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Renal > Presentation of kidney disease > Flashcards

Presentation of kidney disease Flashcards

1
Q

How can kidney disease present?

A 
Asymptomatic
Loin pain/ urinary symptoms
Haematuria - microscopic, painless macroscopic haematuria
Proteinuria
Hypertension
AKI
CKD
Nephrotic syndrome
Nephritic syndrome
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2
Q

What are the functions of the kidneys?

A 
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
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3
Q

What is the consequence of a lack of excretion of urea?

A

Uraemia - pericarditis, encephalopathy, neuropathy, asterixis, gastritis, nausea, vomiting

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4
Q

What is the consequence of a lack of fluid balance?

A

Fluid retention

Oedema

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5
Q

What is the consequence of a lack of electrolyte balance?

A

Hyperkalemia

Arrhythmia

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6
Q

What is the consequence of a lack of acid-base balance?

A

Metabolic acidosis

Kussmaul’s respiration

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7
Q

What is the consequence of a lack of vitamin D metabolism/ phosphate excretion?

A

Renal bone disease

Vascular calcification

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8
Q

What is the consequence of a lack of production of erythropoietin?

A

Anaemia

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9
Q

What is the consequence of a lack of drug excretion?

A

Drug toxicity e.g. digoxin, gapapentin

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10
Q

What will result as a failure in the barrier to loss of proteins?

A

Proteinuria

Nephrotic syndrome

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11
Q

What should be investigated in those with asymptomatic renal disease?

A 
Diptix microscopic haematuria and/or proteinuria
Reduced eGFR on biochem screen
Hypertensive
Incidental findings on abdominal imaging
Screening because of family history
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12
Q

What can lead to kidney disease?

A

DM
Connective tissue disorder
Vascular disease

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13
Q

How can renal disease present related to a loss of kidney function?

A

Uraemic
Fluid retention
Anaemia
Bone pain

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14
Q

How can renal disease present locally?

A

Loin/abdo pain
Macroscopic haematuria
UTI

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15
Q

What should be included in the systemic enquiry of someone with kidney disease?

A 
Appetite and weight loss
N+V
Dyspepsia
Dyspnoea
Urinary symptoms: frequency, urgency, hesitancy, polyuria and nocturia
Joint pains and arthralgia
Skin rashes
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16
Q

What conditions are important in respect of renal disease?

A 
Previous renal problems - ask about recurrent UTI in childhood, bedwetting etc
DM
Vascular disease - renovascular 
Surgery
TB
Rheumatological
17
Q

What drugs are important in respect to renal disease?

A 
ACEi
ARB
Diuretic (thiazide, loop, potassium sparing) 
NSAIDs
Antibiotic: gentamicin, trimethoprim, pencillins
PPI
Contrast
OTC/herbal
18
Q

How do NSAIDs affect the kidneys?

A

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

19
Q

What are signs related to chronic disease renal problems?

A 
Pyrexia
Skin rash 
Heart murmurs
Consolidation 
ENT 
Retinopathy (DM and HBP_ 
Neuropathy
Arterial bruits
Rheumatoid
20
Q

What are the signs associated with loss of kidney function?

A 
Pallor
Arrhythmia
Pericardial rub
Raised JVP
Lung creps
Oedema
Gout
21
Q

What are signs related to local kidney disease?

A

Tenderness in loins/flank/RUQ/LUQ
Arterial bruits
Palpable kidneys

22
Q

What is the target BP in renal clinic?

A

130/90

23
Q

What is accelerated hypertension and what can it result in?

A

Diastolic >120
Papilloedema
End organ decompensation: encephalopathy, fits, cardiac failure, acute renal failure

24
Q

What can be seen in hypertensive fundoscopy?

A

Flame haemorrhages
Cotton wool spots
Blurred optic disc

25
Q

What is leukonychia associated with?

A

Acute illness

Hyperalbuminaemia

26
Q

What are splinter haemorrhages associated with?

A

Vasculitis

Endocarditis

27
Q

What is a vasculitis skin rash associated with?

A

Purpuric rash
Systemic vasculitis
Acute glomerulonephritis
Henoch-schonlein purpura (GI, GU, arthralgia, purpuric rash on extensors)

28
Q

Why does rhabdomyolysis result in reduced kidney function?

A

Releases myoglobin which is nephrotoxic resulting in AKI
Symptoms made worse by dehydration
Measure CK

29
Q

What is included in urinalysis?

A

Specific gravity - urine concentration
Haematuria - hemoglobin (RBC, free hemoglobin/ myoglobin)
Proteinuria
pH - if alkaline suggests distal RTA, UTI
Leukocytes and nitrates = UTI

30
Q

What is the nephrotic range of proteinuria?

A

More than 3g a day

31
Q

What does a hyaline cast suggest?

A

Nothing - this is normal

32
Q

What does a red cell cast suggest?

A

ALWAYS pathological

Associated with glomerulonephritis (nephritic syndrome)

33
Q

What does a leukocyte cast suggest?

A

Infection or inflammation

34
Q

What does a granular cast suggest?

A

Indicative of chronic disease

35
Q

What is the triad of nephrotic syndrome?

A 
Proteinuria more than 3g a day (mostly albumin) 
Hypoalbuminaemia
Oedema
Hypercholesterolaemia
Normal renal function
36
Q

Why does hypoalbuminemia result in oedema?

A

Loss of oncotic pressure so fluid leaks out into tissues

37
Q

Why can patients with nephrotic syndrome lie flat and why do their hands and face swell?

A

No pulmonary oedema

Because they can lie flat, the fluid can collect in any tissue around the body

38
Q

What is nephritic syndrome?

A 
AKI
Oliguria
Oedema/fluid retention 
Hypertension
Active urinary sediment: RBC, RBC and granular cast, proteinuria

Renal (22 decks)

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