Lec 2 - Renal disease symptoms and signs Flashcards
What is Acute kidney disease ?
AKI = abrupt drop in renal function.
- — There is a reversible build up of nitrogen waste products.
- may last hours to days.
- may get increased electrolytes such as increased potassium ion concentration, leading to arrhythmia and palpatations.
- If untreated may become CKD.
What is Chronic kidney disease?
CKD = gradual drop in renal function.
- It is irreversible.
- may last months to years.
What are the three different causes of AKI?
- pre-renal - everything before we get to the kidney.
- intra-renal - affects the kidney itself.
- post-renal
Describe the pre-renal causes?
causes hypovolaemia by:
- dehydration
- haemorrhage
- Burns
- diarrhoea and vomiting.
Decreased cardiac output by:
- Heart failure
- Myocardial infarction – less blood flow to kidneys.
Decreased PVR by:
- Anaphylaxis
- Septic shock
Describe the Intra-renal causes
Nephrotoxic injury caused by:
- drugs
- contrast
- Rhabdomyolysis - this is the breakdown of muscle and protein kinase into the bloodstream.
interstitial nephritis
Acute glomerulonephritis
Describe the post- renal causes.
- Benign prostatic hypertrophy (BPH) — this is when the prostate becomes enlarged, presses on the ureter and bladder, stopping the filtration process = build up of toxins,
- Bladder Cancer
- Renal calculi
What are the causes of CKD?
- diabetes
- high blood pressure
- heart problems or stroke
- obesity
- family history
- tobacco use
- 60+ years old
What is uraemia?
The build up of nitrogen waste products
What does uraemia do?
It impairs host defences, particularly leukocytes.
- leads to defect in platelet function, resulting in a bleeding tendency, which may contribute to haemorrhage.
What are the symptoms of uraemia?
- nausea
- vomiting
- fatigue
- anorexia
- weight loss
- muscles cramps
- pruritis (itching)
- mental state changes
What would you check for during history taking?
- dark coloured urine
- swelling
- rash
- fever
- arthritis
- Past medical history - hypertension
- Family history
- Medications
- Exposure to contrast
What would you check for on examination?
- Volume depletion, such as skin tutor loss and tachycardia.
- Body weight changes
- Bleeding
- Volume overload –> jugular vein distension, basal crepitations and oedema
- Rash
- Ballotable kidneys (rare)–> need to examine the kidneys.
What investigations would be used?
- urine dip
- blood tests (U&E, eGFR)
- Imaging - USS, CT
What may cause dipstick inaccuracies?
- extreme exercise can cause proteinuria and haematuria for up to 72 hours.
- Menstruation
- Indwellina catheters as these always have infection.
What are the non-glomerular causes of proteinuria?
- UTI
- Inflammation
- Kidney tubule damage (CKD, AKI)
- Bence Jones Protein
- Myoglobin and Haemoglobin
