Renal History Taking and Fluid Balance Assessment Flashcards
What are some examples of presenting complaints in urology?
- Dysuria
- Haematuria
- Passing too much urine
- LUTS
- Urinary Retention
- Incontinence
What systems should be considered during systems review that affect blood flow to the kidneys?
- Cardiovascular related diseases e.g HTN and heart failure
- Infectious diseases e.g sepsis and HIV
- Systemic Inflammatory Diseases e.g sarcoidosis, rheumatological disorders e.g SLE
Affect blood flow to kidneys therefore GFR affected
What systems should be considered during systems review that obstruct urine flow?
- Myeloma and malignancy e.g myeloma, prostate cancer, renal cancer carcinoma
- Neurological e.g stroke, multiple sclerosis, spina bifida
- Other e.g drug induced, BPH, trauma, pregnancy
Obstruct urine flow and affect GFR this way
Why is drug history so important during renal history taking?
- Majority of drugs are excreted renally
- May be the cause of the problem or lack of excretion may be the cause of symptoms
Why are allergies so important during renal history taking?
- Drugs causing allergic skin reactions can cause the same effect on kidneys
Why is social history so important during renal history taking?
- Smoking related cardiovascular disease is a major cause of chronic kidney disease.
- Association between alcohol consumption and IgA nephropathy due to liver cirrhosis
- Association between bladder cancer and benzene occupational exposure and vasculitis with petrochemical exposure.
- Cocaine can cause reduction in renal blood flow
What are some steps that can be taken following a renal history?
- Physical examinations e.g cardiovascular/abdominal examinations - urological DRE and genitalia examinations if necessary
- Investigations
- Fluid Balance Assessment
What are you looking for in a fluid balance assessment?
Signs of hypo or hypervolaemia
Name some things you would do during a fluid balance assessment.
FULL LIST IS ON GEEKY MEDICS
What are some action steps that can be taken following fluid balance assessments?
- Fluid balance charts
- Monitoring fluid intake
- Monitoring output (urine, drains, vomit, blood)
- Daily weights (1L = 1kg)
- Urinary sodium measurement
- Urine osmolality paired with serum
- U+E (Sodium levels, urea and eGFR)
- Imaging e.g. CXR (pulmonary oedema)
What kind of blood tests could be considered following fluid balance assessments?
- Full blood count: may reveal a raised haematocrit in hypovolaemic patients and a sudden drop in haemoglobin in patients with ongoing haemorrhage.
- Urea and electrolytes: urea/creatinine will be raised in hypovolaemic patients and in those with acute or chronic renal disease. Electrolytes such as sodium may be low in hypervolaemic patients (e.g. dilutional hyponatraemia).
What is the normal physiology behind ADH when there is no diabetes insipidus? PART 1
- Vasopressin produced by the hypothalamus in response to increased serum osmolality - detected by osmoreceptors
- Vasopressin transported to the posterior pituitary gland, where it is released into the blood.
- Vasopressin then travels to kidneys where it binds to vasopressin receptors on the DCT.
- Binding causes aquaporin-2 channels to move from the cytoplasm into the apical membrane of the tubules:
- Aquaporin-2 channels allow water to be reabsorbed out of the collecting ducts and back into the bloodstream
What is the normal physiology behind ADH when there is no diabetes insipidus? PART 2
- Results in both a decrease in volume and an increase in osmolality (concentration) of the urine being excreted
- extra water that has been reabsorbed re-enters the circulatory system, reducing serum osmolality.
- Reduction in serum osmolality is detected by the hypothalamus as negative feedback, resulting in decreased production of vasopressin.
