S9) Signs and Symptoms of Renal Disease Flashcards
The spectrum of kidney disease is broad & presentations also numerous.
Describe 4 common presentations
- 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
Identify 6 causes of kidney disease
- Hypotension
- Diabetes
- Inflammatory conditions e.g. glomerulonephritis
- -* Cystic kidney disease
- Hypovolaemia
- Nephrotoxins
How does a patient with CKD present? (5 signs and symptoms)
- Fatigue / malaise
- Loss of appetite / weight
- Acute illness / recent infection
- Ankle swelling
- Haematuria / nocturia
What investigation abnormalities are observed in a patient with CKD?
- Abnormal blood result
- Abnormal urine dipstick
How does a patient present with AKI? (6 signs and symptoms)
- Fatigue / Malaise
- Ankle swelling
- Nausea & vomiting
- Pain (supra-pubic / loin / joints)
- Change in urine – amount / colour
- Fever
Identify 3 features in the history of a typical patient with AKI
- Preceding illness / infection
- Inter-current illness
- History of volume depletion
Which 5 questions regarding history should one ask a patient presenting with renal disease?
- Prescribed drugs (new, potential to cause renal function) ?
- OTC drugs?
- NSAIDs?
- Illicit drugs?
- Herbal medicines?
In the past medical history of a patient with renal disease, what 7 clinical conditions should one ask about?
- DM
- Hypertension
- IHD
- Cerebrovascular disease
- Known CKD (major risk for AKI)
- Enuresis in childhood (inability to control urine)
- Problems in pregnancy
With regards to the patient’s family history, which 6 conditions act as risk factors for renal disease?
- Kidney disease (inherited, CKD)
- DM
- Hypertension
- IHD / Cerebrovascular disease
- Auto-immune disease
- UTIs
Which 6 different systems does one review in a consultation with a patient with suspected renal disease?
- General
- Cardio-respiratory
- Genito-urinary
- Gastro-intestinal
- Central Nervous
- MSK
Which two symptoms does one check for in a general review of a patient presenting with renal disease?
- Change in weight
- Fever
Which three symptoms does one check for in a cardio-respiratory review of a patient presenting with renal disease?
- Chest pain
- Breathlessness
- Haemoptysis
In a cardio-respiratory system review, breathlessness, chest pain and/or haemoptysis are symptoms significant in which 6 clinical conditions?
- IHD
- Pericarditis
- Fluid overload
- Infection
- Anaemia
- Vasculitis
Which three symptoms does one check for in a GI review of a patient presenting with renal disease?
- Nausea & vomiting
- Diarrhoea
- GI blood loss
In a GI system review, diarrhea, nausea, vomiting and/or blood loss are symptoms significant in which 4 clinical conditions?
- Uraemia
- Infection
- Volume depletion
- Anaemia
Which three symptoms does one check for in a GU review of a patient presenting with renal disease?
- Varying urine volume
- Nocturia
- Haematuria
In a GU system review, nocturia, varying urine volume and/or haematuria are symptoms significant in which 4 clinical conditions?
- Oliguria / anuria
- CKD
- Infection
- Bleeding
Which three symptoms does one check for in a CNS review of a patient presenting with renal disease?
- Reduced cognition
- Hiccough
- Twitching
In a CNS system review, hiccough, reduced cognition and/or twitching are symptoms significant in which 2 clinical conditions?
- Uraemia
- Hypotension uraemia
Which 4 features of a patient’s social history, must ask about?
- Functional status (working, activities of daily living)
- Smoking
- Alcohol
- Drugs
What are the two vital elements in the examination and investigation of a patient presenting with renal disease?
- BP
- Urine dipstick (if passing urine)
Which 5 abnormalities does one look out for in the general examination of a patient with renal disease?
- Pallor
- Uraemia
- Nails
- Rashes
- Bruises
In a thorough cardio-respiratory examination of a patient with renal disease, which 4 features does one look out for?
- BP
- Fluid balance (JVP, RR, O2 saturation, chest sounds)
- Heart sounds (additional sounds/murmurs)
- Bruits
In a thorough GI&GU examination of a patient with renal disease, which 5 features does one look out for?
- Palpable masses (incl bladder)
- Pain (esp loin)
- Ballotable kidneys (rare)
- Abdominal bruits
- Urine output
In a urinalysis for a patient with renal disease, which 6 substances should one look out for in the urine dipstick?
- Protein
- Blood
- Glucose (threshold exceeded)
- Ketones
- White cells
- Nitrites (infection)
Which 3 different events could cause inaccuracies in a urinalysis?
- Extreme exercise (proteinuria & haematuria for up to 72 hours)
- Menstruation
- Indwelling catheters (always have infection)
Proteinuria varies on the time of day and concentration of urine.
When is best to perform this measurement?
Early morning
Identify 4 glomerular causes of proteinuria
- Glomerulonephritis
- Amyloidosis
- Fever
- Exercise
Identify 4 non-glomerular causes of proteinuria
- UTI
- Inflammation
- Kidney tubule damage (AKI/CKD)
- Myoglobin/haemoglobin abnormalities
What are the 4 different mechanisms of proteinuria?
What does haematuria indicate?
- GN – damage to endothelium
- Damage anywhere in urinary tract
Identify 5 renal causes of haematuria
- Renal infarct
- Renal carcinoma
- Renal cysts
- Glomerulonephritis
- Trauma
Identify 2 ureteral causes of haematuria
- Stone
- Carcinoma
Identify 4 causes of haematuria in relation to the bladder
- Cystitis
- Trauma
- Stone
- Carcinoma
Identify 4 urethral causes of haematuria
- Stone
- BPH
- Trauma
- Prostatic carcinoma
Few white cells in urine is normal but this does not show on urine dipstick.
What do white cells in the urine indicate?
Infection & inflammation of urinary tract
Identify 5 clinical conditions which are positive with white cells in the urine
- Infection
- GN
- Interstitial nephritis / cystitis
- Neoplasms
- Stones
When would white cells (leukocytes) in the urine give a false negative result?
Contamination with vaginal secretions
Urine microscopy can be used in the investigation of an infection.
What are common abnormalities observed?
- Crystals (gout, pseudogout)
- Casts
- Red cell casts
