2: Presentation of renal disease

Question 1

What type of pain is seen in kidney disease?

Answer 1

Loin pain

posterior flanks

Question 2

What are some urinary symptoms of kidney disease?

Answer 2

Oiligouria

Polyuria

Haematuria

Question 3

What may be detected in the urine?

Answer 3

Blood - haematuria

(Myoglobin - same colour, sign of rhabdomyolysis)

Protein - proteinuria

Urea - uraemia, sign of serious disease

Glucose - sign of diabetes

Ketones - signs of DKA

Question 4

What is a common cardiovascular presentation of kidney disease?

Answer 4

Hypertension

Question 5

Kidney disease can be ___ or ___.

Answer 5

primary

secondary (as in systemic disease)

Question 6

Kidney disease can present ___ or ___.

Answer 6

acutely

chronic

Question 7

What symptoms are produced by the failure of the kidneys to control fluid balance?

Answer 7

Fluid retention

Oedema

Question 8

What signs are produced by the failure of the kidneys to control acid base balance?

Answer 8

Metabolic acidosis

Kussmaul breathing

Question 9

What types of disease are caused by the failure of the kidney to metabolise Vitamin D?

What is the active form of Vitamin D called?

Answer 9

Bone disease

Calcification of vessels (e.g digital arteries, renal arteries, aorta…)

Calcitriol

Question 10

What hormone, produced by the kidneys, causes anaemia if it is deficient?

Answer 10

Erythropoeitin

Question 11

What causes proteinuria?

Answer 11

Loss of barrier to proteins of kidneys

Question 12

What is a vital sign which should always be checked in people with renal disease?

Answer 12

BP

Question 13

What investigation analyses the urine of people with suspected kidney disease?

Answer 13

Urinalysis

Question 14

What are some systemic diseases which can cause nephropathy?

Answer 14

Diabetes (complications)

Connective tissue diseases e.g SLE

Vasculitis

CVD (e.g renal artery stenosis)

Question 15

What drugs can cause kidney disease?

Answer 15

Anti-hypertensives (ACEIs, ARBs, diuretics)

NSAIDs

Antibiotics (gentamicin, trimethoprim, penicillins)

PPIs

Question 16

What substances, used in MRI and CT scans, can cause nephropathy?

Answer 16

Contrast

Question 17

What does trimethoprim cause, mimicking kidney disease?

Answer 17

Raised creatinine

Question 18

What should always be asked about in a drug history?

Answer 18

OTC drugs

Herbal remedies

Question 19

What acute arthropathy can be caused by chronic kidney disease?

Answer 19

Gout

Question 20

Above which BP is someone hypertensive?

Answer 20

140 / 90 mmHg

Question 21

People with chronic kidney disease must maintain good control of what?

Answer 21

BP

Question 22

What type of hypertension can kidney disease cause?

What is it associated with?

Answer 22

Accelerated hypertension (diastolic > 120)

Papilloedema, organ failure

Question 23

___ hypertension due to kidney disease must be treated urgently.

Answer 23

Accelerated

Question 24

What nail sign is seen in chronic kidney disease?

Answer 24

Leukonychia

Question 25

What sign is seen in the skin in **gout**?

Answer 25

**Tophi**

Question 26

What nail sign may be seen in patients with **haematuria** and is also seen in infective endocarditis and vasculitis?

Answer 26

**Splinter haemorrhages**

Question 27

What type of **vasculitis** is seen on the **extensor surfaces** **of the thighs and buttocks**? What symptoms is it associated with?

Answer 27

**Henoch-Schonlein purpura** Abdominal pain, ***joint pain*** (is the big one according to peer tutor)

Question 28

What is a **significant** indicator of renal disease on urinalysis?

Answer 28

**Proteinuria**

Question 29

What might suggest a UTI on urinalysis?

Answer 29

**Elevated white blood cells**

Question 30

What is the gold standard for classifying proteinuria?

Answer 30

**24h urine collection**

Question 31

What test is not gold standard but gives an indication of proteinuria?

Answer 31

**Protein/creatinine ratio**

Question 32

What can be done with urine to see if there is bacterial infection?

Answer 32

**Microscopy**

Question 33

What is a **urinary cast**?

Answer 33

**Protein mould of urinary tract**

Question 34

What types of urinary cast are associated with: a) nephritic syndrome b) infection or inflammation c) chronic disease?

Answer 34

**a) Red cells** **b) Leukocytes** **c) Granular**

Question 35

What type of crystal makes up **renal calculi**?

Answer 35

**Calcium oxalate**

Question 36

What ECG changes are seen in a) LVH b) Hyperkalaemia?

Answer 36

**a) Increased voltage** (i.e taller waves) **b) Tall, tented P waves** & **shortened QT interval**

Question 37

Why do crush injuries or skeletal muscle death in general cause hyperkalaemia?

Answer 37

**Rhabdomyolysis** **Acute kidney injury** **Can't filter potassium** **Hyperkalaemia**

Question 38

How is kidney disease staged?

Answer 38

**GFR**

Question 39

What is **acute kidney injury**?

Answer 39

**Rapid (\<48h) increase in creatinine** (either by 26.4 or \>50% of original) or **Rapid decrease in urine output**

Question 40

Levels of which metabolite increase in AKI?

Answer 40

**Creatinine**

Question 41

What is **nephrotic** **syndrome**?

Answer 41

**Syndrome due to glOmerular damage**

Question 42

What are the triad of symptoms seen in **nephrotic syndrome**?

Answer 42

**Proteinuria** (\>3g/day) **Hypoalbuminaemia** **Oedema** O because patient swells up

Question 43

What does a patient with **nephrotic syndrome** look like?

Answer 43

**Swollen peripheries** (if severe enough, arms and orbits, which isn't seen in heart failure)

Question 44

Why don't you get periorbital oedema in heart failure?

Answer 44

**Orthopnoea** patient won't lie flat

Question 45

What is **nephritic syndrome**?

Answer 45

**Glomerulonephritis**

Question 46

What are the signs of **nephritic syndrome**?

Answer 46

**AKI** (proteinuria, increased creatinine, decreased GFR) ## Footnote **Oliguria** **Oedema** **Hypertension** **Sediment in urine**