Clinical Presentations of Kidney Disease Flashcards
How will patients present to you when they have kidney problems?
- Rarely present with kidney pain (mostly in stones or sometimes obstruction)
- Urinary Appearance – usually only when it turns red/cloudy
- Urine flow disturbance – changes sometimes this is normal and common (men)
- No presentation
What signs appear due to failure of the excretion side of kidney function?
- High levels of potassium causing hyperkalaemia.
- Na+ overload is cancelled out by the retention of water that it results in so the concentration generally stays the same but you will develop oedema (peripheral or pulmonary) and hypertension.
- Acidosis resulting in acidotic breathing.
- Lethargy and fatigue from the build-up of waste products (usually fairly well developed and also called Uraemic syndrome)
What happens when the glomerular perm selectivity fails?
Selectively excreting small molecules only. When this fails this will result in proteinuria and haematuria.
What signs are there due to tubular failures of kidneys?
- Impaired ability to concentrate the urine causing high frequency and nocturia due to altered diurnal urine concentrating ability (we concentrate our urine a lot at night)
- Contribution to acidosis
- Glycosuria – if hyperglycaemic you may exceed tubular threshold or tubular disease reduces the tubular threshold
What signs are there due from failure of the endocrine functions of the kidney?
- If kidney isn’t acting properly patients will become functionally deficient in Vitamin D as Vitamin D that we ingest is inactive. It must by hydroxylated in the liver and then again in the kidney. This then effects bones and calcium metabolism.
- As kidneys fail they gradually reduce their production of erythropoietin and cause renal anaemia.
- If stimulated to produce renin then this will result in Hypertension
What are the common casues of haematuria?
Urinary infection, Polycystic kidney, Renal stones, Renal/bladder tumours, Arteriovenous malformations or Kidney/glomerular disease – incidence of glomerular disease increases if microhaematuria associated with proteinuria and/or hypertension. Microscopically haematuria actually very common
If blood clots are present in the urine what does this indicate?
If clots are present these are usually coming from the bladder.
What is a non pathological cause of haematuria?
Some food dyes such as beetroot.
What are dysmorphic red cells?
In Haematuria, we can get Dysmorphic red cells – red cells that have squeezed through glomerular barrier. We also get red cell casts where blood cells bind to a tubular protein called TAMM horsefall protein.
When patietns have proteinuria how will they present?
Frothy urine (in toilet), reduce plasma oncotic pressure (oedema), loss of immunoglobulins (infection) and imbalanced regulatory of coagulation cascade – thromboembolic risk increased.
How can you tell whether oedema is caused due to kidney function or heart failure?
Patients who have oedema due to heart failure can’t lie flat because they get breathless and this is called orthopnoea, this doesn’t happen in oedema due to nephrotic syndrome and so they will get a swollen face.
How do nephrotic patients present?
proteinuria, hypoalbuminemia, oedema and hyperlipidaemia. This is a glomerular disease and required a renal biopsy for diagnosis. Muehrcke’s bands occur in nephrotic syndrome as well as xanthelasmas and fat bodies in their urine.
How does nephritic syndrome present?
Classically this accompanies post streptococcal glomerulonephritis in children (not so common now due to antibiotics). This manifests rapidly with: oliguria (low volume of urine), hypertension, generalised oedema, haematuria with smoky brown urine, normal serum albumin, variable renal impairment and urine contains blood protein and red cell casts.
What is rapidly progressive glomerulonephritis?
Glomerular injury is so severe that renal function deteriorates over days, patients may present as a uraemic emergency with evidence of extrarenal disease.
Which diseases is RPGN associated with?
Associated crescentic glomerulonephritis, antineutrophil cytoplasmic antibodies, anti-glomerular basement membrane antibodies (immune mediated condition). Often associated with systemic vasculitis. Renal biopsy required for diagnosis.
