Renal Flashcards
Possible cause of jaundice in renal failure?
Hepatorenal syndrome - complication of liver cirrhosis, severe renal vasconstriction
What’s this? Associated with what?
Aniridia (have poor vision and photophobia)
Associated with Wilms tumour
WAGR - wilms tumour, aniridia, genitourinary abnormalities, retardation
What’s this?
Band keratopathy - cloudy line from calcium build up
IHUGVIDEP - important things
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
Upper limb
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
Face (not eyes)
Malar flush
Hirsute
Periorbital oedema
Hearing - impaired Alport or aminoglycosides
Mouth - dry, uremic breath
Neck
JVP - measure at 45 degrees, increased w CKD
Cervical LNs
Eyes
Aniridia
Conjunctiva pallor
Jaundice - sclera icterus
Band keratopathy
Cataract - steroids
On fundo: retinopathy or retinitis pigmentosa
Chest exam for Renal
Anterior:
- rib rosary (rickets)
- palpate apex beat, heaves and thrills,
- auscultate heart
Posterior:
- lung fields - pleural effusion and pulmonary oedema
- sacral oedema
Abdo exam
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
Lower limbs
Ankle oedema
Inspect muscle bulk, nail changes
Stand - inspect for deformities
Gait + reflexes - peripheral neuropathy of CKD
What to ask for at end!
Temp chart
UA
Define nephrotic syndrome
Proteinuria
Oedema
Low albumin
Define nephritic syndrome
Haematuria +++
Signs of renal allograft rejection
Fever, tenderness
Rise in creatinine
Worsening HTN
Proteinuria
CKD invx
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
CKD DDx
Non-glomerular
CAKUT most common
- obstructive uropathy eg VUR
- aplastic, hypoplastic or dysplastic kidneys
- Polycystic KD
- cytinosis
- wilms (BWS)
Nephrotic syndrome DDx
Protein, oedema, low albumin
Minimal change disease
Focal segmental glomerularsclerosis
Membranous nephropathy
Congenital NS
Secondary - diabetes, amyloidosis
Hearing loss and nephritic
Alport
SNHL
X-linked
CKD and eye things
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
