RENAL SYSTEM Flashcards
What are some presenting symptoms in a genitourinary history for renal issues?
Change in urine appearance, abnormalities of micturition, suprapubic or flank pain, and systemic symptoms of renal failure.
What are the main elements of a renal system physical examination?
General impression, normal vital signs, inspection, palpation, percussion, and auscultation.
Describe the blood supply to the kidneys.
Supplied by renal arteries with branches: inferior adrenal, capsular, and ureteric arteries; these divide into segmental arteries and arterioles serving glomeruli.
What nerves innervate the kidneys?
The renal plexus with sympathetic nerves, receiving inputs from the coeliac and aorticorenal plexuses and the least splanchnic nerve.
List some general physical signs of renal disease.
Pallor, edema, muscle wasting, petechiae, pruritus, hypertension, and asterixis.
What is Beau’s lines and how do they appear?
Transverse linear depressions on nails indicating arrested growth due to factors like anticancer therapy or malnutrition.
What are some causes of dry skin (xeroderma)?
Advanced age, dehydration, certain medications, cold climate, and dermatological conditions.
How is dehydration assessed in patients?
By checking for dry mucous membranes and reduced skin turgor.
Define anasarca
Generalized edema, often due to conditions like heart failure, kidney disease, or hypoalbuminemia.
What are “half and half nails”?
Nails with distinct transverse bands, associated with chronic renal failure and other diseases.
Describe an arterio-venous fistula.
A surgically created connection between an artery and vein for hemodialysis access in chronic kidney disease.
What is uraemia?
Accumulation of urea and other waste products due to kidney failure, often presenting with sallow skin and malaise.
What is uraemic frost?
Fine white powder of crystallized urea on the skin, seen in terminal chronic kidney disease.
What is uraemic fetor?
A fishy or musty smell in the breath due to high urea concentration in saliva.
What can cause discoloured urine?
Hematuria, hemoglobinuria, infections, and medications.
What are common causes of urinary retention?
Urethral obstruction, autonomic neuropathy, medications, and spinal cord lesions.
Define cystitis and its common causes.
Inflammation of the bladder, usually from bacterial infections like E. coli.
What are symptoms of acute pyelonephritis?
Fever, loin pain, bacteriuria, and sometimes nausea and vomiting.
What is Acute Kidney Injury (AKI)?
Rapid kidney function impairment, characterized by increased serum creatinine and reduced urine output.
Describe Chronic Kidney Disease (CKD).
A progressive decline in kidney function with a spectrum of underlying pathologies.
What is nephrotic syndrome?
Characterized by heavy proteinuria, hypoalbuminemia, hypercholesterolemia, edema, and hypertension.
What are renal stones and their main types?
Calcifications in the urinary tract, mainly calcium oxalate and phosphate stones.
What is the function of the glomerulus in the kidney?
It filters blood, allowing water and small molecules to pass while retaining larger molecules like proteins and blood cells.
How is periorbital edema related to nephrotic syndrome?
It is a classic symptom due to severe protein loss and low albumin levels.
Describe polycystic kidney disease (PKD).
A genetic disorder marked by renal cysts and associated with hypertension and progressive CKD.
What is a common risk of untreated nephrolithiasis?
Increased risk of End-Stage Kidney Disease (ESKD), bone disease, and cardiovascular complications.
What is the main function of the renal tubules?
They reabsorb water, electrolytes, and nutrients back into the bloodstream while excreting waste products into urine.
What is “renal parenchyma”?
The functional tissue of the kidney, which includes the glomeruli and tubules responsible for filtration and urine production.
How does diabetes increase the risk of kidney disease?
High blood glucose levels damage blood vessels in the kidneys, impairing their filtering capacity.
What is the purpose of performing a urine dipstick test?
To check for substances like protein, glucose, blood, and ketones, which can indicate renal pathology.
Describe the role of the juxtaglomerular apparatus in the kidney.
It regulates blood pressure and GFR through the release of renin in response to changes in blood flow.
Explain the concept of “glomerular filtration rate” (GFR).
GFR is a measure of kidney function, estimating how much blood passes through the glomeruli each minute.
What is oliguria, and what conditions may cause it?
Oliguria is low urine output, commonly caused by dehydration, shock, acute kidney injury, or obstructive uropathy.
What does the presence of protein in urine indicate?
It suggests potential kidney damage, as proteins are normally retained in the blood and not excreted in urine.
What is the significance of “renal bruit” heard during auscultation?
It may indicate renal artery stenosis or other vascular abnormalities affecting blood flow to the kidney.
Define the term “nephrotoxic” and provide examples
Nephrotoxic substances are harmful to the kidneys, such as certain antibiotics (e.g., aminoglycosides) and NSAIDs.
What are “renal cysts,” and in which condition are they commonly seen?
Renal cysts are fluid-filled sacs in the kidneys, often seen in polycystic kidney disease (PKD).
