Renal

Question 1

Possible cause of jaundice in renal failure?

Answer 1

Hepatorenal syndrome - complication of liver cirrhosis, severe renal vasconstriction

Question 2

What’s this? Associated with what?

Answer 2

Aniridia (have poor vision and photophobia)
Associated with Wilms tumour
WAGR - wilms tumour, aniridia, genitourinary abnormalities, retardation

Question 3

What’s this?

Answer 3

Band keratopathy - cloudy line from calcium build up

Question 4

IHUGVIDEP - important things

Answer 4

Sick or well
Jaundiced?
Growth parameters
- short, thin w CRF
- obese w steroids
Tanner stage - delay CRF
Nutrition at fat stores - down CRF
Expose chest

Question 5

Upper limb

Answer 5

Pulse - tachy dehydration of cardiac failure
BP
Hands - melanonychia, onchiolysis
Palmar crease pallor
Wrists - flaring, tender
ASTRERIXIS
Proximal myopathy w steroids or CRF
Feel muscle bulk and fat stores

Question 6

Face (not eyes)

Answer 6

Malar flush
Hirsute
Periorbital oedema

Hearing - impaired Alport or aminoglycosides

Mouth - dry, uremic breath

Question 7

Neck

Answer 7

JVP - measure at 45 degrees, increased w CKD
Cervical LNs

Question 8

Eyes

Answer 8

Aniridia
Conjunctiva pallor
Jaundice - sclera icterus
Band keratopathy
Cataract - steroids

On fundo: retinopathy or retinitis pigmentosa

Question 9

Chest exam for Renal

Answer 9

Anterior:
- rib rosary (rickets)
- palpate apex beat, heaves and thrills,
- auscultate heart
Posterior:
- lung fields - pleural effusion and pulmonary oedema
- sacral oedema

Question 10

Abdo exam

Answer 10

Inspect:
- PD cath, other iatrogenic
- scars
- swelling
- prune belly (Eagle-Barrett Triad: deficient abdo musculature, cryptochidism, urinary tract abnormalities)

Palpate:
- comment on abdo wall musculature
- tenderness
- ballot kidneys
- measure transplant kidney. Is it tender?

Shifting dullness - Ascites

Percuss:
- bladder from umbilicus down - loud when reach bladder ? Retention

Auscultate: renal arteries ? Bruits

Question 11

Lower limbs

Answer 11

Ankle oedema
Inspect muscle bulk, nail changes
Stand - inspect for deformities
Gait + reflexes - peripheral neuropathy of CKD

Question 12

What to ask for at end!

Answer 12

Temp chart
UA

Question 13

Define nephrotic syndrome

Answer 13

Proteinuria
Oedema
Low albumin

Question 14

Define nephritic syndrome

Answer 14

Haematuria +++

Question 15

Signs of renal allograft rejection

Answer 15

Fever, tenderness
Rise in creatinine
Worsening HTN
Proteinuria

Question 16

CKD invx

Answer 16

Request UA!
Nephrotic - protein; nephritic - blood

Bloods:
- FBC (anaemia)
- EUC, CMP, albumin (low nephrotic)
- bones: phosphate, bicarbonate, PTH, vit D
- complement C3, C4

Only nephritic:
- ASOT (post strep GN)
- serum IgA (IgA nephropathy)
- ESR + CRP (up HSP, some nephritic)
- anti-dsDNA + ANCA

Imaging
- US KUB
- DMSA (scarring, morphology, function)
- MAG3 (obstruction)

Tachypnoea? VBG for acidosis

Question 17

CKD DDx
Non-glomerular

Answer 17

CAKUT most common
- obstructive uropathy eg VUR
- aplastic, hypoplastic or dysplastic kidneys
- Polycystic KD
- cytinosis
- wilms (BWS)

Question 18

Nephrotic syndrome DDx

Answer 18

Protein, oedema, low albumin
Minimal change disease
Focal segmental glomerularsclerosis
Membranous nephropathy
Congenital NS
Secondary - diabetes, amyloidosis

Question 19

Hearing loss and nephritic

Answer 19

Alport
SNHL
X-linked

Question 20

CKD and eye things

Answer 20

Nephronophthisis
Cliopathy - so extra renal features

Senior Loken: RP, visual, dev delay
Jouberts: nystagmus, coloboma, cerebellar abnormalities
Bardet-biedel: poor night visions, tunnel vision, obesity, polydactyl