renal history and ddx

Question 1

renal systems review

Answer 1

pain - loin pain, renal colic, dysuria
difficulty with micturition - frequency, nocturia, retention
obstructive symptoms - incontinence, pis-en-deux, hesitancy, dribbling, poor stream
alteration in amount of urine - polyuria, oliguria, anuria
alteration in general appearance of urine - colour, frothy, offensive odour, haematuria
fever
urethral discharge
symptoms of CRF - breathlessness, oedema, anorexia, fatigue, itch, vomiting, bruising, persistent hiccups

Question 2

phx absolute core

Answer 2

Have you had diabetes, high blood pressure, cardiovascular disease or peripheral vascular disease?

Question 3

phx acute (7)

Answer 3

Have you had ever had a urinary tract infection?
Have you had kidney infections recently or as a child?
Have you ever had inflammation of the kidneys (GN) or frothy urine?
Have you passed blood in the urine?
Have you had kidney stones or urinary obstruction?
Have you ever had cancer treated with chemotherapy or radiotherapy?
Have you had any episodes of AKI?

Question 4

phx chronic (5)

Answer 4

Have you had problems with swelling or shortness of breath? (Fluid retention)
Have you had problems with rashes or arthritis? (SLE, scleroderma)
Have you had gout?
Have you had bedwetting beyond the age of 3?
Vesicoureteric reflux and subsequent renal scarring
Have you been told how bad your kidney function is and whether you may need dialysis one day?

Question 5

phx procedures (3)

Answer 5

Have you had a biopsy of your kidney? Do you know the result?
Have you had kidney surgery or removal of a kidney, or have you been told you have only one functioning kidney?

Question 6

fhx (ABKD)

Answer 6

Alport’s syndrome - deafness and renal impairment
Blood pressure
Chronic kidney disease
Is there a history of kidney disease in the family?
Is there a history in the family of enlarged kidneys and high blood pressure? (PCKD)
Diabetes

Question 7

mhx (principles)

Answer 7

What medications are you taking? Are you on any medications to help your kidney function?
CKD - fluids/Na/K, phosphate, protein

Question 8

mhx (specifics) (STAND)

Answer 8

Steroids/immunosuppressants
Treatment for hypertension
Antibiotics for UTIs
NSAIDs
Dosages of drugs cleared by kidneys must be adjusted

Question 9

ddx transient incontinence

Answer 9

UTIs
Delirium
Excess urine output (e.g. diuretics)
Immobility (unable to reach toilet)
Urethritis/vaginitis
Stool impaction

Question 10

ddx established incontinence

Answer 10

Stress incontinence
Urge (detrusor overactivity) 
Detrusor underactivity 
Overflow incontinence
Vesico/urethral fistula

Question 11

stress incontinence

Answer 11

after stress of coughing or other rise in intra-abdominal pressure (more common in women)

Question 12

urge incontinence

Answer 12

intense urge to urinate and then leakage of urine in the absence of rise in intra-abdominal pressure (men and women)

Question 13

detrusor underactivity

Answer 13

frequency, nocturia, frequent leaking of small amounts of urine (due to neurological disease)

Question 14

overflow incontinence

Answer 14

dribbling incontinence after incomplete urination (typically in men with prostate disease)

Question 15

vesico/urethral fistula

Answer 15

complication of obstructive labour

Question 16

ddx haematuria

Answer 16

UTI
Renal calculi
Trauma
Malignancy
Nephritic syndrome
Bleeding disorder
Use of anticoagulant drugs
Non-glomerular source - clots in urine
Blood not in urine (menstruation)