Presentation of kidney disease

Question 1

what are the possible features of kidney disease presentation

Answer 1

asymptomatic 
loin pain/ urinary symptoms 
haematuria (microscopicm painless macroscopic haematuria) 
proteinuria
hypertension 
AKI
CKD
nephrotic syndrome 
nephritic syndrome

Question 2

what do the majority of people with kidney disease present with

Answer 2

are asymptomatic- will be an incidental finding

Question 3

what causes systemic symptoms in kidney disease

Answer 3

underlying disease (DM, CTD, vascular disease)
or effects of loss of kidney function (uraemic, fluid retention, bone pain)

Question 4

what happens when the kidney stops excreting urea

Answer 4

uraemia

Question 5

what are the can be caused by uraemia

Answer 5

pericarditis, encephalopathy, neuropathy, asterixis, gastritis

Question 6

what happens when the kidney stops maintaing fluid balance

Answer 6

fluid retention- oedema, ascites

Question 7

what happens when the kidney stops maintaining electrolyte balance

Answer 7

hyperkalaemia- arrhythmia

Question 8

what happens when the kidney stops maintaining acid- base balance

Answer 8

metabolic acidosis

kussmauls respiration

Question 9

what happens when the kidney stops metabolising Vit d and excreting phosphate

Answer 9

renal bone disease (bony pain) and vascular calcification

Question 10

what happens when the kidney stops producing erytropoietin

Answer 10

anaemia

Question 11

what happens when the kidney stops excreting drugs

Answer 11

can get drug toxicity - digoxin, gabapentin

Question 12

what happens when the kidney stops working as a barrier to loss of proteins

Answer 12

proteinuria and nephrotic syndrome

Question 13

how might asymptomatic patient’s get diagnosed with kidney disease

Answer 13

dipstix (microscopic haematuria &/or protein uria)
reduced eGFR on biochem screen 
raised BP
abdo imaging 
screening because of family history

Question 14

what local/ renal signs and symptoms might patients present with

Answer 14

loin/ abdo pain
macroscopic haematuria 
UTI
arterial bruits 
palpable kidneys

Question 15

what questions should you ask in the systemic enquiry

Answer 15

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

Question 16

how do NSAIDs affect GFR

Answer 16

reduce pressure within the glomerulus, reducing filtration rate
can also cause ASK by causing an allergic reaction within the kidney

Question 17

what drugs should you ask about in a history (in patient with kidney disease)

Answer 17

ACEi, ARB, diuretics, NSAIDs, gentamicin, trimethoprim, penicillin, PPIs, radiology contrast, herbal remedies

Question 18

what are the systemic signs related to an underlying disease causing kidney disease

Answer 18

pyrexia, skin rash, heart murmurs, consolidation, ENT, retinopathy (DM & HBP), neuropathy, arterial bruits, rheumatoid

Question 19

what are the systemic signs related to an loss of kidney function

Answer 19

pallor, arrythmia, pericardial rub (pericarditis life threatening comp of kidney disease), rasied JVP, lung crepitations, gout

Question 20

what is accelerated hypertension

Answer 20

medical emergency
diastolic BP > 120 mmHg
papilloedema
end organ decompensation (encephalopathy, fits, cardiac failure, acute renal failure)

Question 21

what does accelerated hypertension look like on fundoscopy

Answer 21

papilloedema
flame haemorrhages
cotton wool spots

Question 22

what nail changes in renal disease

Answer 22

leukonychia 
splinter haemorrhages (come from kidneys after infection)

Question 23

is gout caused by/ causes renal disease

Answer 23

both
may cause renal impairment (renal stones)
or be a consequence of renal impairment

Question 24

what possible skin changes in renal disease

Answer 24

gouty trophi
vasculitis rash (vasculitis (HSP), acute glomerulonephritis)
malar rash (SLE)

Question 25

what causes myogloin to be in urine

Answer 25

e.g. a crush injury when someone has been lying in same position for ages get Rhabdomyolosis were muscles break down

Question 26

what do the parameters of urinalysis tell you

Answer 26

specific gravity- urine concentration
haematuria- haemoglobin, RBC, myoglobin 
proteinuria 
pH(4.5-7). alkaline  = distal renal tubular acidosis. UTI
leukocyte esterase/ nitrates= UTI

Question 27

what are the levels of urine protein

Answer 27

asymptomatic low grade <1g/day
heavy proteinuria 1-3 g/day
nephrotic range >3 g/day

Question 28

when are urinary casts formed

Answer 28

when low urine out put/ low pH

Question 29

what causes a hyaline cast

Answer 29

usually benign (normal)

Question 30

what causes a red cell cast

Answer 30

always pathological (associated with nephritic syndrome)

Question 31

what causes a leucocyte cast

Answer 31

infection or inflammation

Question 32

what causes granular cast

Answer 32

indicative of chronic disease

Question 33

what ECG results for severe hypertension

Answer 33

LVH and strain

Question 34

what ECG in hyperkalaemia

Answer 34

peaked T waves (tall tented)

Question 35

what is acute kidney disease

Answer 35

decline in GFR over hours/ days/ weeks

can be with/without oliguria or normal/ impaired baseline renal function

Question 36

what is oligouria

Answer 36

<400 ml urine/ day

Question 37

what is nephrotic syndrome

Answer 37

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

Question 38

what is nephritic syndrome

Answer 38

si/sy of glomerulonephritis

• AKI
• oliguria
• oedema/ fluid retention (not as bad as nephrOtic syndrome)
• hypertension
• active urinary sediment
• RBC’s, granulae casts, proteinuria