Presentation of renal disease Flashcards
How might heavy proteinuria present in terms of the urine?
“Frothy” urine
Accelerated hypertension is a medical emergency. T/F
True
Relate the functions of the kidney to clinical symptoms/signs which result from the loss of each function
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
Define uraemia
Serum urea over 40
Pericarditis occuring from renal disease is a result of what being elevated?
Urea
How does renal bone disease present?
Asymptomatic
Pathological fracture
Name two drugs which can cause drug toxicity in renal disease?
Gabapentin
Digoxin
What clinical and biochemical signs may indicate renal disease?
Microscopic haematuria
Proteinuria
Reduced GFR
Raised blood pressure
How does Alport syndrome present?
Haematuria Proteinuria High BP Oedema Deafness Family history
What systemic diseases are related to kidney disease?
Vascular disease
Diabetes mellitus
Connective tissue disorder
What systemic symptoms may the patient present with which are related to kidney disease?
Uraemia
Fluid retention (oedema)
Anaemia
Bone pain
What local symptoms may the patient present with in kidney disease?
Loin pain
Macroscopic haematuria
UTI
How do most patients with renal disease present?
Asymptomatic
What questions are important to ask a patient with suspected renal disease?
Appetite Weight loss Nausea & vomiting (dehydration can cause AKI) Dyspepsia Dyspnoea Urinary symptoms Joint pain Arthralgia Skin rash
List the lower urinary tract symptoms
Frequency Urgency Hesitancy Polyuria Nocturia
What aspects of a patients past medical history would be relevant to a renal history?
Kidney disease Diabetes Vascular disease Previous surgery TB Rheumatological conditions
What aspects of a family history are relevant to a renal history?
Kidney disease
Hypertension
Which aspects of a drug history are relevant to a renal history?
ACE/ARB
Diuretic
NSAIDs
Antibiotics (gentamicin, trimethoprim - high potassium)
PPI
Radiology contrast (contrast nephropathy)
Over the counter
ACE inhibitors are used to treat which biochemical derangement (in relation to the kidney)? In which condition is this commonly found?
Proteinuria Diabetic nephropathy (microalbuminuria+)
List the systemic signs of kidney disease
Pyrexia Skin rash Murmur Arrhythmia Pericardial rub Retinopathy (BP & DM) Bruits ENT (vasculitis) Rheumatoid Raised JVP Oedema Gout
List the local signs of kidney disease
Tenderness
Bruits
Palpable kidneys
What clinical measurement is it always important to ask about in the context of kidney disease?
Blood pressure!
Define accelerated hypertension. What sign is seen in the eye in accelerated hypertension? What happens to the organs?
Diastolic BP over 120
Papilloedema
Decompensation (encephalopathy, fits, renal failure, heart failure, etc)
What is leukonychia a sign of in relation to the kidney?
Acute illness
Profound hypoalbuminaemia
What are gouty tophus a sign of in relation to the kidney?
Chronic kidney disease
What are splinter haemorrhages a sign of in relation to the kidney?
Subacute bacterial endocarditis associated with nephritis
Vasculitis
Vasculitic skin rashes are blanching or non-blanching? What might it be associated with in terms of the kidney?
Non-blanching
Acute glomerulonephritis
Purpura found on extensor surfaces of the skin and buttocks are typically what type of vasculitis?
Henloch-schonlein purpura
Malar rash is associated with which connective tissue disease?
SLE
What are the two causes of “smoky” (dark red/brown) urine?
Haematuria (old blood) in nephritic syndrome
Myoglobin (muscle breakdown & dehydration)
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
What tests can be carried out to determine the level of protein in the urine?
24 hr urine collection (
Classify the levels of proteinuria
Asymptomatic low grade (3g)
Isomorphic RBC in urine would indicate blood coming from where?
Lower urinary tract
If dysmorphic then coming from kidney
Describe urinary cast analysis
Hyaline - benign
RBC - pathological (nephritic)
Leukocyte - infection or inflammation
Granular - indicative of chronic disease
How are urinary casts formed?
Precipitation of Tamm-Horsfall mucoprotein secreted by renal tubules
Formation of urinary casts are increased when?
Low urine flow
low pH
You can use microscopy to determine composition of urinary tract stones. T/F
True - can determine crystals
What is a sign of hyperkalaemia on ECG?
Peaked T waves
What is the best measure of kidney function?
GFR
What is stable chronic kidney disease?
Kidney function low but not deteriorating
What is progressive chronic kidney disease?
Kidney function declining steadily
What is acute kidney injury?
Decline in GFR over hours/days/weeks
+/- oliguria
In a patient with normal/impaired baseline renal function
Define oliguria
Patients with acute kidney injury don’t need dialysis. T/F
False - they may need dialysis temporarily or long term
What is nephrotic syndrome?
Proteinuria >3g
Hypoalbuminuria
Oedema (periorbital common)
Can you have proteinuria >3g per day and not be nephrotic?
Yes - albumin has to have dropped
What is associated with nephrotic syndrome?
Hypercholesterolaemia
Do patients with nephrotic syndrome have normal renal function?
Often
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
Do patients with nephrotic syndrome get pulmonary effusions?
Yep they can do
What causes nephrotic syndrome?
Glomerulonephritis
Uncontrolled diabetes
Lead poisoning
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
