Presentation of Kidney Disease Flashcards
What are some symptoms and signs of kidney disease?
Asymptomatic
Loin pain/urinary symptoms
Haematuria = microscopic, painless macroscopic
Acute kidney injury and chronic kidney disease
Proteinuria and nephrotic/nephritic syndrome
Hypertension = asymptomatic, accelerated
What are some signs of significant loss of renal function?
Uraemia and anaemia
Fluid retention and oedema
Hyperkalaemia and arrhythmia
Metabolic acidosis and Kussmaul’s breathing
Renal bone disease and vascular calcification
Drug toxicity
What are some signs of uraemia?
Pericarditis, encephalopathy, neuropathy, asterixis, gastritis
What symptoms can occur even if renal function is normal?
Proteinuria and nephrotic syndrome
How may asymptomatic kidney disease be detected?
Dipstix microscopic haematuria and/or proteinuria, reduced eGFR, raised BP, incidental finding on abdominal imaging, screening
What may be some important underlying causes of kidney disease?
Diabetes, connective tissue disorder, vascular disease
What may be the presenting complaint of a patient with kidney disease?
Uraemic presentation, fluid retention, anaemia, bone pain, loin or abdominal pain, macroscopic haematuria, UTI
What should be covered in the systemic enquiry?
Appetite and weight loss, nausea and vomiting, dyspepsia, dyspnoea, joint pains and arthralgia, skin rashes
What are some urinary symptoms that may occur?
Frequency, urgency, hesitancy, polyuria, nocturia
What may be some important features of a drug history?
ACE inhibitors/ARBs, loop/thiazide/potassium sparing diuretics, gentamicin, trimethoprim, penicillins, NSAIDs, PPIs, radiology contrast, herbal remedies
What are some examination findings related to disease?
Pyrexia, skin rash, heart murmurs, consolidation, retinopathy, neuropathy, arterial bruits
What are some examination findings related to loss of function?
Pallor, arrhythmia, pericardial rub, raised JVP, lung crepitations, oedema, gout
What are some possible features of the examination of the kidneys?
Tender loin or upper abdomen, bruits, palpable kidneys
What is accelerated hypertension defined as?
Diastolic BP >120 mmHg = presents as papilloedema
What are some associated symptoms of accelerated hypertension?
End organ decompensation = encephalopathy, fits, cardiac failure, acute renal failure
What are some disease-specific signs that may occur?
Leukonychia, gouty tophus, splinter haemorrhages
Vasculitic skin rash = acute glomerulonephritis due to systemic vasculitis, Henoch-Schonlein purpura
Malar rash = due to SLE
What are some features of urinalysis?
Specific gravity = urine concentration
Proteinuria and haematuria
How may haematuria be detected in urinalysis?
Haemoglobin = red blood cells, free haemoglobin/myoglobin
What are some signs of a UTI on urinalysis?
pH 4.5-7 = alkaline (distal RTA)
Leukocyte esterase/nitrites
What is the normal volume of urine collected in a 24 hour period?
<150mg
What is the normal urine protein to creatine ratio?
<15 mg/mmol
What value of urine protein would be considered indicative of asymptomatic low grade proteinuria?
<1g/24hrs
What would be considered proteinuria?
Urine protein content of 1-3g/24hrs
What is the nephrotic range of urine protein?
> 3g/24hrs
How are urinary casts produced?
By precipitation of Tamm-Horsfall mucoprotein which is secreted by renal tubule cells
In what environment are urinary cast production pronounced?
In environments favouring protein denaturation and precipitation (low urine, low pH)
What are some features of urinary casts?
Hyaline = usually benign
Leucocyte = infection, inflammation
Red cell = always pathological, nephritic syndrome
Granular = chronic disease
What does severe hypertension cause in the heart?
Left ventricular hypertrophy and strain
What ECG change does hyperkalaemia cause?
Peaked T-waves
What is the best overall measure of kidney function?
GFR
What is kidney damage defined as?
Evidence of disease haematuria/proteinuria
What is acute kidney injury defined as?
Decline in GFR over hours-weeks with or without oliguria (<400ml urine output/day) in a patient with normal or impaired baseline renal function
What is stage 1 of chronic kidney disease?
Kidney damage with normal or raised GFR
eGFR >=90
What is stage 2 of chronic kidney disease?
Kidney damage with mild decrease in GFR
eGFR of 60-89
What is stage 3 of chronic kidney disease?
Moderate decrease in GFR
eGFR of 30-59
What is stage 4 of chronic kidney disease?
Severe decrease in GFR
eGFR of 15-29
What is stage 5 of chronic kidney disease?
Kidney failure
eGFR < 15 or dialysis
What are the triad of symptoms that make up nephrotic syndrome?
Caused by glomerular disease = proteinuria >3g/day (mostly albumin, also globulins), hypoalbuminaemia, oedema (hypercholesterolaemia)
What are some features of nephrotic syndrome?
Often normal renal function
May cause peri-orbital oedema
What causes nephritic syndrome?
Glomerulonephritis
What are some features of nephritic syndrome?
Oliguria, acute kidney injury, hypertension, oedema/fluid retention
Active urinary sediment = RBC, proteinuria
What are some casts that may be done for nephritic syndrome?
RBC and granular casts
