systemic disease and the kidney

Question 1

diagnoses of patients?

Answer 1

Symptoms of underlying condition, abnormal renal function –Symptoms of abnormal renal function, investigations reveal systemic disease •Immunological: Systemic Lupus Erythematosus (SLE, younger, ♀); ANCA-associated small vessel vasculitis (older); RhA; Sjogren’s syndrome; sarcoid •Haematological: Myeloma (older)

Question 2

intercurrent illness?

Answer 2

Hypotension •Renal hypoperfusion •Volume depletion –Haemorrhage, diarrhoea/vomiting •Cardiac –Acute myocardial infarction, poor left ventricular function •Infection –Urinary tract, systemic, may be trivial

Question 3

urinary symptoms?

Answer 3

Urinary Symptoms –Oliguria –Polyuria •Sufficient intake? –Dysuria •Urinary sepsis? –Haematuria •Visible, non-visible, recurrent? –Bladder outflow obstruction? •Hesitancy, poor stream, frequency, nocturia

Question 4

drugs?

Answer 4

Diuretics •Renin-angiotensin blockade •NSAIDs •Antibiotics •Recent changes •Many require dose alteration with renal impairment

Question 5

examination/

Answer 5

General appearance •Vital signs: temperature, pulse, blood pressure, respiratory rate •Volume status •Jugular venous pressure •Respiratory pattern (acidosis), pulmonary oedema •Abdominal masses, palpable bladder, rectal examination •Peripheral oedema (face/ankle/sacral) •Skin, joints •Urinalysis

Question 6

Investigstions?

Answer 6

Urine tests –Dipstick – blood, protein – “active urinary sediment” –Biochemistry: protein:creatinine ratio, albumin:creatinine ratio, Bence-Jones protein •Blood tests –Haematology: FBC (film?), clotting screen –Biochemistry: urea, creatinine + electrolytes, bicarbonate, LFT’s, bone profile –Extras: immunology (ANA, ANCA, Igs, complement, RhF etc…), CK, PSA •Radiology –Renal ultrasound –CXR •Kidney Biopsy