Clinical presentation of renal failure and investigations Flashcards
How can renal dysfunction present
- Asymptomatic
- Proteinuria
- Nephritic syndrome
- Nephrotic syndrome
- Acute kidney injury (AKI)
- Acute tubular necrosis
- Microscopic haematuria
How do we assess a patients URINE
By using a urine dipstick
What does a urine dipstick examination show
Urine pH
Blood
Proteins
Glucose
Ketones
Bilirubin
Urobilinogen
In whom is a urine dipstick examination more frequently done
Pts at high risk of renal disease eg hypertensive or diabetics
Urine dipstick examination carried our annually
Other than renal function what else can urinary dipsticks assess
Screen for leukocytes and nitrites, suggestive of urinary tract infection
What might the detection of blood on a urine dipstick examination suffuse
Blood loss from the urinary tract secondary to urinary tract infection and bladder inflammation, renal stones or cancer etc
What might abnormal amounts of protein on a urine dipstick examination suggest
Damage and leakage at the glomerular filtration barrier with increased amounts of high molecular weight proteins overwhelming the tubular capacity for reabsorption
What does nephritic syndrome comprise of
- Oliguria
- Smokey or coca cola coloured urine due to haematuria
- Oedema
- Hypertension due to salt and water retention
- Acute renal dysfunction
What can the clinical presentation nephritic syndrome suggest
A variety of underlying renal pathologies causing disruption of the glomerular filtration barrier
What is nephritic syndrome due to usually
Immune mediate inflammation and glomerulonephritis
What can nephritic syndrome look like on a urine dipstick exam
Significant haematuria and proteinuria
What does nephrotic syndrome comprise of
- Significant proteinuria
- hypoalbuminaemia, which results in oedema
- hyperlipidaemia
What can the clinical presentation nephrotic syndrome suggest
Several underlying pathological processed with protein leakage at the glomerular filtration barrier
What can nephrotic syndrome look like on a urine dipstick exam
Exaggerated proteinuria
What was acute kidney injury previously referred to as
Acute renal failure
What is acute kidney injury (AKI)
Renal dysfunction occurring over hours to weeks
In whom is acute kidney injury commonly seen in
Critically ill patients
What is acute kidney injury associated with
Increased morbidity and mortality
What can acute kidney injury be mistaken for
Chronic kidney disease
Why is it vital to distinguish between acute kidney injury and chronic kidney disease
As acute kidney injury is reversible and treatable depending on the underlying cause
What can acute kidney injury be caused by
- Pre renal causes such as impaired kidney perfusion
- Renal causes
- Post renal causes such as obstruction of outflow
What are most acute intrinsic acute kidney injuries caused by
Hypotension or nephrotoxins and this is associated with acute tubular necrosis
How can hypotension lead to acute tubular necrosis
Prolonged hypertension can result in renal hypo perfusion which results in damage and necrosis of the epithelial cells lining the renal tubules
These damaged tubular cells slugs into the tubular lumen leaving denuded basement membrane (ATN)
Can acute tubular necrosis be cured
yes however even if renal perfusion is restored the injured tubular cells need to regenerate before GFR will return to normal, and this may take many days or even several weeks.
