Presentation of Kidney Disease

Question 1

name the 2 types of haematuria found in renal patients

Answer 1

microscopic

macroscopic

Question 2

where is pain in the kidney usually felt?

Answer 2

loin

Question 3

what conditions can present with uraemia?

Answer 3

pericarditis
encephalopathy
neuropathy
gastritis

Question 4

what is the main electrolyte imbalance found in renal disease?

Answer 4

hyperkalaemia

Question 5

main complication of hyperkalaemia?

Answer 5

arrhythmia

Question 6

what acid base imbalance is most commonly found in renal disease?

Answer 6

metabolic acidosis

Question 7

what happens if erythropoeitin is not made?

Answer 7

patient will get anaemia (no rbc’s made)

Question 8

give examples of drugs that can be toxic to the kidneys

Answer 8

digoxin
gabapentin
gentamicin
ACEi
ARB
NSAIDs
diuretics
PPIs

Question 9

what techniques will be used to accompany kidney examination?

Answer 9

BP

urinalysis

Question 10

how is GFR estimated?

Answer 10

biochemical screening

Question 11

what dermatological symptoms are important in nephrology?

Answer 11

recent skin rash

Question 12

what MSK symptoms are important in nephrology?

Answer 12

joint pain
bone pain
arthralgia

Question 13

what GI symptoms are relevant to nephrology?

Answer 13

dyspepsia
nausea/vomiting
anorexia

Question 14

what effect can oedema have on the kidney?

Answer 14

decreased pressure within the glomerulus -> decreased renal function

Question 15

what effect can trimethoprim have on patients with CKD’s creatinine levels?

Answer 15

will rise

Question 16

what signs on examination would suggest loss of kidney function?

Answer 16

pallor
arrhythmia
pericardial rub
lung creps
raised JVP
oedema
gout

Question 17

pericardial rub is caused by what problem with the kidneys?

Answer 17

uraemia

Question 18

renal disease is a risk factor for gout T or F?

Answer 18

T

Question 19

hypertension is classed as a BP of…

Answer 19

> 140/90

Question 20

accelerated hypertension is not an emergency T or F

Answer 20

F

Question 21

what is the diastolic BP in accelerated hypertension?

Answer 21

> !20mmHg

Question 22

what retinal symptoms will a patient with accelerated hypertension present with?

Answer 22

papilloedema

Question 23

why are splinter haemorrhages important in renal?

Answer 23

allude to bacterial endocarditis or vasculitis which can both cause renal disease (eso glomerulonephritis)

Question 24

symptoms of henoch schonlein purpura?

Answer 24

abdo pain
joint pains
acute kidney injury

Question 25

what colour is urine in rhabdomyolysis

Answer 25

due to acute muscle damage causing myoglobin release

Question 26

what findings on urinalysis would indicate a UTI?

Answer 26

leukocytes blood nitrites

Question 27

presence of nitrites indicates...

Answer 27

bacteria

Question 28

normal 24hr urine collection?

Answer 28

<150mg/24hr

Question 29

normal urine protein/creatinine ratio?

Answer 29

0.5g/24hr

Question 30

what weight of protein per day would be classed as heavy proteinuria?

Answer 30

1-3g/day

Question 31

what type of urinary cast is indicative of chronic disease?

Answer 31

granular

Question 32

what urinary cast is usually benign?

Answer 32

hyaline

Question 33

red cell urinary casts indicate what problem?

Answer 33

nephritic syndrome

Question 34

what urinary cast indicates inflammation?

Answer 34

leukocyte

Question 35

what does rhabdomyolysis do to the kidneys?

Answer 35

causes acute kidney injury

Question 36

hyperkalaemia presentation on ECG?

Answer 36

tall T waves broadened QRS flat p waves bradycardia

Question 37

normal K+ level?

Answer 37

5

Question 38

Tx of hyperkalaemia

Answer 38

1. IV calcium gluconate 2. actrapid + glucose 3. salbutamol

Question 39

what test is the best overall measure of kidney function?

Answer 39

GFR

Question 40

what levels indicate severe GFR in ml/min

Answer 40

15-29

Question 41

kidney failure has what GFR level?

Answer 41

<15ml/min

Question 42

the higher the GFR, the less likely there is kidney disease T or F

Answer 42

T

Question 43

define acute kidney injury

Answer 43

decline in GFR over hours/days/weeks +/- oliguria

Question 44

name the 3 main components of nephrotic syndrome?

Answer 44

proteinuria >3g/day hypoalbuminaemia oedema

Question 45

why dont you get periorbital oedema in heart failure?

Answer 45

patients cant lie flat

Question 46

what is renal function like in nephrotic syndrome?

Answer 46

normal

Question 47

you cant get periorbital oedema in nephrotic syndrome?

Answer 47

F, you can because you can lie flat

Question 48

symptoms of nephritic syndrome?

Answer 48

``` acute kidney injury oligura oedema hypertension positive urinalysis (blood, protein) ```

Question 49

what tests need to be done before a renal biopsy is carried out and why?

Answer 49

FBC - any thrombocytopaenia? coagulation screen- clotting problems? renal USS- size/position of kidneys

Question 50

contraindications to renal biopsy? why?

Answer 50

``` small kidneys (inc bleeding risk) uncontrolled HT (bleeding risk) untreated UTI (bleeding risk) ```

Question 51

what dose of prednisolone is given for minimal change nephropathy?

Answer 51

40-60mg

Question 52

in patients <45, isolated haematuria is most likely to be from...

Answer 52

the kidneys

Question 53

in patients >45, isolated haematuria is most likely to be from...

Answer 53

the bladder