renal disease Flashcards
where are the kidneys
retropritoneally on either side of vertebral columns from T12 to 13
functions kidney
elimination of waste material
regulation of volume and composition of body fluid
endocrine function - production of erythropoietin, renin, vit D in it’s active form
autocrine function - production of endothelin, prostaglandins, renal natriuretic peptide
symptoms suggesting renal tract disease
dysuria (pain on micturition)
frequency of micturition
urinary retention
haematuria
alteration of urine volume (either polyuria or oliguria)
pain anywhere on renal tract
non spec symps: lethargy, anorexia, pruritus
dysuria caused by
inflammation involving urethra (urethritis) or bladder (cystitis)
inflammation involving vagina or glans penis
polyuria
XS urine output > 3L in 24h
must be differentiated from urinary frequency and nocturia
causes of polyuria
XS thirst
diabetes insipidus
CKD
solute diuresis
oliguria
low urine output
maintained over several hours indicate AKI or UT obstruction
anuria
no urine
suggests bilateral ureteric or bladder outflow obstruction
first steps in renal disease investigation
estimation of eGFR is used to determine the degree of renal dysfunction
hx and exam
urine dipstick
urine microscopy
blood tests renal disease
urea and creatinine conc represents dynamic equilibrium between production and elimination but levels dont rise above normal until 50-60% reduction in gfr
urine dipstick
detects blood, protein, glucose, ketones, bilirubin, urobilinogen and pH
also nitrates and leucocyte elastase for UTIs
what on urine dipstick suggests renal tract disease
haematuria or proteinuria
blood only apparent at start of micturition suggests
urethral disease
blood at end of micturition suggests
bleeding from prostate or bladder base
blood as even discolouration throughout urine suggests
bleeding from source in bladder or above
