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5TH YR- CMS2- Kidneys and Liver > Clinical presentation of renal failure and investigations > Flashcards

Clinical presentation of renal failure and investigations Flashcards

1
Q

How can renal dysfunction present

A
  1. Asymptomatic
  2. Proteinuria
  3. Nephritic syndrome
  4. Nephrotic syndrome
  5. Acute kidney injury (AKI)
  6. Acute tubular necrosis
  7. Microscopic haematuria
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2
Q

How do we assess a patients URINE

A

By using a urine dipstick

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3
Q

What does a urine dipstick examination show

A

Urine pH
Blood
Proteins
Glucose
Ketones
Bilirubin
Urobilinogen

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4
Q

In whom is a urine dipstick examination more frequently done

A

Pts at high risk of renal disease eg hypertensive or diabetics
Urine dipstick examination carried our annually

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5
Q

Other than renal function what else can urinary dipsticks assess

A

Screen for leukocytes and nitrites, suggestive of urinary tract infection

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6
Q

What might the detection of blood on a urine dipstick examination suffuse

A

Blood loss from the urinary tract secondary to urinary tract infection and bladder inflammation, renal stones or cancer etc

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7
Q

What might abnormal amounts of protein on a urine dipstick examination suggest

A

Damage and leakage at the glomerular filtration barrier with increased amounts of high molecular weight proteins overwhelming the tubular capacity for reabsorption

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8
Q

What does nephritic syndrome comprise of

A
  1. Oliguria
  2. Smokey or coca cola coloured urine due to haematuria
  3. Oedema
  4. Hypertension due to salt and water retention
  5. Acute renal dysfunction
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9
Q

What can the clinical presentation nephritic syndrome suggest

A

A variety of underlying renal pathologies causing disruption of the glomerular filtration barrier

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10
Q

What is nephritic syndrome due to usually

A

Immune mediate inflammation and glomerulonephritis

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11
Q

What can nephritic syndrome look like on a urine dipstick exam

A

Significant haematuria and proteinuria

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12
Q

What does nephrotic syndrome comprise of

A
  1. Significant proteinuria
  2. hypoalbuminaemia, which results in oedema
  3. hyperlipidaemia
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13
Q

What can the clinical presentation nephrotic syndrome suggest

A

Several underlying pathological processed with protein leakage at the glomerular filtration barrier

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14
Q

What can nephrotic syndrome look like on a urine dipstick exam

A

Exaggerated proteinuria

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15
Q

What was acute kidney injury previously referred to as

A

Acute renal failure

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16
Q

What is acute kidney injury (AKI)

A

Renal dysfunction occurring over hours to weeks

17
Q

In whom is acute kidney injury commonly seen in

A

Critically ill patients

18
Q

What is acute kidney injury associated with

A

Increased morbidity and mortality

19
Q

What can acute kidney injury be mistaken for

A

Chronic kidney disease

20
Q

Why is it vital to distinguish between acute kidney injury and chronic kidney disease

A

As acute kidney injury is reversible and treatable depending on the underlying cause

21
Q

What can acute kidney injury be caused by

A
  1. Pre renal causes such as impaired kidney perfusion
  2. Renal causes
  3. Post renal causes such as obstruction of outflow
22
Q

What are most acute intrinsic acute kidney injuries caused by

A

Hypotension or nephrotoxins and this is associated with acute tubular necrosis

23
Q

How can hypotension lead to acute tubular necrosis

A

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)

24
Q

Can acute tubular necrosis be cured

A

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.

25
Q

What is reduced renal perfusion caused by

A

Circulating volume depletion such as:
1. Blood loss
2. Gut losses from diarrhoea or vomitting
3. cutaneous losses from burns)

OR

Reduction in effective volume due to:
1. pump failure with acute myocardial injury
2. Volume redistribution eg in shock

26
Q

Which part fo the nephron can be affected that can cause infrarenal acute renal dysfucntion

A
  1. Blood vessels – vasculitis, thromboembolic disease and scleroderma
  2. Glomerular disease
  3. Tubular and interstitial disease.
27
Q

If one kidney is affected does notifiable renal dysfunction occur

A

not really as the working kidney can compensate

28
Q

What is chronic renal disease (CKD)

A

Renal dysfunction occurring over many months or years
Most likler progressive and irreversible

29
Q

What can reduced erythropoietin cause

A

Can contribute to a normochromic normocytic anaemia

30
Q

What is normochromic normocytic anaemia also referred to as in renal dysfunction

A

anaemia of chronic kidney disease (as long as other causes of anaemia have been excluded)

31
Q

How can anaemia of CKD (normochromic normocytic anaemia) be treated

A

With iron supplements and erythropoietin if haemoglobin’s less than 11g/ dl

32
Q

List some relative symptoms that we should look out for when investigating renal dysfunction

A
  1. Fatigue
  2. Anorexia
  3. Weight loss
  4. Oedema
  5. Heart failure
  6. Haematuria
  7. Reduced volume of urine
33
Q

A history of what conditions should we be aware of when investigating renal dysfunction

A
  1. Hypertension
  2. Diabetes
  3. Connective tissue disorders
34
Q

Give examples of nephrotoxic drugs

A
  1. Antibiotics
  2. Medicines that may cause interstitial nephritis
  3. NSAIDs
  4. ACE inhibitors
35
Q

Give examples fo physical signs you may see when investigating Renal dysfunction

A
  1. Pallor due to anaemia
  2. Vasculitic rash
  3. Oedema
  4. Abdominal masses
  5. Palpable bladder
  6. Presence of peripheral pulses
  7. Vascular bruits
36
Q

What does the initial investigation of renal dysfunction include

A
  1. Full blood count
  2. Urea and electrolytes
  3. Liver function
  4. Bone chemistry
  5. Markers of inflammation such as ESR and CRP
37
Q

How can we image the kidneys

A
  1. Ultrasound scan
  2. Doppler ultrasound scanning
  3. Intravenous urogram
  4. Plain abdominal x ray
  5. CT scan (preferred method)
  6. Magnetic resonance imaging (MRI)
  7. Intra arterial angiogram
  8. Isotope renogrpahy

5TH YR- CMS2- Kidneys and Liver (6 decks)

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