Renal History and Hypernatraemia

Question 1

what are common presenting complaints in a renal history?

Answer 1

• dyspnoea
• leg swelling
• nausea and vomiting
• upper airway symptoms
• constitutional symptoms
• LUTS
• flank pain

Question 2

what is important to explore in a patient presenting with dyspnoea?

Answer 2

• exercise tolerance
• triggers
• relieving/aggravating factors
• orthopnoea/PND
• associated symptoms

Question 3

what is important to explore in a patient presenting with leg swelling?

Answer 3

• site, severity
• time of onset
• amount of fluid intake
• DHx and THx

Question 4

what is important to explore in a patient presenting with nausea and vomiting?

Answer 4

• triggers
• aggravating/ relieving factors
• are they able to keep down food?
• bowel frequency
• associated symptoms

Question 5

what is important to explore in a patient presenting with upper airway symptoms?

Answer 5

• symptoms (nasal secretions, sinusitis, epistaxis, haemoptysis, sore throat)
• visual disturbances
• hearing loss

Question 6

what is important to explore in a patient presenting with constitutional symptoms?

Answer 6

• fever
• joint pains
• muscle aches
• weight changes
• lethargy
• night sweats
• pruritis

Question 7

what is important to explore in a patient presenting with LUTS?

Answer 7

dysuria, frequency, quantity of urine, colour of urine, frothiness, haematuria

Question 8

what is important to explore in a patient presenting with flank pain?

Answer 8

SOCRATES/SQUITARS

Question 9

what is important in a past medical history when taking a renal history?

Answer 9

• AKI/ CKD (causes and any hospital admissions)
• CVS risk factors (DM, HTN, hypercholesterolaemia)
• recent UTIs
• childhood infections
• cancers
• previous surgeries

Question 10

what is important in a family history when taking a renal history?

Answer 10

• renal disease
• CVS disease
• diabetes
• hypertension

Question 11

what are the results that put a patient in metabolic alkalosis?

Answer 11

• pH = high
• bicarbonate = high
• pCO2 = normal

Question 12

what are the results that put a patient in metabolic acidosis?

Answer 12

• pH = low
• bicarbonate = low
• pCO2 = normal/ low

Question 13

what is the anion gap and what is it’s normal range?

Answer 13

a calculation that helps work out what could be the cause of a patient’s acidosis state
normal range = 8-12

Question 14

how do you calculate the anion gap?

Answer 14

[Na+] - [Cl-] + [HCO3-]

Question 15

if the anion gap is high, what tends to be the cause of the acidosis?

Answer 15

acidosis due to increased acid (e.g. lactic acidosis, ketoacidosis, toxins, or renal failure)

Question 16

if the anion gap is normal, what tends to be the cause of the acidosis?

Answer 16

acidosis due to reduced alkali (e.g. GI or renal losses of HCO3-, or toxins)

Question 17

true or false: diabetes is the only way someone can get ketoacidosis

Answer 17

false.

ketoacidosis can also occur if there is alcohol abuse or starvation

Question 18

what causes renal losses of HCO3-?

Answer 18

• renal tubular acidosis

- mineralcorticoid deficiency (Addison’s)

Question 19

what is the most common cause of hypernatraemia?

Answer 19

dehydration

Question 20

what are the consequences of hypernatraemia on a cellular level?

Answer 20

• causes cellular dehydration (water moving out of the cells)
• creates vascular shear stress (bleeding and thrombosis)

Question 21

what are the common symptoms of hypernatraemia?

Answer 21

thirst, irritability, weakness, confusion, reduced GCS, seizures, hyper-reflexia, spasticity, and coma

Question 22

what are the causes of hypovolaemic hypernatraemia?

Answer 22

• renal free water losses (NG feed tube, loop diuretics, intrinsic renal disease)
• non-renal free water losses (sweating, burns, diarrhoea, fistulas)

Question 23

what are the causes of euvolaemic hypernatraemia?

Answer 23

• renal losses (diabetes insipidus, hypodipsia)

- extra-renal losses (respiratory losses)

Question 24

what are the causes of hypervolaemic hypernatraemia (excess Na)?

Answer 24

• primary hyperaldosteronism
• Cushing’s syndrome
• hypertonic dialysis
• hypertonic NaCO3
• exogenous sodium

Question 25

how is diabetes insipidus diagnosed?

Answer 25

• dilute urine (osmolality <300)

- polydipsia and polyuria

Question 26

what causes diabetes insipidus?

Answer 26

impaired release of ADH (cranial DI) or increased resistance to ADH (nephrogenic DI)

Question 27

what are common causes of cranial diabetes insipidus?

Answer 27

trauma/post-op, tumours, cranial infection, cerebral vasculitis, TB

Question 28

what are the common causes of nephrongenic diabetes insipidus?

Answer 28

congenital, hypokalaemia, hypercalcaemia, tubulointerstitial disease

Question 29

how do you treat diabetes insipidus?

Answer 29

by giving the patient free water