Investigating renal disease

Question 1

3 categories of renal disease

Answer 1

acute
chronic
acute on chronic

Question 2

4 things to consider when diagnosing kidney disease

Answer 2

• Syndromes/ Px- nephritic syndrome, AKI, CKD, haematuria, nephrotic syndrome, asymptomatic proteinuria
• Urine tests
• Blood tests
• Imaging

Question 3

3 types of intrinsic renal disease and examples

Answer 3

glomerular- glomerulonephritis

interstitial- interstitial nephritis

tubular- acute tubular necrosis

Question 4

5 pre-renal cause of renal disease

Answer 4

hypovolemia- haemorrhage, diarrhoea and vomiting
spetic shock
cardiac failure
ACEi 
NSAIDs

Question 5

2 post-renal causes of renal disease

Answer 5

hydronephrosis

hydroureter

Question 6

what 2 things can you detect in urine dip for renal disease

Answer 6

blood

proteins but only after a certain level

Question 7

what else can you do with urine in diagnosis of renal disease

Answer 7

microscopy

Question 8

what are red cell casts indicative of

Answer 8

glomerular nephritis

Question 9

what is the earliest stage of diabetic kidney disease

Answer 9

Microalbuminuria

Question 10

describe pathogenesis of diabetic nephropathy?

Answer 10

Protein and basement membrane have negative charge. In early diabetes you lose the basement membrane negative charge, proteins aren’t repelled so some proteins will fall through the membrane
Later in diabetes, the holes in the membrane get bigger

Question 11

difference between protein creatinine ratio and albumin creatinine ratio

Answer 11

• PCR: measures all the proteins

* ACR: only measures albumin

Question 12

Is PCR or ACR better for detecting early diabetic nephropathy?

Answer 12

ACR

Question 13

Why do you get hyperNa in shock?

Answer 13

• If our circulating volume is low kidney tubular cells will hold onto sodium
• In shock when there is poor blood flow to the kidneys the tubular cells die (acute tubular necrosis) and the kidneys cannot hold onto sodium anymore.
• Can test sodium in urine

Question 14

Name some common blood tests in renal disease investigation

Answer 14

•	FBC
o	Anaemia
o	Haemolytic anaemia
o	Eosinophilia
o	Thrombocytopenia 
•	Renal profile
•	Bone and liver profile
o	Corrected calcium- low in renal disease
o	PTH
o	Phosphate 
o	Albumin 
•	ANCA- marker of small vessel vasculitis
o	C-ANCA (proteinase 3 antibody)
o	P-ANCA (myeloperoxidase antibody)
•	Anti-GBM (anti glomerular basement membrane)- Goodpasteur’s syndrome 
•	ANA
o	dsDNA
•	Complement (C3&C4)
•	Cryoglobulins
•	Virology
•	Serum and urine electrophoresis- Bence Jones in myeloma
•	ASO titre or DNase- for streptococcal bacteria
•	CK

Question 15

Imaging used in renal disease diagnosis

Answer 15

US

rarely- DMSA for scarring and DTPA for split function