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SA urinary > S9) Signs and Symptoms of Renal Disease > Flashcards

S9) Signs and Symptoms of Renal Disease Flashcards

1
Q

The spectrum of kidney disease is broad & presentations also numerous.

Describe 4 common presentations

A
  • Generalised symptoms e.g. tiredness & malaise
  • -* Symptoms related to the underlying causative disease

- Symptoms/signs of advanced renal impairment (acute or chronic)

  • Asymptomatic patient who has abnormal investigation findings
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2
Q

Identify 6 causes of kidney disease

A
  • Hypotension
  • Diabetes
  • Inflammatory conditions e.g. glomerulonephritis
  • -* Cystic kidney disease
  • Hypovolaemia
  • Nephrotoxins
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3
Q

How does a patient with CKD present? (5 signs and symptoms)

A
  • Fatigue / malaise
  • Loss of appetite / weight
  • Acute illness / recent infection
  • Ankle swelling
  • Haematuria / nocturia
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4
Q

What investigation abnormalities are observed in a patient with CKD?

A
  • Abnormal blood result
  • Abnormal urine dipstick
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5
Q

How does a patient present with AKI? (6 signs and symptoms)

A
  • Fatigue / Malaise
  • Ankle swelling
  • Nausea & vomiting
  • Pain (supra-pubic / loin / joints)
  • Change in urine – amount / colour
  • Fever
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6
Q

Identify 3 features in the history of a typical patient with AKI

A
  • Preceding illness / infection
  • Inter-current illness
  • History of volume depletion
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7
Q

Which 5 questions regarding history should one ask a patient presenting with renal disease?

A
  • Prescribed drugs (new, potential to cause renal function) ?
  • OTC drugs?
  • NSAIDs?
  • Illicit drugs?
  • Herbal medicines?
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8
Q

In the past medical history of a patient with renal disease, what 7 clinical conditions should one ask about?

A
  • DM
  • Hypertension
  • IHD
  • Cerebrovascular disease
  • Known CKD (major risk for AKI)
  • Enuresis in childhood (inability to control urine)
  • Problems in pregnancy
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9
Q

With regards to the patient’s family history, which 6 conditions act as risk factors for renal disease?

A
  • Kidney disease (inherited, CKD)
  • DM
  • Hypertension
  • IHD / Cerebrovascular disease
  • Auto-immune disease
  • UTIs
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10
Q

Which 6 different systems does one review in a consultation with a patient with suspected renal disease?

A
  • General
  • Cardio-respiratory
  • Genito-urinary
  • Gastro-intestinal
  • Central Nervous
  • MSK
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11
Q

Which two symptoms does one check for in a general review of a patient presenting with renal disease?

A
  • Change in weight
  • Fever
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12
Q

Which three symptoms does one check for in a cardio-respiratory review of a patient presenting with renal disease?

A
  • Chest pain
  • Breathlessness
  • Haemoptysis
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13
Q

In a cardio-respiratory system review, breathlessness, chest pain and/or haemoptysis are symptoms significant in which 6 clinical conditions?

A
  • IHD
  • Pericarditis
  • Fluid overload
  • Infection
  • Anaemia
  • Vasculitis
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14
Q

Which three symptoms does one check for in a GI review of a patient presenting with renal disease?

A
  • Nausea & vomiting
  • Diarrhoea
  • GI blood loss
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15
Q

In a GI system review, diarrhea, nausea, vomiting and/or blood loss are symptoms significant in which 4 clinical conditions?

A
  • Uraemia
  • Infection
  • Volume depletion
  • Anaemia
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16
Q

Which three symptoms does one check for in a GU review of a patient presenting with renal disease?

A
  • Varying urine volume
  • Nocturia
  • Haematuria
17
Q

In a GU system review, nocturia, varying urine volume and/or haematuria are symptoms significant in which 4 clinical conditions?

A
  • Oliguria / anuria
  • CKD
  • Infection
  • Bleeding
18
Q

Which three symptoms does one check for in a CNS review of a patient presenting with renal disease?

A
  • Reduced cognition
  • Hiccough
  • Twitching
19
Q

In a CNS system review, hiccough, reduced cognition and/or twitching are symptoms significant in which 2 clinical conditions?

A
  • Uraemia
  • Hypotension uraemia
20
Q

Which 4 features of a patient’s social history, must ask about?

A
  • Functional status (working, activities of daily living)
  • Smoking
  • Alcohol
  • Drugs
21
Q

What are the two vital elements in the examination and investigation of a patient presenting with renal disease?

A
  • BP
  • Urine dipstick (if passing urine)
22
Q

Which 5 abnormalities does one look out for in the general examination of a patient with renal disease?

A
  • Pallor
  • Uraemia
  • Nails
  • Rashes
  • Bruises
23
Q

In a thorough cardio-respiratory examination of a patient with renal disease, which 4 features does one look out for?

A
  • BP
  • Fluid balance (JVP, RR, O2 saturation, chest sounds)
  • Heart sounds (additional sounds/murmurs)
  • Bruits
24
Q

In a thorough GI&GU examination of a patient with renal disease, which 5 features does one look out for?

A
  • Palpable masses (incl bladder)
  • Pain (esp loin)
  • Ballotable kidneys (rare)
  • Abdominal bruits
  • Urine output
25
Q

In a urinalysis for a patient with renal disease, which 6 substances should one look out for in the urine dipstick?

A
  • Protein
  • Blood
  • Glucose (threshold exceeded)
  • Ketones
  • White cells
  • Nitrites (infection)
26
Q

Which 3 different events could cause inaccuracies in a urinalysis?

A
  • Extreme exercise (proteinuria & haematuria for up to 72 hours)
  • Menstruation
  • Indwelling catheters (always have infection)
27
Q

Proteinuria varies on the time of day and concentration of urine.

When is best to perform this measurement?

A

Early morning

28
Q

Identify 4 glomerular causes of proteinuria

A
  • Glomerulonephritis
  • Amyloidosis
  • Fever
  • Exercise
29
Q

Identify 4 non-glomerular causes of proteinuria

A
  • UTI
  • Inflammation
  • Kidney tubule damage (AKI/CKD)
  • Myoglobin/haemoglobin abnormalities
30
Q

What are the 4 different mechanisms of proteinuria?

A
31
Q

What does haematuria indicate?

A
  • GN – damage to endothelium
  • Damage anywhere in urinary tract
32
Q

Identify 5 renal causes of haematuria

A
  • Renal infarct
  • Renal carcinoma
  • Renal cysts
  • Glomerulonephritis
  • Trauma
33
Q

Identify 2 ureteral causes of haematuria

A
  • Stone
  • Carcinoma
34
Q

Identify 4 causes of haematuria in relation to the bladder

A
  • Cystitis
  • Trauma
  • Stone
  • Carcinoma
35
Q

Identify 4 urethral causes of haematuria

A
  • Stone
  • BPH
  • Trauma
  • Prostatic carcinoma
36
Q

Few white cells in urine is normal but this does not show on urine dipstick.

What do white cells in the urine indicate?

A

Infection & inflammation of urinary tract

37
Q

Identify 5 clinical conditions which are positive with white cells in the urine

A
  • Infection
  • GN
  • Interstitial nephritis / cystitis
  • Neoplasms
  • Stones
38
Q

When would white cells (leukocytes) in the urine give a false negative result?

A

Contamination with vaginal secretions

39
Q

Urine microscopy can be used in the investigation of an infection.

What are common abnormalities observed?

A
  • Crystals (gout, pseudogout)
  • Casts
  • Red cell casts

SA urinary (25 decks)

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