Presentation of Kidney Disease Flashcards
What are the common symptoms of kidney disease
Asymptomatic Loin pain/ urinary symptoms Haematuria Proteinuria Hypertension AI CKD Nephrotic syndrome Nephritic syndrome
What are the 8 main functions of the kidney
Excretion of nitrogenous waste (urea) Fluid balance Electrolyte balance Acid- Base balance vitamin D metabolism/ phosphate excretion Production of erythropoietin Drug excretion Barrier to loss of proteins
What is important to ask about in a systemic enquiry
Appetite and weight loss nausea and vomiting dyspepsia dyspnoea urinary symptoms joint pains and arthralgia skin rashes
What are some drugs that are important to find out about in a history
ACEI - dehydrating effect ARB - dehydrating effect NSAID gentamicin - nephrotoxic trimethoprim, penicillins PPI - allergic reaction in the kidney
What are patients at increased risk of in chronic situations
Gout
What is the ideal blood pressure to aim for
Why is hypotension also a problem
The kidneys need a certain pressure in order to work
What is accelerated hypertension
A medical emergency
What happens in accelerated hypertension
There is end organ decompensation
e.g. encephalopathy, fits, cardiac failure, acute renal failure
Papilloedema
What is seen on fundoscopy of accelerated hypertension
Flame haemorrhages and cottonwool spots - classic of papilloedema
What symptom on the fingers is often seen in patients with CKD
Gouty Tophus
What might cause splinter haemorrhages
Vasculitis or subacute infective endocarditis
What is Henoch-Schonlein Purport
A form of vasculitis that is IgA mediated
What is the classic distribution of rash in Henoch-Schonlein Purport
Extensor surfaces of the skin and the buttocks
What might give urine the appearance of blood
Myoglobin (from muscle)
What do we use to quantify proteinuria
Urine protein/ creatinine ratio
It is easier to do than a 24 hour urine collection
If RBCs are dysmorphic on urine microscopy, what does this indicate
The problem is occurring high up in the urinary tract
How do urinary casts form
By precipitation of Tamm-Horsfall mucoprotein which is secreted by renal tubule cells
When are urinary casts formation pronounced
In environments favouring protein denaturation and precipitation (low urine flow, low pH)
Why are urine microscopy crystals useful
Can help to identify the cause f renal stones and this may help to reduce the recurrence
Why are ECGs important in assessing a patient with a kidney problem
May show hyperkalaemia
Show LVH strain
What is the best overall measure of kidney function
GFR
What is an acute kidney injury
Decline in GFR (renal function) over hours/ days/ weeks
with or without oliguria
in a patient with normal or impaired baseline renal function
What is oliguria
