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Y3M - Renal > Renal History and Examination > Flashcards

Renal History and Examination Flashcards

1
Q

Common presenting complaints of renal disease.

A

Dyspnoea

Leg swelling

Nausea/Vomiting

Upper Airway Symptoms

Constitutional symptoms

Lower UT symptoms

Flank pain

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2
Q

History of dyspnoea.

A

Exercise tolerance

Triggers

Relieving factors

Diurnal variation

Orthopnoea

PND

Associated symptoms

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3
Q

History of leg swelling.

A

Site

Severity

Time of onset

Amount of fluid intake

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4
Q

History of Nausea/Vomiting.

A

Triggers

Relieving factors

Able to keep food down?

UT Frequency

Associated symptoms

Bowel frequency

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5
Q

History of ENT.

A

Nasal secretions

Sinusitis

Epistaxis

Haemoptysis

Sore throat

Visual disturbances

Hearing loss

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6
Q

History of constitutional symptoms.

A

Fever

Joint pains

Muscles aches

Weight changes

Lethargy

Night sweats

Pruritus

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7
Q

History of lower UT symptoms.

A

Dysuria

Frequency

Quantity of urine

Colour of urine

Frothiness

Haematuria

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8
Q

History of flank pain.

A

Duration

Radiation

Associated symptoms

Intensity

Aggravating/relieving factors

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9
Q

What should you ask patients on dialysis?

A

Mode of RRT (APD/CAPD/Assisted PD/UHD/HHD)

What access?

When last dialysed?

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10
Q

PMH of renal disease.

All is relevant but specifically…

A

Previous AKI

Requiring dialysis?

CKD stage if known

Cause of CKD/ESRF

CVS risk factors (DM/HTN/Hypercholesterolaemia)

Recurrent UTI?

Childhood infections

Surgery

Cancer

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11
Q

What else do you want to ask in a history of renal patient?

A

Drugs (especially NSAIDs)

Allergies

FH for renal, cardiac, diabetes and HTN.

Smoking
Occupation
Recent foreign travel
Daily activities
Alcohol
Performance status

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12
Q

General inspection on examination of a renal patient.

A

Any obvious discomfort or pain

Dyspnoea

Colour/cyanosis

Resp rate

Tremor

O2

Vomit bowl

Dialysis machines

IV access

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13
Q

General inspection of hands.

A

Clubbing

Peripheral cyanosis

Uraemic flap

Cogwheel rigidity

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14
Q

General inspection of arms.

A

Arteriovenous fistula (Size, colour, thrill)

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15
Q

General inspection of face.

A

Anaemia

Rashes (malar rash as in SLE)

Swelling (SVCO from haemodialysis access)

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16
Q

General inspection of neck..

A

JVP

Haemodialysis tunnelled/non-tunnelled lines

Previous access scars

17
Q

What is this?

A

A tunnelled aka “Perm-cath” line.

18
Q

What is this?

A

A non-tunnelled aka “Vas-Cath” line.

19
Q

Explain assessment of fluid balance status in renal patient.

A

Check BP

Listen to heart sounds for murmurs or added sounds

Check pulse for character and rate.

Auscultation of the chest;
Fine crackles for pulmonary oedema.
Decreased air entry and dull percussion with reduced vocal resonance for pleural effusion.

Check urine output

Sacral oedema

Peripheral oedema

Lying and standing BP

20
Q

What to look for on abdominal examination.

A

PD tube?

Palpable polycystic kidney?

Enlarged cystic liver?

Scars from previous surgery

Palpable transplanted kidney?

Indwelling catheter?

21
Q

Signs of advanced renal disease.

A

Brown nails

Discoloration of the skin from uraemia (yellow-brown)

Under-nutrition leading to muscle wasting

“Uraemic frost” which is urea from sweat crystallises on the skin.

Hyper-reflexia

Pericardial rub

GI ulceration and bleeding.

22
Q

Give broad classes of renal function tests.

A

Bloods

Urine

Imaging

23
Q

What bloods are done to check renal function?

A

FBC for anaemia, infection and allergic reactions

Haematinics (Iron/Folate/B12 def.)

U&Es - Potassium, Urea, Creatinine and Bicarbonate

Bone profile - Calcium, Phosphate, PTH and ALP

CRP

HbA1c

24
Q

What urine tests are done to assess renal function?

A

Urine dipstic to check for infection (leuko and nitrites) as well as check for glomerular pathology (blood and proteins)

Urine Protein:Creatinine ratio - quantifies the amount of protein in the urine

Urine Albumin:Creatinine ratio - quantifies the amount of albumin to monitor Diabetic nephropathy

Urine microscopy, culture and sensitivity.

25
Q

What is looked for on imaging?

A

US KUB is done (Kidney, ureter bladder)

Peri-nephric collection

Size of kidneys

Corticomedullary differentiation

Hydronephrosis

26
Q

Why are you doing venous blood gases in renal patients?

A

To assess Acid-Base balance

Metabolic acidosis

Metabolic alkalosis

27
Q

Causes of metabolic alkalosis.

A

Diarrhoea

Vomiting

Primary hyperaldosteronism

Tubular transporter defects

Diuretics

Hypokalaemia

28
Q

Acidosis due to increased acid (High anion gap)

A

Lactic acidosis

Ketoacidosis

Toxin (Ethylene glycol, methanol, isoniazid, aspirin, salicylate)

Renal failure

29
Q

Acidosis due to reduced alkali (Normal anion gap)

A

GI losses of HCO3

Renal loss of HCOs (renal tubular acidosis, mineralcorticoid def. (Addison’s))

Toxins such as ammonium chloride and acetazolamide.

30
Q
A
31
Q
A

Y3M - Renal (11 decks)

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