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Block 10 Ellen > L1: The approach to the patient with kidney disease > Flashcards

L1: The approach to the patient with kidney disease Flashcards

1
Q

6 functions of the kidneys

A
  • excretions of waste products
  • fluid and electrolyte balance
  • acid: base balance
  • control of Bp
  • EPO production
  • conversion of 25-Vit D to 1,25-Vit D
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2
Q

end stage kidney disease=

A

not enough kidney function to sustain normal life

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3
Q

RRT=

A

renal replacement therapy - dialysis/ transplant

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4
Q

main presentation of kidney disease

A

asymptomatic –> incidental/ screening

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5
Q

normal glomerular filtration rate=

A

80-120 m/m

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6
Q

which effect of kidney disease often can lead to symptoms

A

endocrine dysfunction –> EPO

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7
Q

2 upper urinary tract symptoms

A

pain

haematuria

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8
Q

where is the pain in upper urinary tract symptoms

A

loin pain –> may radiate to groin/testicle

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9
Q

name 6 obstructive voiding symptoms

A
  • hesitancy
  • delay in initiating micturition
  • weak stream
  • straining to void
  • incomplete emptying
  • terminal dribbling
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10
Q

name 6 storage symptoms

A
  • urinary frequency
  • Nocturia
  • urgency
  • incontinence
  • bladder pain
  • dysuria
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11
Q

3 urine abnormalities

A

volume
colour
odour

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12
Q

increase in urine volume =

A

polyuria

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13
Q

decrease in urine volume=

A

oliguria

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14
Q

no urine=

A

anuria

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15
Q

3 reasons for polyuria

A
  • post renal obstruction
  • osmotic diuretic (e.g glucose in diabetes)
  • early kidney disease
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16
Q

reason for oliguria

A

acute kidney injury

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17
Q

reasons for anuria

A
  • severe actue kidney injury
  • end stage kidney failure
  • complete post renal obstruction
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18
Q

what colour is urine with muscle breakdown in it

A

browny red

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19
Q

cloudy urine=

A

excess white cells due to infection

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20
Q

thick urine=

A

pus (infected)

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21
Q

frothy urine=

A

proteins

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22
Q

debris in the urine= (3)

A
  • infection
  • vesico-colic fistula
  • infarction of the pili in the kidney (papillary necrosis)
23
Q

dipstick- leucocyte esterase =

A

white cells in urine= infection

24
Q

dipstick- nitrites present=

A

bacteria

25
Q

dipstick- urobilinogen =

A

haemolysis

26
Q

dipstick- protein=

A

problem with glomerular basement membrane and glomerular filtre

27
Q

dipstick pH high =

A

bacterial infection or renal tubular acidosis

28
Q

dipstick blood in urine=

A

bleeding from urothelium or leakage through glomerular filtrate

29
Q

haemolysis=

A

rupture/ destruction of RBCs

30
Q

what changes specific gravity

A

dilute urine or excess ADH

31
Q

dipstick- ketones=

A

ketoacidosis

32
Q

dipstick- high bilirubin=

A

obstructive jaundice

33
Q

dipstick- glucose =

A

diabetes mellitus

34
Q

what is creatinine

A

muscle protein released into serum and filtered through kidneys

35
Q

what can creatinine be used for

A

to estimate glomerular filtration rate (GFR)

36
Q

what 2 things is creatine based GFR dependant on

A

muscle mass and renal function

37
Q

urea=

A

breakdown product of protein metabolism

38
Q

when does urea rise

A

as kidney function worsens, people with severe renal failure develop uremia

39
Q

what electrolytes does the kidney control

A

Na and K levels in blood

40
Q

how do kidneys balance water and sodium

A

RAAS (renin angiotensin system)

41
Q

name 4 things the kidneys excrete

A

urea
creatinine
uric acid
phosphate

42
Q

in chronic kidney disease what does retention of salts and water cause

A

oedema

hypertension

43
Q

in chronic kidney disease what does the redistribution of salt and water cause

A

hypoalbuminaemia due to proteinuria

44
Q

why in chronic kidney disease is salt and water retained

A
  • because of a decreased nephron mass (so can’t filter sodium)
  • increased renin release
45
Q

what is secondary hypertension most often caused by

A

kidney disease

46
Q

what is accelerated phase hypertension

A

kidney arteries with excess muscle and intima leaving little lumen –> acute kidney injury as no blood

47
Q

what does accelerated phase hypertension lead to in the eye

A

grade 4 hypertensive retinopathy

48
Q

2 manifestations of glomerular damage

A

protein loss

haematuria

49
Q

2 types of haematuria

A

visible vs non visible

50
Q

common genetic kidney disease=

A

autosomal dominant polycystic kidney disease

51
Q

what is the age of presentation with end stage kidney disease bc of polycystic disease

A

bimodal:

-30-40s or 70s

52
Q

what gene causes polycystic disease to cause ESKD at 30-40

A

APKD1

53
Q

what gene causes polycystic disease to cause ESKD at 70

A

APKD2

Block 10 Ellen (9 decks)

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