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Renal and Urology > PRESENTATION OF KIDNEY DISEASE > Flashcards

PRESENTATION OF KIDNEY DISEASE Flashcards

1
Q

Haematuria can be

A

microscopic (non-visible) or macroscopic (visible)

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2
Q

haematuria means

A

blood in the urine

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3
Q

proteinuria means

A

protein in the urine

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4
Q

proteinuria usually indicates that

A

significant kidney damage has occurred

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5
Q

main functions of the kidney

A
  • excretion of nitrogenous waste and drugs
  • fluid balance
  • electrolyte balance
  • acid base balance
  • vitamin D metabolism/ phosphate excretion
  • production of erythropoietin
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6
Q

inability to excrete nitrogenous waste causes

A

uraemia which causes pericarditis, encephalopathy, increased risk of infection, bleeding

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7
Q

disruption fo fluid balance can cause

A

fluid balance and oedema

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8
Q

disruption of electrolyte balance can cause

A

hyperkalaemia which can cause cardiac arrest

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9
Q

disruption of acid-base balance causes a

A

metabolic acidosis which leads to kaussmals repsiration

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10
Q

disorder of drug excretion causes

A

drug toxicity i.e. digoxin and garbapentin

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11
Q

the kidney is also a barrier to

A

the loss of proteins

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12
Q

disruption to this barrier causes

A

proteinuria causing nephrotic syndrom

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13
Q

history taking in renal disease

A
  • presenting complaint but if they are asymptomatic may have to be pick up using urinalysis or reduced eGFR or biochemical screen or incidental finding using abdominal imaging or screening because of family history
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14
Q

presenting symptoms in an underlying disease caused by

A

diabetes mellitus, connective tissue disorders, vascular disease

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15
Q

presenting symptoms relating to loss of kidney fucntion

A

uraemia, anaemia, hypocalcaemia

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16
Q

localised presenting symptoms

A

loin pain, macroscopic haemturia, fever

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17
Q

systemic enquiry

A
  • appetite and weight loss
  • nausea and vomiting
  • dyspnoea
  • urinary symptoms (urinary frequency, urgency, hesitancy, polyuria, nocturia)
  • joint paina/ skin or rashes
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18
Q

urinary frequency

A

is the need to urinate more often than normal

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19
Q

urinary urgency

A

sudden urge to urinate due to involuntary contraction of the bladder

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20
Q

polyuria

A

the excessive passage of urine at least 2.5 litres per day in adults

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21
Q

past medical history

A

kidney disease, diabetes mellitus, vascular disease, surgery, TB, rheumatological

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22
Q

family history

A

renal disease or hypertension

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23
Q

social history

A

smoking, alcohol or occupation

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24
Q

drug history

A

ace inhibitors, angiotensin receptor blockers, aldosterone antagonists

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25
Q

why are NSAIDS avoided in renal disease

A

because they can cause haemodynamically mediated acute kidney injury, electrolyte ad acid-base disorders, acute-interstial nephritis which may be accompanied by the nephrotic syndrome and papillary necrosis

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26
Q

what weird drug increases the risk of an AKI

A

proton pump inhibitors

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27
Q

what antibiotics can cause an AKI

A

gentamicin and vancomycin

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28
Q

what is used for investigations which should not be used in people with renal disease

A

radiological IV contrast

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29
Q

why is blood pressure so important in renal disease

A
  • hypotension means the kidney are not being adequately perfused therefore, they are not adequately functioning
  • hypertension is damaging to the kidneys and is the number one cause of chronic kidney disease
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30
Q

what is accelerated hypertension (malignant hypertension)

A

a medical emergency diastolic blood pressure is usually greater than 120mmHg

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31
Q

malignant hypertension will cause end organ decompensation

A

encephalopathy, cardiac failure,acute renal failure

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32
Q

leukonychia is a sign of

A

hypoalbunaemia which can be seen in nephrotic syndrome

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33
Q

causes of haematuria

A

UTIS, bladder tumour, calculi, benign prostatic hypertrophy, prostate cancer

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34
Q

infections causing haematuria

A

cystitis, tuberculosis, prostatitis, schistosomiasis

35
Q

tumours causing haematuria

A

renal carcinoma,wilms tumour (nephroblastoma), carcinoma of the bladder, prostate cancer, urethral cancer

36
Q

trauma causing haematuria

A

RTAS, catheter, foreign bodies

37
Q

inflammation causing haematuria

A

glomerulonephritis, IgA vasculitis, good pastures syndrome

38
Q

structural renal disease causing haematuria

A

calculi, simple cysts, polycystic kidney disease, congenital vascular anomalies

39
Q

haematological disease causing haematuria

A

sickle cell disease, coagulation disorders, anti-coagulation therapy

40
Q

toxins causing haematuria

A

sulfonadmides, cyclophosphamide, NSAIDS

41
Q

differential diagnosis of red or dark urine

A
  • myoglobinuria= presence of myoglobin in the urine caused by rhabdomyolysis
42
Q

rhabdomyolysis is caused

A

by the breakdown of skeletal muscle fibres and myocyte cell membranes leading the release muscle content into the circulation causing multiple complications including hyperkalaemia

