PRESENTATION OF KIDNEY DISEASE Flashcards
1
Q
Haematuria can be
A
microscopic (non-visible) or macroscopic (visible)
2
Q
haematuria means
A
blood in the urine
3
Q
proteinuria means
A
protein in the urine
4
Q
proteinuria usually indicates that
A
significant kidney damage has occurred
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
6
Q
inability to excrete nitrogenous waste causes
A
uraemia which causes pericarditis, encephalopathy, increased risk of infection, bleeding
7
Q
disruption fo fluid balance can cause
A
fluid balance and oedema
8
Q
disruption of electrolyte balance can cause
A
hyperkalaemia which can cause cardiac arrest
9
Q
disruption of acid-base balance causes a
A
metabolic acidosis which leads to kaussmals repsiration
10
Q
disorder of drug excretion causes
A
drug toxicity i.e. digoxin and garbapentin
11
Q
the kidney is also a barrier to
A
the loss of proteins
12
Q
disruption to this barrier causes
A
proteinuria causing nephrotic syndrom
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
14
Q
presenting symptoms in an underlying disease caused by
A
diabetes mellitus, connective tissue disorders, vascular disease
15
Q
presenting symptoms relating to loss of kidney fucntion
A
uraemia, anaemia, hypocalcaemia
16
Q
localised presenting symptoms
A
loin pain, macroscopic haemturia, fever
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
18
Q
urinary frequency
A
is the need to urinate more often than normal
19
Q
urinary urgency
A
sudden urge to urinate due to involuntary contraction of the bladder
20
Q
polyuria
A
the excessive passage of urine at least 2.5 litres per day in adults
21
Q
past medical history
A
kidney disease, diabetes mellitus, vascular disease, surgery, TB, rheumatological
22
Q
family history
A
renal disease or hypertension
23
Q
social history
A
smoking, alcohol or occupation
24
Q
drug history
A
ace inhibitors, angiotensin receptor blockers, aldosterone antagonists
25
why are NSAIDS avoided in renal disease
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
26
what weird drug increases the risk of an AKI
proton pump inhibitors
27
what antibiotics can cause an AKI
gentamicin and vancomycin
28
what is used for investigations which should not be used in people with renal disease
radiological IV contrast
29
why is blood pressure so important in renal disease
- 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
30
what is accelerated hypertension (malignant hypertension)
a medical emergency diastolic blood pressure is usually greater than 120mmHg
31
malignant hypertension will cause end organ decompensation
encephalopathy, cardiac failure,acute renal failure
32
leukonychia is a sign of
hypoalbunaemia which can be seen in nephrotic syndrome
33
causes of haematuria
UTIS, bladder tumour, calculi, benign prostatic hypertrophy, prostate cancer
34
infections causing haematuria
cystitis, tuberculosis, prostatitis, schistosomiasis
35
tumours causing haematuria
renal carcinoma,wilms tumour (nephroblastoma), carcinoma of the bladder, prostate cancer, urethral cancer
36
trauma causing haematuria
RTAS, catheter, foreign bodies
37
inflammation causing haematuria
glomerulonephritis, IgA vasculitis, good pastures syndrome
38
structural renal disease causing haematuria
calculi, simple cysts, polycystic kidney disease, congenital vascular anomalies
39
haematological disease causing haematuria
sickle cell disease, coagulation disorders, anti-coagulation therapy
40
toxins causing haematuria
sulfonadmides, cyclophosphamide, NSAIDS
41
differential diagnosis of red or dark urine
- myoglobinuria= presence of myoglobin in the urine caused by rhabdomyolysis
42
rhabdomyolysis is caused
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
myocyte function under normal conditions is maintained
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
any myoglobin within the circualtion
will be filtered by the kidneys and can lead to an acute kidney injury through direct toxicity or precipitation
45
causes of rhabdomyolysis
alcohol abuse, status epileptics, trauma, burns, crush injuries
46
urinalysis gross insepction
gross insepction= colour and turbidity
47
urinalysis urine dipstick
specific gravity, pH, glucose, heme, leukocyte esterase, nitrites, ketones, bilirubin, urobilingen
48
urine microscopy
WBC'S, RBC'S, bacteria, crystals and casts
49
urine colour varies with
states of hydration but can be influenced by medical condition, medications and food
50
red urine can be caused by
bleeding anywhere in the renal tract, rifampicin and beetroot
51
organe urine caused by
hyperbilirunaemia, rifampicin, excess ingestion of vitamin A or Vitamin B
52
brown/ black urine caused by
metronidazole or nitrofurantoin
53
green urine caused by
UTIS secondary to pseudomonas, methylene blue, amytryptyline
54
purple urine caused by
infected urinary catheters
55
white urine caused by
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
Turbidity of urine is
how clear or cloudy the urine is
57
turbid urine may indicate
presence a UTI ore precipitated crystals
58
specific gravity is
density of urine/ density of water
59
specific gravity various from
1.01 to 1.02 depending on renal perfusion and fluid status
60
specific gravity is a measure of
relative density although urine is mostly composed of water because it also contains electrolytes and urea it is more dense
61
as a general rule
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
in normal patients specific gravity is around
1.01which implies the urine omsolairtyis the same than the omsoalirty of the serum
63
if specific gravity is close to 1.001 this means
that the urine is more dilute than normal and implies either excessive hydration, diabetes insidious or acute tubular necrosis
64
if specific gravity is close to 1.035 then this means
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
specific gravity fixed at1.01 is likely to indicate
advanced kidney failure where the kidney cannot regulate urine concentration
66
when the kidneys are functioning normally
- 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
low pH of urine (around 5)
caused by academia caused by hypoventilation or from excessive production of lactation ketones
68
pH around 7.8 of urine
caused by alkalaemia
| - organisms that produces creases (proteus, klebsiella) catalyses the breakdown of urea to ammonia
69
glycosuria
if sever can cause an osmotic diuresis
70
causes of glycosuria
serum hyperglycaemia, proximal tubuarl dysfunction (e.g in fanconi syndrome)
71
heme
urine dipstick for heme is highly sensitive for heme but it also detects myoglobin positive in haematuria or rhabdomyolysis
72
protein in urine is most sensitive for
albumin: the more concentrated the urine the more sensitive the test
73
leukocyte esterase and nitrites used to diagnose
UTIS
74
what is leukocyte esterase
an enzyme released from white blood cells
75
nitrites detect specific presence of
enterobactirase which convert nitrates in urine to nitrites
76
leukocyte esterase
is only a marker for inflammation, nitrites are more specific for actual bacteria
77
both leukocyte esterase and nitrites
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
urinary cast is a
protein mould of the renal tubule
79
red cells stuck to a renal cast
indicates nephritis
80
white cells stuck to cast
are associated with infection
81
nephrotic syndrome
- 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
hypoalbunaeia causes decreased what?
Increased intra-vascular oncotic pressure as a result fluid moves out of the intra-vascular compartment into surrounding tissues causing oedema
83
due to the hypoalbunaemia
the liver compensates and increased albumin production however, this has the side affect of causing hyperlipideamea
84
oedema can affect the
arms ankles and eyes
