The Approach to the Patient with Kidney Disease Flashcards
Give examples of symptoms which may suggest an Upper Urinary Tract pathology (affecting kidneys)
Severe colicky pain which may radiate to groin or testicle, or haematuria
Lower urinary tract symptoms (affecting bladder and urethra) can be divided into two different pathologies - what are they?
- Obstructive voiding
- Storage related
Give six examples of Obstructive Voiding Lower urinary tract symptoms (affecting bladder and urethra)?
- Hesitancy
- Delay in initiating urination
- Weak urinary stream
- Straining to void
- Incomplete emptying
- Terminal dribbling
Give six examples of Storage related Lower urinary tract symptoms (affecting bladder and urethra)?
- Polyuria
- Nocturia
- Urgency
- Incontinence
- Bladder pain
- Dysuria
What are the three symptoms which describe urine volume abnormalities?
Polyuria (high), oligouria (low), anuria (absent)
Give three differentials for polyuria
Early chronic kidney disease
Osmotic diuretic use
Post renal obstruction
Give one cause for oligouria
Acute kidney injury
Give two differentials for anuria
Severe acute kidney injury
Post renal obstruction
Why might urine appear dark yellow?
Urine may be concentrated or have presence of bile pigments
Why may urine appear pink?
Haematuria or beeturia
Why may urine appear red?
Haematuria
Why may urine appear browny red?
Muscle breakdown; rhabdomyolysis
Why may urine appear cloudy?
Excess white cells due to infection
Why may urine appear frothy?
Proteinuria
Why may urine show presence of debris?
Infection
Vesico-colic fistula
Renal papillary necrosis
Why may urine show presence of air?
Vesico-colic fistula
In Urine testing via a Multistix, what enzyme is detected for presence of Leukocytes?
Leukocyte esterase
In Urine testing via a Multistix, what is detected for presence of bacteria?
Nitrites
In Urine testing via a Multistix, what is detected for suggestion of Haemolysis?
Urobillinogen
In Urine testing via a Multistix, detection of protein suggests?
Glomerular injury
In Urine testing via a Multistix, detection of a high pH suggests what two differentials?
Bacterial infection
Renal tubular acidosis
In Urine testing via a Multistix, detection of blood suggests what two differentials?
Uroepithelial damage
Glomerular damage
In Urine testing via a Multistix, detection of ketones suggests?
Ketoacidosis
In Urine testing via a Multistix, detection of bilirubin suggests?
Obstructive jaundice
In Urine testing via a Multistix, detection of glucose suggests?
Diabetes mellitus
In a biochemical profile of urine, creatinine levels can be used as an estimate for?
Glomerular filtration rate (GFR)
What imaging technique is most appropriate for kidneys? Why?
Ultrasound: cheap, non-invasive, no radiation, no risk, can be used to assess renal size and anatomical features
Sodium / water retention can lead to what symptoms?
Periperal oedema - swellings on feet
Pulmonary oedema - breathlessness
What is more common, primary or secondary hypertension?
Primary
How might secondary hypertension occur by renal artery stenosis?
Renal artery stenosis means BP in kidneys will be low due to reduced perfusion, causing an increase in renin release which causes renin mediated hypertension an a systemic rise in BP
How might glomerular damage manifest in urine?
Proteinuria
Visible / non-visible haematuria
Describe why PCKD has a bimodal age distribution
Two genes are involved: APKD1, which presents symptoms in pts aged 30-40 and APKD2, which presents symptoms in pts aged 70
What is inheritance pattern for PCKD?
Autosomal dominant
What are the disadvantages of dialysis use?
- Patients have complex medical problems
- Frequent hospital admissions
- Depression / psychological issues
- Heavy burden on time
- Fluid / diet restriction
- Employment difficulties
- Impact of home treatments on home
- Cost to health provider
