Presentation of kidney disease

Question 1

Presentation of Kidney disease (11)

Answer 1

asymptomatic (incidental finding)
Loin pain (pkd)
urinary symptoms
Haematuria (microscopic or macroscopic)
Proteinuria (frothy)
Hypertension (asymptomatic or accelerated/malignant)
AKI
CKD
Nephrotic syndrome
Nephritic syndrome
\+ systemic disease

Question 2

Describe the result of the breakdown of the flowing kidney functions:

• Urea excretion
• Fluid balance
• Electrolyte balance
• Acid-base balance
• Vit D metabolism/phosphate excretion
• Production of Erytropoitin
• drug excretion
• Barrier to loss of proteins

Answer 2

• Uraemia (pericarditis/encepalopathy/ neuropathy/ asterixis/ gastritis)
• Fluid retention & oedema
• Hyperkalaemia & arrythmia
• Metabolic Acidosis & Kussmaul’s Respiration

-Renal Bone Disease & Vascular
Calcification

• Anaemia
• Drug toxicity e.g. digoxin, gabapentin
• Proteinuria & Nephrotic Syndrome

Question 3

Systemic diseases that can present as renal impairment? (3)

Answer 3

DM
connective tissue disorder
Vascular disease

Question 4

systemic enquiry in Renal impairment? (6)

Answer 4

appetite &weight loss
nausea & vomiting
dyspepsia
dyspnoea
urinary symptoms (e.g. frequency, urgency, hesitancy, polyuria & nocturia)
joint pains & arthralgia
skin rashes

Question 5

Important aspects of history in renal disease?

• PMH (6)
• Fam hx (2)
• Social hx (4)
• Drug hx (6)

Answer 5

• kidney disease, DM, vascular disease, surgery, TB, rheumatological
• renal disease, hypertension
• smoking, alcohol, occupation, carers

-ACE-I, ARB, diuretics 
NSAIDS 
Antibiotics (gentamicin, trimethoprim, penicillins)
Proton pump inhibitors
Radiology contrast
Over the counter/herbal remedies

Question 6

Systemic signs of reduced kidney function? (8)

Answer 6

pallor, 
arrythmia, 
pericardial rub, 
raised JVP, 
lung creps, 
oedema, 
gout

Question 7

renal signs of reduced kidney function? (3)

Answer 7

tenderness loins or upper abdomen,
arterial bruits,
palpable kidneys

Question 8

Investigation in kidney disease?

Answer 8

-BP

Question 9

Features of malignant Hypertension (8)

Answer 9

-Diastolic BP > 120mmHg
papilloedema
End organ decompensation
+ encephalopathy, fits, cardiac failure, acute renal failure

Question 10

Signs on examination of kidney disease? (5)

Answer 10

• leukonychia (hypoalbuminaemia)
• Gouty Tophus in CKD
• Splinter haemorrhages (raised creatinine, hypertensive, proteinuria)
• Vasculitic skin rash (systemic vasculitis or Acute glomerulonephritis)
• Malor rash

Question 11

Proteinuria quantification?

Answer 11

Asymptomatic Low Grade (3 G/Day)
Heavy Proteinuria (1 - 3 G/Day)
Nephrotic Range (>3 G/Day)

Question 12

Describe ECG in patient with severe hypertension (3)

Answer 12

Marked LVH
depression of ST segment
T wave inversion in the lateral leads

Question 13

Describe ECG in hyperkalaemia (2)

Answer 13

Peaked T waves

QRS widens

Question 14

Define acute kidney injury?

Answer 14

Decline in GFR over hours/days/weeks

with or without oliguria

Question 15

Nephrotic Syndrome

• what is it?
• presentation? (7)

Answer 15

-No inflammatory component,
Proteinuria > 3g/day
Hypoalbuminaemia
Oedema
often have normal renal function

-Peri-orbital oedema
peripheral oedema, progresses to whole body
Tiredness
leukonychia
Breathlessness
Dyslipidaemia
Hypercoagulability may manifest as venous or arterial thrombosis

Question 16

Nephritic syndrome

• what is it?
• presentation? (6)
• causes (11)

Answer 16

-acute kidney injury, patient has nephritis

-Oliguria
Oedema/ Fluid retention
Hypertension
haematuria,  
proteinuria,
Uraemic symptoms

-Post infection with group A strep
any other causes of glomerulonephritis (other infection, SLE, vasculitis, Goodpasture’s syndrome, Wegener’s granulomatosis, Berger’s disease, Guillain-Barré syndrome)