How does hypertension contribute to kidney damage?
High blood pressure damages kidney blood vessels over time, reducing their ability to filter blood efficiently.
What is hydronephrosis, and what are common causes?
Hydronephrosis is the swelling of a kidney due to urine buildup, often caused by obstruction (e.g., stones, strictures).
Explain the relationship between kidney function and electrolyte balance.
Kidneys maintain electrolyte balance by adjusting reabsorption and excretion of sodium, potassium, and other ions based on body needs.
A 50-year-old man presents with pallor, muscle wasting, and hypertension. On inspection, he has edema and asterixis.
Chronic Kidney Disease (CKD)
A 25-year-old woman has fever, severe flank pain, nausea, and costovertebral angle tenderness. Urinalysis shows significant bacteriuria.
Acute Pyelonephritis
A patient shows signs of dry mucous membranes, reduced skin turgor, and recent history of severe diarrhea and vomiting.
Dehydration
A 45-year-old man with chronic kidney disease has a sallow complexion and complaints of malaise and anorexia. His skin shows a bronze tint.
Uraemia
A 60-year-old man presents with anasarca, shortness of breath, and elevated capillary hydraulic pressure. He has heart failure and visible edema.
Anasarca (generalized edema) secondary to heart failure
A 40-year-old woman reports fishy-smelling breath, and her laboratory results indicate high levels of urea in the blood.
Uraemic Fetor (Ammonia/Fishy Breath)
A 28-year-old male shows transverse linear depressions across his fingernails. He recently underwent chemotherapy.
Beau’s Lines (associated with chemotherapy)
A 70-year-old patient with end-stage kidney disease presents with fine white powder on his skin.
Uraemic Frost
A 30-year-old man presents with frequent kidney stones, and urinalysis reveals calcium oxalate crystals. He has a recurrent history of renal calculi.
Nephrolithiasis (Renal Stones)
A patient presents with urine discoloration and reports recent catheterization. They have hematuria.
Hematuria (potential trauma to the renal tract from catheterization)
A 60-year-old woman with chronic renal failure has nails showing a proximal white portion with a brown distal band.
Half and Half Nails (Lindsay’s Nails)
A diabetic patient reports difficulty emptying his bladder. Examination reveals an enlarged prostate.
Urinary Retention (likely due to benign prostatic hyperplasia)
A 50-year-old male presents with suprapubic pain, urinary urgency, and dysuria. Laboratory tests show E. coli bacteriuria.
Cystitis (acute bacterial infection)
A patient undergoing regular hemodialysis has an abnormal connection between an artery and a vein, which produces a bruit on auscultation.
Arterio-Venous Fistula
A 45-year-old patient with advanced kidney disease has severe edema around the eyes and hypoalbuminemia.
Nephrotic Syndrome
A 30-year-old female presents with persistent fatigue and generalized swelling. She has no history of heart disease, but examination reveals pitting edema in both legs and hypoalbuminemia. Urinalysis shows proteinuria without significant hematuria.
Nephrotic Syndrome
A 45-year-old man reports intermittent back pain, a feeling of fullness, and occasional flank tenderness. His blood pressure has been increasing over the past year, and he has a family history of “kidney problems.” Imaging reveals cystic structures in both kidneys.
Polycystic Kidney Disease (PKD)
A 55-year-old woman presents with mild yellowing of her skin and complains of itchy, dry patches on her arms and legs. She has a longstanding history of diabetes and hypertension, and her laboratory tests reveal elevated urea levels.
Uraemia with associated pruritus and xeroderma
A 40-year-old man with a history of recurrent respiratory infections and no known renal disease reports shortness of breath. Physical examination shows pale skin with nail abnormalities, including white transverse bands. Lab tests indicate mild renal impairment.
Half and Half Nails (Lindsay’s Nails) potentially indicating Chronic Renal Failure
A 65-year-old woman complains of abdominal discomfort, decreased urine output, and recent swelling in her lower extremities. She has been taking NSAIDs for chronic arthritis. Her lab results reveal elevated serum creatinine and blood urea nitrogen.
Acute Kidney Injury (AKI) likely induced by NSAIDs
A 50-year-old man with a history of hypertension and no recent infections reports mild flank pain. Urinalysis reveals microscopic hematuria but no proteinuria. Imaging is negative for stones.
Glomerulonephritis (may present with isolated hematuria and minimal signs)
28-year-old woman with no significant medical history presents with generalized weakness and a distinct smell on her breath. She describes it as “strange” and “metallic.” Blood tests show elevated blood urea levels.
Uraemic Fetor (fishy/ammoniacal breath) indicative of Chronic Kidney Disease
A 60-year-old man presents with unexplained nausea, hiccups, and occasional vomiting. He has a history of poorly controlled hypertension, but no recent infections or GI issues.
Advanced Uraemia (hiccups can be an ominous sign of advanced uraemia in CKD)
