Lecture 2 - renal disease Flashcards
Presentation of renal disease
Fatigue - due to N + V and weight loss Dry itchy skin - pruritis Trouble sleeping Nocturia Muscle cramps Haematuria Poor appetite and weight loss Foamy urine Pitting oedema Nausea Vomiting Dry cough Anaemia
Examinations
Urine analysis - blood and protein General appearance USS BP - high Pulses - bruits Heart examination - ECG and S3 sound (congestive heart failure) Abdominal examination
Signs of renal disease
Hypertension Hyperkalaemia Cardiac arrythmias - high pottasium (ECG) Low bicarb - metabolic acidosis High creatinine Tachypnea - compensate for metabolic acidosis Tachycardia - caused by acidosis Petechia Pitting oedema - fluid retention Musculoskeletal pain
Hyperkalaemia on ECG
Tall T waves - early sign
Flattening of P waves
Prolongation of QRS
Sine wave - late
Treatment of renal disease
Fluid and salt restricted diet
Renal transplant
Dry cough
Pulmonary oedema
Uraemia
Urea in blood
- N + V
- malaise - due to increased toxins
- itchy skin (pruritis)
Hypertension
Decreased renin production and release - decreased RAAS activity
Musculoskeletal pain
Mineral bone disease as more phosphate retained and less calcium is absorbed due to decreased vit D
Therefore increased activity of PTH and bone reabsorption
Nephrotoxic drugs
Vancomycin
NSAIDs
Neurofen
Normal K+ conc in blood
3.5 - 5.3 mmol/L
In a person with healthy kidneys this conc is retained regardless of large K+ ingested
Erythropoietin
Peptide hormone
Made by interstitial peritubular cells
Produced by kidney in response to hypoxia
Cytochrome P450 enzyme (vit D hydroxylase)
Produced by proximal tubule cells
Activates vit D (calcitriol)
Renin
Produced by granular cells
BP regulation
Treatment of vit D deficiency
D3 calcitriol supplements
NEVER give calcium and phosphate as would overload
