2: Presentation of renal disease Flashcards Preview

Renal Week 2 2017/18 > 2: Presentation of renal disease > Flashcards

Flashcards in 2: Presentation of renal disease Deck (46)
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1
Q

What type of pain is seen in kidney disease?

A

Loin pain

posterior flanks

2
Q

What are some urinary symptoms of kidney disease?

A

Oiligouria

Polyuria

Haematuria

3
Q

What may be detected in the urine?

A

Blood - haematuria

(Myoglobin - same colour, sign of rhabdomyolysis)

Protein - proteinuria

Urea - uraemia, sign of serious disease

Glucose - sign of diabetes

Ketones - signs of DKA

4
Q

What is a common cardiovascular presentation of kidney disease?

A

Hypertension

5
Q

Kidney disease can be ___ or ___.

A

primary

secondary (as in systemic disease)

6
Q

Kidney disease can present ___ or ___.

A

acutely

chronic

7
Q

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

A

Fluid retention

Oedema

8
Q

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

A

Metabolic acidosis

Kussmaul breathing

9
Q

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?

A

Bone disease

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

Calcitriol

10
Q

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

A

Erythropoeitin

11
Q

What causes proteinuria?

A

Loss of barrier to proteins of kidneys

12
Q

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

A

BP

13
Q

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

A

Urinalysis

14
Q

What are some systemic diseases which can cause nephropathy?

A

Diabetes (complications)

Connective tissue diseases e.g SLE

Vasculitis

CVD (e.g renal artery stenosis)

15
Q

What drugs can cause kidney disease?

A

Anti-hypertensives (ACEIs, ARBs, diuretics)

NSAIDs

Antibiotics (gentamicin, trimethoprim, penicillins)

PPIs

16
Q

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

A

Contrast

17
Q

What does trimethoprim cause, mimicking kidney disease?

A

Raised creatinine

18
Q

What should always be asked about in a drug history?

A

OTC drugs

Herbal remedies

19
Q

What acute arthropathy can be caused by chronic kidney disease?

A

Gout

20
Q

Above which BP is someone hypertensive?

A

140 / 90 mmHg

21
Q

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

A

BP

22
Q

What type of hypertension can kidney disease cause?

What is it associated with?

A

Accelerated hypertension (diastolic > 120)

Papilloedema, organ failure

23
Q

___ hypertension due to kidney disease must be treated urgently.

A

Accelerated

24
Q

What nail sign is seen in chronic kidney disease?

A

Leukonychia

25
Q

What sign is seen in the skin in gout?

A

Tophi

26
Q

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

A

Splinter haemorrhages

27
Q

What type of vasculitis is seen on the extensor surfaces of the thighs and buttocks?

What symptoms is it associated with?

A

Henoch-Schonlein purpura

Abdominal pain, joint pain (is the big one according to peer tutor)

28
Q

What is a significant indicator of renal disease on urinalysis?

A

Proteinuria

29
Q

What might suggest a UTI on urinalysis?

A

Elevated white blood cells

30
Q

What is the gold standard for classifying proteinuria?

A

24h urine collection

31
Q

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

A

Protein/creatinine ratio

32
Q

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

A

Microscopy

33
Q

What is a urinary cast?

A

Protein mould of urinary tract

34
Q

What types of urinary cast are associated with:

a) nephritic syndrome
b) infection or inflammation
c) chronic disease?

A

a) Red cells

b) Leukocytes

c) Granular

35
Q

What type of crystal makes up renal calculi?

A

Calcium oxalate

36
Q

What ECG changes are seen in

a) LVH
b) Hyperkalaemia?

A

a) Increased voltage (i.e taller waves)

b) Tall, tented P waves & shortened QT interval

37
Q

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

A

Rhabdomyolysis

Acute kidney injury

Can’t filter potassium

Hyperkalaemia

38
Q

How is kidney disease staged?

A

GFR

39
Q

What is acute kidney injury?

A

Rapid (<48h) increase in creatinine (either by 26.4 or >50% of original)

or

Rapid decrease in urine output

40
Q

Levels of which metabolite increase in AKI?

A

Creatinine

41
Q

What is nephrotic syndrome?

A

Syndrome due to glOmerular damage

42
Q

What are the triad of symptoms seen in nephrotic syndrome?

A

Proteinuria (>3g/day)

Hypoalbuminaemia

Oedema

O because patient swells up

43
Q

What does a patient with nephrotic syndrome look like?

A

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

44
Q

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

A

Orthopnoea

patient won’t lie flat

45
Q

What is nephritic syndrome?

A

Glomerulonephritis

46
Q

What are the signs of nephritic syndrome?

A

AKI (proteinuria, increased creatinine, decreased GFR)

Oliguria

Oedema

Hypertension

Sediment in urine