clinical presentations of renal disease

Question 1

how to diagnose renal disease

Answer 1

history
examination - fluid overload, rash, pallor
blood and urine tests - urea and creatinine elevated, dipstick protein/blood
imaging - USS or CT or nuclear medicine scans (DMSA, MAG3)

Question 2

presentations of both types of renal disease

Answer 2

acute (AKI) - unwell, oliguria/anuria, disturbances of acid-base, fluid or electrolyte balance
Chronic (CKD)- asymptomatic, BP may be high, other conditions like diabetes/vascular disease

Question 3

presentation of renal disease

Answer 3

affect any age
(more common in older)
asymptomatic as sig extra capacity (>50% fall in GFR before kidney function abnormal, symptoms GFR<20, dialysis below 10)

Question 4

signs of renal disease

Answer 4

pitting oedema 
uremic frost (rare, sev)
rash 
forthy urine
uremic (yellow)
pain in kidney area

Question 5

urine tests (urinalysis)

Answer 5

blood
protein 
glucose
ketones
bilirubin
ph
nitrite
leucocytes
using strip to test

Question 6

what is nephrotic syndrome

Answer 6

generalised oedema
low serum albumin 
proteinuria
high cholesterol 
risk of clotting 
many different causes, syndrome not disease 
minimal change glomerulopathy

Question 7

what is diabetic neuropathy

Answer 7

looks well, slow progressive condition

oedema (overloaded kidneys), nausea/vomiting, tiredness/itchiness (waste builds up)

Question 8

stages of CKD

Answer 8

stage 1 - normal func >90% no symptoms
2 mild 60-89, protein in urine
3 30-59 oedema, fatigue, pain, dark foamy urine, micro albumin, food restricted Na and K
4 15-29 more sev symtoms
dialysis and more food restrictions
5 0-14 v sev symtoms, dialysis or transplant

Question 9

why does urea, creatinine and k rise in AKI

Answer 9

urea - ADH inc urea transport, diffuse into medulla
K - less GFR so none excreted
same for creatinine

Question 10

treatment of AKI secondary to gastroenteritis

Answer 10

iv fluids

costly, deadly, preventable

Question 11

what is nephritic syndrome

Answer 11

inflamed kidneys (blood and protein on dipstick, hypertension, AKI, less urine output)  
henoch-scholein purpura - vasculitis affecting skin/kidneys/bowels, often after strep throat, self limiting

Question 12

pain but no fever

Answer 12

kidney stone

Question 13

how can renal disease disease be imaged

Answer 13

USS cheap, no radiation, non invasive (size, shape and blockages)
eg autosomal dominant polycystic kidney disease
CT - detail, stones and tumours
MRI- arteries
Nuclear medicine - scars/obstruction/split function