Presentation of kidney disease Flashcards
Give 8 categories of symptoms
Asymptomatic Loin pain/urinary symptoms Haematuria Proteinuria Hypertension AKD CKD Nephrotic syndrome Nephritic syndrome
What are some of the main functions of the kidneys?
Excretion of urea Fluid balance Electrolyte balance Acid-Base balance VD met EPO production Drug excretion Barrier to protein loss
What symptoms may be seen with a loss of the kidneys’ ability to clear urine?
Uraemia: pericarditis encephalopathy neuropathy gastritis
What symptoms may be seen with a loss of the kidneys’ ability to fluid balance?
Oedema
What symptoms may be seen with a loss of the kidneys’ ability to regulate electrolytes?
Hyperkalemia
Arrhythmias
What symptoms may be seen with a loss of the kidneys’ ability to acid-base balance?
Metabolic acidosis
Deep laboured breathing
What symptoms may be seen with a loss of the kidneys’ ability to met VD?
Renal bone disease
Vascular calcification
What symptoms may be seen with a loss of the kidneys’ ability to produce EPO?
Anaemia
What symptoms may be seen with a loss of the kidneys’ ability to excrete drugs?
Drug toxicity
What symptoms may be seen with a loss of the kidneys’ ability to retain proteins?
Proteinuria
Nephrotic syndrome
How does asymptomatic kidney disease tend to present/be detected?
Raised BP
Incidental finding on abdo imaging
Dipstick test
What are some systemic symptoms of renal disease?
DM, connective tissue disease, vascular disease
Uraemic, fluid retention, anaemia, bone problems
What things are important to ask about in the systemic enquiry if suspecting renal disease?
appetite & weight loss nausea & vomiting dyspepsia dyspnoea urinary symptoms e.g. frequency, urgency, hesitancy, polyuria & nocturia joint pains & arthralgia skin rashes
What drugs are very bad for the kidneys?
NSAIDS
Gent
What are some systemic signs of kidney disease?
pyrexia, skin rash, heart murmurs, consolidation, ENT, retinopathy (DM & HBP), neuropathy, arterial bruits, rheumatoid, pallor, arrythmia, pericardial rub, raised JVP, lung creps, oedema, gout
When is hypertension a medical emergency?
Accelerated hypertension
What is accelerated hypertension?
Diastolic BP>120mmHg with papilloedema and/or end organ decompensation (cardiac arrest etc)
What does specific gravity of urine measure?
Urine conc
What is the standard way of measuring urine protein conc?
24h urine collection
What is a normal protein reading for 24h urine collection?
<150mg/24h
How is urine protein used?
As protein/creatinine ratio
What is a normal protein/creatinine ratio?
0.5G/24h
What are the three categories of protein/creatinine ratio?
Asymptomatic- <1G/24h Heavy Proteinuria (1 - 3 G/Day) Nephrotic Range (>3 G/Day)
What forms urinary casts?
Protein in urine
What are the 5 stages of CKD?
Kidney damage with normal or increased GFR- >90
Kidney damage with mild decreased GFR- 60-89
Moderate decreased GFR- 30-59
Severe decreased GFR- 15-29
Kidney failure- <15
What two paths can CKD take?
Stable or progressive
What defines AKD?
Decline in GFR over hours / days / weeks from baseline (CKD sufferers can get AKD)
What is nephrOtic syndrome?
Proteinuria >3 g/day (mostly albumin, also globulins)
Hypoalbuminaemia
Oedema
(Hypercholesterolaemia)
What is nephrItic syndrome?
Acute Kidney Injury Oliguria Oedema/ Fluid retention Hypertension Active urinary sediment - RBC’s; Granular Casts, proteinuria
