Presentation of kidney disease Flashcards
What does painless macroscopic haematuria indicate?
IgA nephropathy
What symptoms can uraemia cause?
pericarditis; encephalopathy; neuropathy; asterixis; gastritis; N and V; itch; tiredness; loss of appetite and wt loss
What causes anaemia in kidney disease?
lack of erythropoeitin
What might a skin rash associated with kidney disease suggest?
vasculitis or connective tissue disease
What drugs can cause kidney damage?
ACEi; ARB; diuretics; NSAIDS; PPIs; IV contrast; some antibiotics
What antibiotics can cause kidney damage?
gentamicin; trimethoprim and penicillins
What are the signs seen on examination related to loss of kidney function?
pallor; arrythmia; pericardial rub; riased JVP; lung creps; oedema; gout
When might hypotension be related to kidney disease?
If have AKI and are shocked
What is the normal pattern of blood pressure associated with kindey disease?
hypertension
What is the ideal BP with kidney disease?
<130/80
What is accelerated hypertension defined as?
diastolic >120mmHg
What is seen with accelerated HT?
papilloedema; end organ deceompensation- ecephalopathy, fits, CF, acute renal filaure
What are the signs of hypertensive retinopathy?
papilloema; AV nipping; haemorrhagesl exudates; silver/copper wiring
What does red urine indicate?
bleeding from lower UT
What does coca-cola coloured urine indicate?
haematuria from the kidneys
What does specific gravity on urinalysis indicate?
urine conc.
What pH should urine be?
4.5-7
What does alkaline urine indicate?
distal renal tubular alkalsosis or UTI
What is the normal amount of protein in a 24 hour urine collection?
<150mg/24 hours
What is asymptomatic low grade proteinuria defined as?
<1G/day
What is heavy proteinuria defined as?
1-3G/day
Waht is nephrotic range of proteinuria defined as?
> 3G/day
What are the 2 types of RBCs seen on urine microscopy?
isomorphic and dysmorphic
Waht do dysmorphic RBCs indicate?
come from glomerular bleeding- have been squeezed through the basmement membraen
What are red blood cell casts associated with?
glomerulonephritis
What are the 4 types of casts?
hyaline; RBC; leucocyte; granular
When is formation of urinary casts favoured?
low urine flow and low pH
What may be seen on ECG with a patient with renal disease?
LV hypertrophy and strain- very high QRS complexes (should be 4 boxes high)
What is seen with hyperkalaemia of ECG?
generally slower and wider- peaked T waves
What is CKD stage 1?
kidney damage eg haematuria or proteinuria with normal or increased GFR (>90)
What is CKD stage 2?
kidney daamge with mild decrease in GFR- 60-89
What is CKD stage 3?
moderate decrease in GFR- 30-59
Waht is CKD stage 4?
svere decrease in GFR- 15-29
What is CKD stage 5?
kidney failure- GFR<15 or on dialysis
When is dialysis ususally began?
when GFR is between 7-10 ml/min
What is acute kidney injury?
decline in GFR over hours/days/weeks
What is oliguria defined as?
<400ml urine output per day (80kg)—5ml/kg/day
What is nephrotic syndrome defined as?
proteinuria >3 G/day; hypoalbuminaemia; oedema
What additional finding on bloods is also seen with nephrotic syndrome?
hypercholesterolaemia
Why do patients with nephrotic syndrome get hypercholesterolaemia?
lose lipoproteins so cholesterol isnt taken to liver for metabolism
What are patients with nephrotic syndrome at increased risk of?
thrombosis- loss of hte proteins that prevent clotting
What is nephritis synfrom?
AKI; oliguria; oedema/fluid retneion; hypertension; active urinary sediment
What is active urinary sediment?
RBCs; RBC and granular casts; proteinuria
