prez of kidney disease Flashcards
presentation of kidney disease
asymptomatic
loin pain / urinary symptoms
haematuria (non-visible or visible)
proteinuria
hypertension (asymptomatic or accelerated)
aki
ckd
nephrotic synd
nephritic synd
symptoms n signs of affected
local / renal
- site (kidneys & renal tract)
systemic
- underlying disease
- effects of loss of kidney function
functions of kidney
excretion of nitrogenous waste (urea)
- uraemia
fluid balance
- fluid retention & oedema/polyuria
electrolyte balance
- hyperkalaemia & arrhythmia
acid-base balance
- metabolic acidosis & kussmaul’s respiration
vitamin d metabolism / phosphate excretion
- renal bone disease & vascular calcification
production of erythropoietin
- anaemia
drug excretion
- drug toxicity (e.g: digoxin, gabapentin, opiates)
barrier to loss of proteins
- proteinuria & nephrotic syndrome
presenting complaint asymptomatic through…
- dipstick
- raised BP
- screening due to Fx
systemic presenting complaints
related to disease e.g. BM, connective tissue
related to loss of kidney function
local / renal
(loin/abdo pain, haematuria, UTI)
hx systemic enquiry
appetite weight loss
n&v
dyspepsia
dyspnoea
urinary symptoms (frequency, urgency, hesitancy, polyuria, nocturia)
joint pains & arthralgia
skin rashes
pmh
kidney disease, dm, vasc, surgery, tb, rheum
fam hx
renal, hypertension
social hx
smoking, alcohol, occupation, carerse
drug hx
acei, arb, duriectics
nsaids
ABs (gent, trimeth, penicillin)
PPis
radio contrast
over teh counter
systemic signs (related to disease)
pyrexia, skin rash, heart murmurs, consolidation, ent, retinopathy (dm & hbp), neuropathy, arterial bruits, rheumatoid
systemic signs(related toloss of kidney function)
pallor, arrhythmia, pericardial rub, raised JVP, lung creps, oedema, gout
local renal signs
tenderness of loins or upper abdo, arterial bruits, palpable kidneys
accelerated hypertenstion
end organ decompensation
(encephalopathy, sits, cardiac failure, aki)
urine appearance
macroscopic
rhabdomyolsis
urinalysis
specific grav - urine conc
haematuria - Hb
proteinuria
pH (4.5 - 7) - alkaline - distal renal tubular acidosis, uti
leukocyte esterase / nitrites - UTI
urine protein quantification
(* ?)
nephrOtic
triad due to glomerular disease
- proteinuria > 3g/day (mostly albumin, also globulins)
- hypoalbuminaemia
- oedema (hypercholesterolaemia)
often normal renal function
nephrItic syndrome
signs and symptoms of glomerulonephritis
- active urinary sediment (rbcs, rbc and gran casts,proteinuria)
- hypertension
- oedema / fluid retention
- aki
- oliguria
nephrItic syndrome
signs and symptoms of glomerulonephritis
- active urinary sediment (rbcs, rbc and gran casts,proteinuria)
- hypertension
- oedema / fluid retention
- aki
- oliguria
