Kidney Disease Presentation

Question 1

What are the main symptoms which present in kidney disease?

Answer 1

Loin pain
Haematuria
Proteinuria
Hypertension

Question 2

Kidney disease can present as completely asymptomatic. TRUE/FALSE?

Answer 2

TRUE

often an incidental finding

Question 3

How does uraemia usually manifest?

Answer 3

pericarditis
encepalopathy
neuropathy
asterixis (bird flap tremor)
gastritis

Question 4

Electrolyte balance and hyperkalaemia are known to cause what?

Answer 4

Cardiac arrhythmia

Question 5

Why does kidney disease present with anaemia?

Answer 5

Kidneys are struggling to produce erythropoeitin
=> this means less red blood cells are produced
=> anaemia

Question 6

What symptoms of kidney disease can cause patients to be breathless?

Answer 6

Acidosis
fluid overload (=> pulmonary oedema)
anaemia

Question 7

What specific urinary symptoms should the patient be asked about in a systemic enquiry?

Answer 7

frequency
urgency
hesitancy
polyuria and nocturia

Question 8

What factors must you look out for in a patients past medical history if you suspect kidney disease?

Answer 8

Previous kidney disease
Diabetes Mellitus
Vascular / Rheumatological disease
Surgery
TB

Question 9

What drugs should you be aware of in a history for the possibility of them causing renal disease?

Answer 9

ACE-i/ARB, 
Diuretics 
NSAIDs
Antibiotics: gentamicin, trimethoprim, penicillins
PPIs

Question 10

If a patient has recently been for imaging, what could have caused their kidney disease?

Answer 10

Contrast used for scans

Question 11

What is meant by accelerated hypertension?

Answer 11

• diastolic BP >120 mmHg
• papilloedema
• end-organ decompensation
• encephalopathy/ fits, cardiac/renal failure

Question 12

What visible signs can indicate underlying kidney pathology?

Answer 12

Leukonychia
Gouty Tophi
Splinter haemorrhages
Vasculitic Rash (e.g. HSP)
Malar Rash (Lupus)

Question 13

What would cause the urine to appear a dark red/brown colour?

Answer 13

Myoglobin released into urine from muscle death in Rhabdomyolosis

Question 14

What level of protein in the urine is considered as nephrotic?

Answer 14

> 3g a day

Question 15

What are urinary casts?

Answer 15

• Microscopic cylindrical structures
• Produced by the kidney
• Present in the urine in certain diseases
• Form via precipitation of Tamm–Horsfall mucoprotein - - secreted by renal tubule cells

Question 16

What urinary cast would indicate infection/inflammation?

Answer 16

Leukocyte

Question 17

What type of urinary cast indicates nephritic syndrome?

Answer 17

Red cells

Question 18

Granular urinary casts indicate what type of process?

Answer 18

Chronic disease

Question 19

Hyperkalaemia causes what main ECG change?

Answer 19

Peaked T waves

Question 20

What is acute kidney injury?

Answer 20

• Decline in GFR

- with or without oliguria

Question 21

What are the components of nephrotic syndrome?

Answer 21

• Proteinuria >3 g/day
• Hypoalbuminaemia
• Oedema (periorbital, limbs and hands)

Question 22

What are the components of nephritic syndrome?

Answer 22

• AKI
• Oliguria
• Oedema/ Fluid retention (not to the extent of nephrOtic)
• Hypertension