become frothy like there is a head of beer in the toilet
Nephrotic syndrome
Minimal change glomerulopathy
What are the causes of nephrotic syndrome?
•Nephrotic syndrome
–Generalised oedema
–Low serum albumin
–Proteinuria
–(high cholesterol)
(Risk of clotting)
What is minimal change glomerulopathy?
Presentation 2= diabetic nephropathy
What are the late-stage symptoms of diabetic neuropathy?
Swelling legs (fluid overload-kidneys cant get rid)
Nausea/vomiting (waste products build up)
Tiredness/itching (waste products build up)
What are the stages of chronic kidney disease?
What blood results are expected?
- Exam: dehydrated, low blood pressure, fast heart rate (=significant dehydration)
- Blood tests:
- Sodium 151 (high….likely dehydrated)
- Potassium 6.8 (v. high…needs urgent treatment as life threatening)
- Urea 31 (very high…AKI and dehydrated)
- Creatinine 650 (very high)
- Creatinine 3 weeks ago at GP 80 (normal)
- Sodium 151 (high)
- Potassium 6.8 (v. high)
- Urea 31 (very high)
- Creatinine 650 (very high)
- Creatinine 3 weeks ago at GP 80 (normal)
Presentation 3 =Acute kidney injury secondary to gastroenteritis
________ emergency admissions to hospital will have AKI”
”AKI is _____ times more deadly than MRSA infection”
”Around _____ per cent of AKI cases are preventable”
One in five emergency admissions to hospital will have AKI”
”AKI is 100 times more deadly than MRSA infection”
”Around 20 per cent of AKI cases are preventable”
What is nephritic syndrome?
- Inflamed kidneys
- Blood and protein on dipstick
- Hypertension
- AKI
- Reduced urine output
Presentation 5=obstruction due to stone
Whats the diagnosis?
Autosomal dominant polycystic kidney disease
