Presentation of kidney disease Flashcards
what are the possible features of kidney disease presentation
asymptomatic loin pain/ urinary symptoms haematuria (microscopicm painless macroscopic haematuria) proteinuria hypertension AKI CKD nephrotic syndrome nephritic syndrome
what do the majority of people with kidney disease present with
are asymptomatic- will be an incidental finding
what causes systemic symptoms in kidney disease
underlying disease (DM, CTD, vascular disease) or effects of loss of kidney function (uraemic, fluid retention, bone pain)
what happens when the kidney stops excreting urea
uraemia
what are the can be caused by uraemia
pericarditis, encephalopathy, neuropathy, asterixis, gastritis
what happens when the kidney stops maintaing fluid balance
fluid retention- oedema, ascites
what happens when the kidney stops maintaining electrolyte balance
hyperkalaemia- arrhythmia
what happens when the kidney stops maintaining acid- base balance
metabolic acidosis
kussmauls respiration
what happens when the kidney stops metabolising Vit d and excreting phosphate
renal bone disease (bony pain) and vascular calcification
what happens when the kidney stops producing erytropoietin
anaemia
what happens when the kidney stops excreting drugs
can get drug toxicity - digoxin, gabapentin
what happens when the kidney stops working as a barrier to loss of proteins
proteinuria and nephrotic syndrome
how might asymptomatic patient’s get diagnosed with kidney disease
dipstix (microscopic haematuria &/or protein uria) reduced eGFR on biochem screen raised BP abdo imaging screening because of family history
what local/ renal signs and symptoms might patients present with
loin/ abdo pain macroscopic haematuria UTI arterial bruits palpable kidneys
what questions should you ask in the systemic enquiry
appetite & weight loss nausea & vomiting dyspepsia dyspnoea urinary symptoms e.g. frequency, urgency, hesitancy, polyuria & nocturia joint pains & arthralgia skin rashes
how do NSAIDs affect GFR
reduce pressure within the glomerulus, reducing filtration rate
can also cause ASK by causing an allergic reaction within the kidney
what drugs should you ask about in a history (in patient with kidney disease)
ACEi, ARB, diuretics, NSAIDs, gentamicin, trimethoprim, penicillin, PPIs, radiology contrast, herbal remedies
what are the systemic signs related to an underlying disease causing kidney disease
pyrexia, skin rash, heart murmurs, consolidation, ENT, retinopathy (DM & HBP), neuropathy, arterial bruits, rheumatoid
what are the systemic signs related to an loss of kidney function
pallor, arrythmia, pericardial rub (pericarditis life threatening comp of kidney disease), rasied JVP, lung crepitations, gout
what is accelerated hypertension
medical emergency
diastolic BP > 120 mmHg
papilloedema
end organ decompensation (encephalopathy, fits, cardiac failure, acute renal failure)
what does accelerated hypertension look like on fundoscopy
papilloedema
flame haemorrhages
cotton wool spots
what nail changes in renal disease
leukonychia splinter haemorrhages (come from kidneys after infection)
is gout caused by/ causes renal disease
both
may cause renal impairment (renal stones)
or be a consequence of renal impairment
what possible skin changes in renal disease
gouty trophi vasculitis rash (vasculitis (HSP), acute glomerulonephritis) malar rash (SLE)
what causes myogloin to be in urine
e.g. a crush injury when someone has been lying in same position for ages get Rhabdomyolosis were muscles break down
what do the parameters of urinalysis tell you
specific gravity- urine concentration haematuria- haemoglobin, RBC, myoglobin proteinuria pH(4.5-7). alkaline = distal renal tubular acidosis. UTI leukocyte esterase/ nitrates= UTI
what are the levels of urine protein
asymptomatic low grade <1g/day
heavy proteinuria 1-3 g/day
nephrotic range >3 g/day
when are urinary casts formed
when low urine out put/ low pH
what causes a hyaline cast
usually benign (normal)
what causes a red cell cast
always pathological (associated with nephritic syndrome)
what causes a leucocyte cast
infection or inflammation
what causes granular cast
indicative of chronic disease
what ECG results for severe hypertension
LVH and strain
what ECG in hyperkalaemia
peaked T waves (tall tented)
what is acute kidney disease
decline in GFR over hours/ days/ weeks
can be with/without oliguria or normal/ impaired baseline renal function
what is oligouria
<400 ml urine/ day
what is nephrotic syndrome
triad of sy/si due to glomerular disease:
-proteinuria >3g/day (mostly albumins)
-hypoalbuminaemia
-oedema (everywhere but esp periorbital)
(hypercholesterolaemia- liver working overtime to produce more albumin to compensate for loss)
often have normal renal function
what is nephritic syndrome
si/sy of glomerulonephritis
- AKI
- oliguria
- oedema/ fluid retention (not as bad as nephrOtic syndrome)
- hypertension
- active urinary sediment
- RBC’s, granulae casts, proteinuria
