Presentation of kidney disease Flashcards
How can kidney disease present?
Asymptomatic Loin pain/ urinary symptoms Haematuria - microscopic, painless macroscopic haematuria Proteinuria Hypertension AKI CKD Nephrotic syndrome Nephritic syndrome
What are the functions of the kidneys?
Excretion of nitrogenous waste (urea) Fluid balance Electrolyte balance Acid-base balance Vitamin D metabolism/ phosphate excretion Production of erythropoietin Drug excretion Barrier to loss of proteins
What is the consequence of a lack of excretion of urea?
Uraemia - pericarditis, encephalopathy, neuropathy, asterixis, gastritis, nausea, vomiting
What is the consequence of a lack of fluid balance?
Fluid retention
Oedema
What is the consequence of a lack of electrolyte balance?
Hyperkalemia
Arrhythmia
What is the consequence of a lack of acid-base balance?
Metabolic acidosis
Kussmaul’s respiration
What is the consequence of a lack of vitamin D metabolism/ phosphate excretion?
Renal bone disease
Vascular calcification
What is the consequence of a lack of production of erythropoietin?
Anaemia
What is the consequence of a lack of drug excretion?
Drug toxicity e.g. digoxin, gapapentin
What will result as a failure in the barrier to loss of proteins?
Proteinuria
Nephrotic syndrome
What should be investigated in those with asymptomatic renal disease?
Diptix microscopic haematuria and/or proteinuria Reduced eGFR on biochem screen Hypertensive Incidental findings on abdominal imaging Screening because of family history
What can lead to kidney disease?
DM
Connective tissue disorder
Vascular disease
How can renal disease present related to a loss of kidney function?
Uraemic
Fluid retention
Anaemia
Bone pain
How can renal disease present locally?
Loin/abdo pain
Macroscopic haematuria
UTI
What should be included in the systemic enquiry of someone with kidney disease?
Appetite and weight loss N+V Dyspepsia Dyspnoea Urinary symptoms: frequency, urgency, hesitancy, polyuria and nocturia Joint pains and arthralgia Skin rashes
What conditions are important in respect of renal disease?
Previous renal problems - ask about recurrent UTI in childhood, bedwetting etc DM Vascular disease - renovascular Surgery TB Rheumatological
What drugs are important in respect to renal disease?
ACEi ARB Diuretic (thiazide, loop, potassium sparing) NSAIDs Antibiotic: gentamicin, trimethoprim, pencillins PPI Contrast OTC/herbal
How do NSAIDs affect the kidneys?
Fluid retention - decrease pressure within the glomerulus and reduce GFR
Can also cause an allergic reaction within the kidneys resulting in acute on chronic renal issue
What are signs related to chronic disease renal problems?
Pyrexia Skin rash Heart murmurs Consolidation ENT Retinopathy (DM and HBP_ Neuropathy Arterial bruits Rheumatoid
What are the signs associated with loss of kidney function?
Pallor Arrhythmia Pericardial rub Raised JVP Lung creps Oedema Gout
What are signs related to local kidney disease?
Tenderness in loins/flank/RUQ/LUQ
Arterial bruits
Palpable kidneys
What is the target BP in renal clinic?
130/90
What is accelerated hypertension and what can it result in?
Diastolic >120
Papilloedema
End organ decompensation: encephalopathy, fits, cardiac failure, acute renal failure
What can be seen in hypertensive fundoscopy?
Flame haemorrhages
Cotton wool spots
Blurred optic disc
What is leukonychia associated with?
Acute illness
Hyperalbuminaemia
What are splinter haemorrhages associated with?
Vasculitis
Endocarditis
What is a vasculitis skin rash associated with?
Purpuric rash
Systemic vasculitis
Acute glomerulonephritis
Henoch-schonlein purpura (GI, GU, arthralgia, purpuric rash on extensors)
Why does rhabdomyolysis result in reduced kidney function?
Releases myoglobin which is nephrotoxic resulting in AKI
Symptoms made worse by dehydration
Measure CK
What is included in urinalysis?
Specific gravity - urine concentration
Haematuria - hemoglobin (RBC, free hemoglobin/ myoglobin)
Proteinuria
pH - if alkaline suggests distal RTA, UTI
Leukocytes and nitrates = UTI
What is the nephrotic range of proteinuria?
More than 3g a day
What does a hyaline cast suggest?
Nothing - this is normal
What does a red cell cast suggest?
ALWAYS pathological
Associated with glomerulonephritis (nephritic syndrome)
What does a leukocyte cast suggest?
Infection or inflammation
What does a granular cast suggest?
Indicative of chronic disease
What is the triad of nephrotic syndrome?
Proteinuria more than 3g a day (mostly albumin) Hypoalbuminaemia Oedema Hypercholesterolaemia Normal renal function
Why does hypoalbuminemia result in oedema?
Loss of oncotic pressure so fluid leaks out into tissues
Why can patients with nephrotic syndrome lie flat and why do their hands and face swell?
No pulmonary oedema
Because they can lie flat, the fluid can collect in any tissue around the body
What is nephritic syndrome?
AKI Oliguria Oedema/fluid retention Hypertension Active urinary sediment: RBC, RBC and granular cast, proteinuria