43
Q

myocyte function under normal conditions is maintained

A

by adenosine-triphosphate dependant channels, which ensure effective cell ion levels and play a role in calcium flux from myocytes, damage to the mycotic membrane causes an increase in the amount of calcium in the cell which leads to apoptosis through various proteolytic enxymez, this leads to muscle necrosis and released various substances into the circulation including myoglobin, potassium, phosphate, creatinine kinaseand rate

44
Q

any myoglobin within the circualtion

A

will be filtered by the kidneys and can lead to an acute kidney injury through direct toxicity or precipitation

45
Q

causes of rhabdomyolysis

A

alcohol abuse, status epileptics, trauma, burns, crush injuries

46
Q

urinalysis gross insepction

A

gross insepction= colour and turbidity

47
Q

urinalysis urine dipstick

A

specific gravity, pH, glucose, heme, leukocyte esterase, nitrites, ketones, bilirubin, urobilingen

48
Q

urine microscopy

A

WBC’S, RBC’S, bacteria, crystals and casts

49
Q

urine colour varies with

A

states of hydration but can be influenced by medical condition, medications and food

50
Q

red urine can be caused by

A

bleeding anywhere in the renal tract, rifampicin and beetroot

51
Q

organe urine caused by

A

hyperbilirunaemia, rifampicin, excess ingestion of vitamin A or Vitamin B

52
Q

brown/ black urine caused by

A

metronidazole or nitrofurantoin

53
Q

green urine caused by

A

UTIS secondary to pseudomonas, methylene blue, amytryptyline

54
Q

purple urine caused by

A

infected urinary catheters

55
Q

white urine caused by

A

hypercalcaemia, phosphaturia, chyluria (leakage of lymphatic fluid into the urine most commonly seen in the tropics caused by a parasitic infection called phyriasis TU

56
Q

Turbidity of urine is

A

how clear or cloudy the urine is

57
Q

turbid urine may indicate

A

presence a UTI ore precipitated crystals

58
Q

specific gravity is

A

density of urine/ density of water

59
Q

specific gravity various from

A

1.01 to 1.02 depending on renal perfusion and fluid status

60
Q

specific gravity is a measure of

A

relative density although urine is mostly composed of water because it also contains electrolytes and urea it is more dense

61
Q

as a general rule

A

urine osmolality = specific gravity-35 but this is inaccurate in condition where there is significant protein or glucose in the urine because they will increase urine density out of proportion to the osmolality

62
Q

in normal patients specific gravity is around

A

1.01which implies the urine omsolairtyis the same than the omsoalirty of the serum

63
Q

if specific gravity is close to 1.001 this means

A

that the urine is more dilute than normal and implies either excessive hydration, diabetes insidious or acute tubular necrosis

64
Q

if specific gravity is close to 1.035 then this means

A

the urine is more concentrated than normal caused by dehydration, SIADH or caused by impaired perfusion seen in chronic heart failure, cirrhosis, glycosuria or proteinuria

65
Q

specific gravity fixed at1.01 is likely to indicate

A

advanced kidney failure where the kidney cannot regulate urine concentration

66
Q

when the kidneys are functioning normally

A
  • they will excrete more hydrogen ions in academia resulting in a lower pH of urine
  • they wille excrete less hydrogen ions in alkalaemia resulting in a higher pH of urine
67
Q

low pH of urine (around 5)

A

caused by academia caused by hypoventilation or from excessive production of lactation ketones

68
Q

pH around 7.8 of urine

A

caused by alkalaemia

- organisms that produces creases (proteus, klebsiella) catalyses the breakdown of urea to ammonia

69
Q

glycosuria

A

if sever can cause an osmotic diuresis

70
Q

causes of glycosuria

A

serum hyperglycaemia, proximal tubuarl dysfunction (e.g in fanconi syndrome)

71
Q

heme

A

urine dipstick for heme is highly sensitive for heme but it also detects myoglobin positive in haematuria or rhabdomyolysis

72
Q

protein in urine is most sensitive for

A

albumin: the more concentrated the urine the more sensitive the test

73
Q

leukocyte esterase and nitrites used to diagnose

A

UTIS

74
Q

what is leukocyte esterase

A

an enzyme released from white blood cells

75
Q

nitrites detect specific presence of

A

enterobactirase which convert nitrates in urine to nitrites

76
Q

leukocyte esterase

A

is only a marker for inflammation, nitrites are more specific for actual bacteria

77
Q

both leukocyte esterase and nitrites

A

can be seen in UTIS and indwelling catheters but only leukocyte esterase is seen in recent instrumentation of the GU tract, urological malignant, chronic interstitial nephritis and interstitial cystitis

78
Q

urinary cast is a

A

protein mould of the renal tubule

79
Q

red cells stuck to a renal cast

A

indicates nephritis

80
Q

white cells stuck to cast

A

are associated with infection

81
Q

nephrotic syndrome

A
  • loss of protein in the urine= protein greater than 3g/day

- causes hypoalbunaemia because albumin is lost in the urine because gaps in the podocytes allow albumin to leak

82
Q

hypoalbunaeia causes decreased what?

A

Increased intra-vascular oncotic pressure as a result fluid moves out of the intra-vascular compartment into surrounding tissues causing oedema

83
Q

due to the hypoalbunaemia

A

the liver compensates and increased albumin production however, this has the side affect of causing hyperlipideamea

84
Q

oedema can affect the

A

arms ankles and eyes

Renal and Urology (51 decks)

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