Presentation of Renal Disease Flashcards
Diagnosis
History
Examination - Fluid overload, Pallor, Rash
Blood and Urine tests - Urea and creatinine elevated, Dipstick protein/blood
Imaging - USS renal tract or CT Kidneys Ureter Bladder or nuclear medicine scans (DMSA and MAG3)
Presentations
Acutely: Patient unwell; Oliguria/anuria (passing less urine than normal/ no urine); Disturbances of acid base balance or electrolytes or fluid balance
Slowly/chronically: Patient often asymptomatic; BP might be high; Often have other conditions like diabetes or vascular disease
Patients may be asymptomatic for a long time as
Symptoms only really start when GFR < 20
Nephrotic Syndrome
Generalised oedema Low serum albumin Proteinuria (high cholesterol) (Risk of clotting)
Diabetic Nephropathy
Swelling legs (fluid overload)
Nausea/vomiting (waste products build up)
Tiredness/itching (waste products build up)
Chronic Kidney Disease
Stage 1: 90-100% kidney function
Stage 2: 60-90% no symptoms
Stage 3: 30-60%, oedema, fatigue, back pain
Stage 4: 15-30%, nausea, difficulty concentrating, kidney dialysis
Stage 5: 0-15% function, anaemia, thirst, fatigue, need dialysis or transplant
Actue Kidney Problems
Raised urea, potassium and creatinine eGFR falls
Nephritic syndrome
Inflamed kidneys: blood and protein on dipstick, hypertension, AKI, reduced urine output
Henoch-Schonlein purpura (vasculitis affecting skin, kidneys and bowels), often due to a strep throat, usually self-limiting
Obstruction due to a stone
Colic pain
Nausea and pain
Sudden onset pain left loin going down to groin, pain comes and goes
Imaging in Renal Disease
USS: cheap, no radiation, non-invasive – can see blockages/shape and size of kidneys
CT scan: more detail. Good for stones/tumours
MRI scan: good for arteries
Nuclear medicine:
- good for scars/obstruction/
- Good for split function
