clinical presentations of renal disease Flashcards
how to diagnose renal disease
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)
presentations of both types of renal disease
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
presentation of renal disease
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)
signs of renal disease
pitting oedema uremic frost (rare, sev) rash forthy urine uremic (yellow) pain in kidney area
urine tests (urinalysis)
blood protein glucose ketones bilirubin ph nitrite leucocytes using strip to test
what is nephrotic syndrome
generalised oedema low serum albumin proteinuria high cholesterol risk of clotting many different causes, syndrome not disease minimal change glomerulopathy
what is diabetic neuropathy
looks well, slow progressive condition
oedema (overloaded kidneys), nausea/vomiting, tiredness/itchiness (waste builds up)
stages of CKD
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
why does urea, creatinine and k rise in AKI
urea - ADH inc urea transport, diffuse into medulla
K - less GFR so none excreted
same for creatinine
treatment of AKI secondary to gastroenteritis
iv fluids
costly, deadly, preventable
what is nephritic syndrome
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
pain but no fever
kidney stone
how can renal disease disease be imaged
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