L1: The approach to the patient with kidney disease Flashcards
6 functions of the kidneys
- 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
end stage kidney disease=
not enough kidney function to sustain normal life
RRT=
renal replacement therapy - dialysis/ transplant
main presentation of kidney disease
asymptomatic –> incidental/ screening
normal glomerular filtration rate=
80-120 m/m
which effect of kidney disease often can lead to symptoms
endocrine dysfunction –> EPO
2 upper urinary tract symptoms
pain
haematuria
where is the pain in upper urinary tract symptoms
loin pain –> may radiate to groin/testicle
name 6 obstructive voiding symptoms
- hesitancy
- delay in initiating micturition
- weak stream
- straining to void
- incomplete emptying
- terminal dribbling
name 6 storage symptoms
- urinary frequency
- Nocturia
- urgency
- incontinence
- bladder pain
- dysuria
3 urine abnormalities
volume
colour
odour
increase in urine volume =
polyuria
decrease in urine volume=
oliguria
no urine=
anuria
3 reasons for polyuria
- post renal obstruction
- osmotic diuretic (e.g glucose in diabetes)
- early kidney disease
reason for oliguria
acute kidney injury
reasons for anuria
- severe actue kidney injury
- end stage kidney failure
- complete post renal obstruction
what colour is urine with muscle breakdown in it
browny red
cloudy urine=
excess white cells due to infection
thick urine=
pus (infected)
frothy urine=
proteins
debris in the urine= (3)
- infection
- vesico-colic fistula
- infarction of the pili in the kidney (papillary necrosis)
dipstick- leucocyte esterase =
white cells in urine= infection
dipstick- nitrites present=
bacteria
dipstick- urobilinogen =
haemolysis
dipstick- protein=
problem with glomerular basement membrane and glomerular filtre
dipstick pH high =
bacterial infection or renal tubular acidosis
dipstick blood in urine=
bleeding from urothelium or leakage through glomerular filtrate
haemolysis=
rupture/ destruction of RBCs
what changes specific gravity
dilute urine or excess ADH
dipstick- ketones=
ketoacidosis
dipstick- high bilirubin=
obstructive jaundice
dipstick- glucose =
diabetes mellitus
what is creatinine
muscle protein released into serum and filtered through kidneys
what can creatinine be used for
to estimate glomerular filtration rate (GFR)
what 2 things is creatine based GFR dependant on
muscle mass and renal function
urea=
breakdown product of protein metabolism
when does urea rise
as kidney function worsens, people with severe renal failure develop uremia
what electrolytes does the kidney control
Na and K levels in blood
how do kidneys balance water and sodium
RAAS (renin angiotensin system)
name 4 things the kidneys excrete
urea
creatinine
uric acid
phosphate
in chronic kidney disease what does retention of salts and water cause
oedema
hypertension
in chronic kidney disease what does the redistribution of salt and water cause
hypoalbuminaemia due to proteinuria
why in chronic kidney disease is salt and water retained
- because of a decreased nephron mass (so can’t filter sodium)
- increased renin release
what is secondary hypertension most often caused by
kidney disease
what is accelerated phase hypertension
kidney arteries with excess muscle and intima leaving little lumen –> acute kidney injury as no blood
what does accelerated phase hypertension lead to in the eye
grade 4 hypertensive retinopathy
2 manifestations of glomerular damage
protein loss
haematuria
2 types of haematuria
visible vs non visible
common genetic kidney disease=
autosomal dominant polycystic kidney disease
what is the age of presentation with end stage kidney disease bc of polycystic disease
bimodal:
-30-40s or 70s
what gene causes polycystic disease to cause ESKD at 30-40
APKD1
what gene causes polycystic disease to cause ESKD at 70
APKD2
