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Presentation of renal disease Flashcards

1
Q

How might heavy proteinuria present in terms of the urine?

A

“Frothy” urine

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2
Q

Accelerated hypertension is a medical emergency. T/F

A

True

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3
Q

Relate the functions of the kidney to clinical symptoms/signs which result from the loss of each function

A

Excretion of urea - uraemia

Fluid balance - retention & oedema

Electrolyte balance - hyperkalaemia & arrhythmia

Acid-base balance - metabolic acidosis & kassmall’s respiration

Vitamin D metabolism/phosphate excretion - renal bone disease & vascular calcification

Erythtopoietin - anaemia

Drug excretion - drug toxicity

Barrier to protein loss - proteinuria and nephrotic syndrome

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4
Q

Define uraemia

A

Serum urea over 40

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5
Q

Pericarditis occuring from renal disease is a result of what being elevated?

A

Urea

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6
Q

How does renal bone disease present?

A

Asymptomatic

Pathological fracture

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7
Q

Name two drugs which can cause drug toxicity in renal disease?

A

Gabapentin

Digoxin

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8
Q

What clinical and biochemical signs may indicate renal disease?

A

Microscopic haematuria
Proteinuria
Reduced GFR
Raised blood pressure

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9
Q

How does Alport syndrome present?

A 
Haematuria
Proteinuria
High BP
Oedema 
Deafness 
Family history
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10
Q

What systemic diseases are related to kidney disease?

A

Vascular disease
Diabetes mellitus
Connective tissue disorder

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11
Q

What systemic symptoms may the patient present with which are related to kidney disease?

A

Uraemia
Fluid retention (oedema)
Anaemia
Bone pain

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12
Q

What local symptoms may the patient present with in kidney disease?

A

Loin pain
Macroscopic haematuria
UTI

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13
Q

How do most patients with renal disease present?

A

Asymptomatic

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14
Q

What questions are important to ask a patient with suspected renal disease?

A 
Appetite 
Weight loss
Nausea & vomiting (dehydration can cause AKI)
Dyspepsia 
Dyspnoea 
Urinary symptoms
Joint pain
Arthralgia 
Skin rash
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15
Q

List the lower urinary tract symptoms

A 
Frequency
Urgency 
Hesitancy
Polyuria
Nocturia
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16
Q

What aspects of a patients past medical history would be relevant to a renal history?

A 
Kidney disease
Diabetes
Vascular disease
Previous surgery
TB
Rheumatological conditions
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17
Q

What aspects of a family history are relevant to a renal history?

A

Kidney disease

Hypertension

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18
Q

Which aspects of a drug history are relevant to a renal history?

A

ACE/ARB
Diuretic
NSAIDs
Antibiotics (gentamicin, trimethoprim - high potassium)
PPI
Radiology contrast (contrast nephropathy)
Over the counter

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19
Q

ACE inhibitors are used to treat which biochemical derangement (in relation to the kidney)? In which condition is this commonly found?

A 
Proteinuria
Diabetic nephropathy (microalbuminuria+)
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20
Q

List the systemic signs of kidney disease

A 
Pyrexia
Skin rash
Murmur
Arrhythmia 
Pericardial rub
Retinopathy (BP & DM)
Bruits
ENT (vasculitis)
Rheumatoid
Raised JVP
Oedema
Gout
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21
Q

List the local signs of kidney disease

A

Tenderness
Bruits
Palpable kidneys

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22
Q

What clinical measurement is it always important to ask about in the context of kidney disease?

A

Blood pressure!

23
Q

Define accelerated hypertension. What sign is seen in the eye in accelerated hypertension? What happens to the organs?

A

Diastolic BP over 120
Papilloedema
Decompensation (encephalopathy, fits, renal failure, heart failure, etc)

24
Q

What is leukonychia a sign of in relation to the kidney?

A

Acute illness

Profound hypoalbuminaemia

25
What are gouty tophus a sign of in relation to the kidney?
Chronic kidney disease
26
What are splinter haemorrhages a sign of in relation to the kidney?
Subacute bacterial endocarditis associated with nephritis | Vasculitis
27
Vasculitic skin rashes are blanching or non-blanching? What might it be associated with in terms of the kidney?
Non-blanching | Acute glomerulonephritis
28
Purpura found on extensor surfaces of the skin and buttocks are typically what type of vasculitis?
Henloch-schonlein purpura
29
Malar rash is associated with which connective tissue disease?
SLE
30
What are the two causes of "smoky" (dark red/brown) urine?
Haematuria (old blood) in nephritic syndrome | Myoglobin (muscle breakdown & dehydration)
31
Explain the biochemical markers used in urinalysis
``` Specific gravity (1.01-1.02) - concentration of urea Haematuria - RBC/free Hb/myoglobin Proteinurea pH (4.5-7) Leukocytes + nitrites - UTI ```
32
What tests can be carried out to determine the level of protein in the urine?
24 hr urine collection (
33
Classify the levels of proteinuria
Asymptomatic low grade (3g)
34
Isomorphic RBC in urine would indicate blood coming from where?
Lower urinary tract | If dysmorphic then coming from kidney
35
Describe urinary cast analysis
Hyaline - benign RBC - pathological (nephritic) Leukocyte - infection or inflammation Granular - indicative of chronic disease
36
How are urinary casts formed?
Precipitation of Tamm-Horsfall mucoprotein secreted by renal tubules
37
Formation of urinary casts are increased when?
Low urine flow | low pH
38
You can use microscopy to determine composition of urinary tract stones. T/F
True - can determine crystals
39
What is a sign of hyperkalaemia on ECG?
Peaked T waves
40
What is the best measure of kidney function?
GFR
41
What is stable chronic kidney disease?
Kidney function low but not deteriorating
42
What is progressive chronic kidney disease?
Kidney function declining steadily
43
What is acute kidney injury?
Decline in GFR over hours/days/weeks +/- oliguria In a patient with normal/impaired baseline renal function
44
Define oliguria
45
Patients with acute kidney injury don't need dialysis. T/F
False - they may need dialysis temporarily or long term
46
What is nephrotic syndrome?
Proteinuria >3g Hypoalbuminuria Oedema (periorbital common)
47
Can you have proteinuria >3g per day and not be nephrotic?
Yes - albumin has to have dropped
48
What is associated with nephrotic syndrome?
Hypercholesterolaemia
49
Do patients with nephrotic syndrome have normal renal function?
Often
50
Why do patients with nephrotic syndrome get periorbital oedema?
Oedema is dependent and since they don't get pulmonary oedema (as in heart failure) they are able to lie flat - oedema collects in face
51
Do patients with nephrotic syndrome get pulmonary effusions?
Yep they can do
52
What causes nephrotic syndrome?
Glomerulonephritis Uncontrolled diabetes Lead poisoning
53
What is nephritic syndrome? What are the symptoms and signs?
``` Nephritis caused by acute kidney injury Olguria Oedema/retention (oedema or pulmonary oedema) Hypertension Haematuria Proteinuria ```

Year 2 (72 decks)

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