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SM Renal > Presentation of Kidney Disease > Flashcards

Presentation of Kidney Disease Flashcards

1
Q

What are the common symptoms of kidney disease

A 
Asymptomatic 
Loin pain/ urinary symptoms 
Haematuria 
Proteinuria 
Hypertension 
AI 
CKD 
Nephrotic syndrome 
Nephritic syndrome
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2
Q

What are the 8 main functions of the kidney

A 
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
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3
Q

What is important to ask about in a systemic enquiry

A 
Appetite and weight loss 
nausea and vomiting
dyspepsia 
dyspnoea 
urinary symptoms 
joint pains and arthralgia 
skin rashes
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4
Q

What are some drugs that are important to find out about in a history

A 
ACEI - dehydrating effect 
ARB - dehydrating effect 
NSAID 
gentamicin - nephrotoxic 
trimethoprim, penicillins 
PPI - allergic reaction in the kidney
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5
Q

What are patients at increased risk of in chronic situations

A

Gout

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6
Q

What is the ideal blood pressure to aim for

A
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7
Q

Why is hypotension also a problem

A

The kidneys need a certain pressure in order to work

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8
Q

What is accelerated hypertension

A

A medical emergency

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9
Q

What happens in accelerated hypertension

A

There is end organ decompensation
e.g. encephalopathy, fits, cardiac failure, acute renal failure
Papilloedema

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10
Q

What is seen on fundoscopy of accelerated hypertension

A

Flame haemorrhages and cottonwool spots - classic of papilloedema

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11
Q

What symptom on the fingers is often seen in patients with CKD

A

Gouty Tophus

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12
Q

What might cause splinter haemorrhages

A

Vasculitis or subacute infective endocarditis

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13
Q

What is Henoch-Schonlein Purport

A

A form of vasculitis that is IgA mediated

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14
Q

What is the classic distribution of rash in Henoch-Schonlein Purport

A

Extensor surfaces of the skin and the buttocks

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15
Q

What might give urine the appearance of blood

A

Myoglobin (from muscle)

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16
Q

What do we use to quantify proteinuria

A

Urine protein/ creatinine ratio

It is easier to do than a 24 hour urine collection

17
Q

If RBCs are dysmorphic on urine microscopy, what does this indicate

A

The problem is occurring high up in the urinary tract

18
Q

How do urinary casts form

A

By precipitation of Tamm-Horsfall mucoprotein which is secreted by renal tubule cells

19
Q

When are urinary casts formation pronounced

A

In environments favouring protein denaturation and precipitation (low urine flow, low pH)

20
Q

Why are urine microscopy crystals useful

A

Can help to identify the cause f renal stones and this may help to reduce the recurrence

21
Q

Why are ECGs important in assessing a patient with a kidney problem

A

May show hyperkalaemia

Show LVH strain

22
Q

What is the best overall measure of kidney function

A

GFR

23
Q

What is an acute kidney injury

A

Decline in GFR (renal function) over hours/ days/ weeks
with or without oliguria
in a patient with normal or impaired baseline renal function

24
Q

What is oliguria

A
25
Q

What might happen if a patient with CKD presents with AKI

A

They may not recover and may end up on long term dialysis

26
Q

What is nephrotic syndrome

A

Characterised by proteinuria >3g/day
Hypoalbuminaemia
Oedema

27
Q

What must you have to be nephrotic

A

Sufficient protein loss to drop albumin and become oedematous with that

28
Q

What is nephrotic syndrome associated with

A

Hypercholesterolaemia though to be due to liver output trying to churn out albumin output to keep up with the losses

29
Q

What are the 3 key features of nephrotic syndrome

A

Oedema (periorbital)
proteinuria
Hypoalbuminaemia

30
Q

Why does periorbital oedema occur in nephrotic syndrome but not in pulmonary oedema

A

Patients with pulmonary oedema can’t lie flat. Nephrotic syndrome patients can and so all the fluid goes to their eyes. The fluid shifts throughout the day.

31
Q

Why do patients with nephrotic syndrome not get pulmonary oedema

A

Because the intra-alveolar pressure in the lungs is low even though you have lost oncotic pressure.

32
Q

What other problems do patients with nephrotic syndrome get

A

Ascites and pleural effusions

33
Q

What is nephritic syndrome

A 
Acute kidney injury 
Oliguria 
Oedema / fluid retention 
Hypertension
Active urinary sediment
34
Q

If we did a urine microscopy on a patient with nephritic syndrome, what would we see

A

RBCs, RBC and granular casts, proteinuria

35
Q

When might a patient develop nephritic syndrome

A

Following a strep throat infection and develop AKI after

SM Renal (23 decks)

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