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Renal > Presentation of Kidney Disease > Flashcards

Presentation of Kidney Disease Flashcards

1
Q

What are some symptoms and signs of kidney disease?

A

Asymptomatic
Loin pain/urinary symptoms
Haematuria = microscopic, painless macroscopic
Acute kidney injury and chronic kidney disease
Proteinuria and nephrotic/nephritic syndrome
Hypertension = asymptomatic, accelerated

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2
Q

What are some signs of significant loss of renal function?

A

Uraemia and anaemia
Fluid retention and oedema
Hyperkalaemia and arrhythmia
Metabolic acidosis and Kussmaul’s breathing
Renal bone disease and vascular calcification
Drug toxicity

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3
Q

What are some signs of uraemia?

A

Pericarditis, encephalopathy, neuropathy, asterixis, gastritis

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4
Q

What symptoms can occur even if renal function is normal?

A

Proteinuria and nephrotic syndrome

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5
Q

How may asymptomatic kidney disease be detected?

A

Dipstix microscopic haematuria and/or proteinuria, reduced eGFR, raised BP, incidental finding on abdominal imaging, screening

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6
Q

What may be some important underlying causes of kidney disease?

A

Diabetes, connective tissue disorder, vascular disease

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7
Q

What may be the presenting complaint of a patient with kidney disease?

A

Uraemic presentation, fluid retention, anaemia, bone pain, loin or abdominal pain, macroscopic haematuria, UTI

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8
Q

What should be covered in the systemic enquiry?

A

Appetite and weight loss, nausea and vomiting, dyspepsia, dyspnoea, joint pains and arthralgia, skin rashes

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9
Q

What are some urinary symptoms that may occur?

A

Frequency, urgency, hesitancy, polyuria, nocturia

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10
Q

What may be some important features of a drug history?

A

ACE inhibitors/ARBs, loop/thiazide/potassium sparing diuretics, gentamicin, trimethoprim, penicillins, NSAIDs, PPIs, radiology contrast, herbal remedies

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11
Q

What are some examination findings related to disease?

A

Pyrexia, skin rash, heart murmurs, consolidation, retinopathy, neuropathy, arterial bruits

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12
Q

What are some examination findings related to loss of function?

A

Pallor, arrhythmia, pericardial rub, raised JVP, lung crepitations, oedema, gout

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13
Q

What are some possible features of the examination of the kidneys?

A

Tender loin or upper abdomen, bruits, palpable kidneys

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14
Q

What is accelerated hypertension defined as?

A

Diastolic BP >120 mmHg = presents as papilloedema

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15
Q

What are some associated symptoms of accelerated hypertension?

A

End organ decompensation = encephalopathy, fits, cardiac failure, acute renal failure

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16
Q

What are some disease-specific signs that may occur?

A

Leukonychia, gouty tophus, splinter haemorrhages
Vasculitic skin rash = acute glomerulonephritis due to systemic vasculitis, Henoch-Schonlein purpura
Malar rash = due to SLE

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17
Q

What are some features of urinalysis?

A

Specific gravity = urine concentration

Proteinuria and haematuria

18
Q

How may haematuria be detected in urinalysis?

A

Haemoglobin = red blood cells, free haemoglobin/myoglobin

19
Q

What are some signs of a UTI on urinalysis?

A

pH 4.5-7 = alkaline (distal RTA)

Leukocyte esterase/nitrites

20
Q

What is the normal volume of urine collected in a 24 hour period?

A

<150mg

21
Q

What is the normal urine protein to creatine ratio?

A

<15 mg/mmol

22
Q

What value of urine protein would be considered indicative of asymptomatic low grade proteinuria?

A

<1g/24hrs

23
Q

What would be considered proteinuria?

A

Urine protein content of 1-3g/24hrs

24
Q

What is the nephrotic range of urine protein?

A

> 3g/24hrs

25
Q

How are urinary casts produced?

A

By precipitation of Tamm-Horsfall mucoprotein which is secreted by renal tubule cells

26
Q

In what environment are urinary cast production pronounced?

A

In environments favouring protein denaturation and precipitation (low urine, low pH)

27
Q

What are some features of urinary casts?

A

Hyaline = usually benign
Leucocyte = infection, inflammation
Red cell = always pathological, nephritic syndrome
Granular = chronic disease

28
Q

What does severe hypertension cause in the heart?

A

Left ventricular hypertrophy and strain

29
Q

What ECG change does hyperkalaemia cause?

A

Peaked T-waves

30
Q

What is the best overall measure of kidney function?

A

GFR

31
Q

What is kidney damage defined as?

A

Evidence of disease haematuria/proteinuria

32
Q

What is acute kidney injury defined as?

A

Decline in GFR over hours-weeks with or without oliguria (<400ml urine output/day) in a patient with normal or impaired baseline renal function

33
Q

What is stage 1 of chronic kidney disease?

A

Kidney damage with normal or raised GFR

eGFR >=90

34
Q

What is stage 2 of chronic kidney disease?

A

Kidney damage with mild decrease in GFR

eGFR of 60-89

35
Q

What is stage 3 of chronic kidney disease?

A

Moderate decrease in GFR

eGFR of 30-59

36
Q

What is stage 4 of chronic kidney disease?

A

Severe decrease in GFR

eGFR of 15-29

37
Q

What is stage 5 of chronic kidney disease?

A

Kidney failure

eGFR < 15 or dialysis

38
Q

What are the triad of symptoms that make up nephrotic syndrome?

A

Caused by glomerular disease = proteinuria >3g/day (mostly albumin, also globulins), hypoalbuminaemia, oedema (hypercholesterolaemia)

39
Q

What are some features of nephrotic syndrome?

A

Often normal renal function

May cause peri-orbital oedema

40
Q

What causes nephritic syndrome?

A

Glomerulonephritis

41
Q

What are some features of nephritic syndrome?

A

Oliguria, acute kidney injury, hypertension, oedema/fluid retention
Active urinary sediment = RBC, proteinuria

42
Q

What are some casts that may be done for nephritic syndrome?

A

RBC and granular casts

Renal (36 decks)

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