Presentation of kidney disease Flashcards
(38 cards)
How can kidney disease present?
Asymptomatic Loin pain/ urinary symptoms Haematuria - microscopic, painless macroscopic haematuria Proteinuria Hypertension AKI CKD Nephrotic syndrome Nephritic syndrome
What are the functions of the kidneys?
Excretion of nitrogenous waste (urea) Fluid balance Electrolyte balance Acid-base balance Vitamin D metabolism/ phosphate excretion Production of erythropoietin Drug excretion Barrier to loss of proteins
What is the consequence of a lack of excretion of urea?
Uraemia - pericarditis, encephalopathy, neuropathy, asterixis, gastritis, nausea, vomiting
What is the consequence of a lack of fluid balance?
Fluid retention
Oedema
What is the consequence of a lack of electrolyte balance?
Hyperkalemia
Arrhythmia
What is the consequence of a lack of acid-base balance?
Metabolic acidosis
Kussmaul’s respiration
What is the consequence of a lack of vitamin D metabolism/ phosphate excretion?
Renal bone disease
Vascular calcification
What is the consequence of a lack of production of erythropoietin?
Anaemia
What is the consequence of a lack of drug excretion?
Drug toxicity e.g. digoxin, gapapentin
What will result as a failure in the barrier to loss of proteins?
Proteinuria
Nephrotic syndrome
What should be investigated in those with asymptomatic renal disease?
Diptix microscopic haematuria and/or proteinuria Reduced eGFR on biochem screen Hypertensive Incidental findings on abdominal imaging Screening because of family history
What can lead to kidney disease?
DM
Connective tissue disorder
Vascular disease
How can renal disease present related to a loss of kidney function?
Uraemic
Fluid retention
Anaemia
Bone pain
How can renal disease present locally?
Loin/abdo pain
Macroscopic haematuria
UTI
What should be included in the systemic enquiry of someone with kidney disease?
Appetite and weight loss N+V Dyspepsia Dyspnoea Urinary symptoms: frequency, urgency, hesitancy, polyuria and nocturia Joint pains and arthralgia Skin rashes
What conditions are important in respect of renal disease?
Previous renal problems - ask about recurrent UTI in childhood, bedwetting etc DM Vascular disease - renovascular Surgery TB Rheumatological
What drugs are important in respect to renal disease?
ACEi ARB Diuretic (thiazide, loop, potassium sparing) NSAIDs Antibiotic: gentamicin, trimethoprim, pencillins PPI Contrast OTC/herbal
How do NSAIDs affect the kidneys?
Fluid retention - decrease pressure within the glomerulus and reduce GFR
Can also cause an allergic reaction within the kidneys resulting in acute on chronic renal issue
What are signs related to chronic disease renal problems?
Pyrexia Skin rash Heart murmurs Consolidation ENT Retinopathy (DM and HBP_ Neuropathy Arterial bruits Rheumatoid
What are the signs associated with loss of kidney function?
Pallor Arrhythmia Pericardial rub Raised JVP Lung creps Oedema Gout
What are signs related to local kidney disease?
Tenderness in loins/flank/RUQ/LUQ
Arterial bruits
Palpable kidneys
What is the target BP in renal clinic?
130/90
What is accelerated hypertension and what can it result in?
Diastolic >120
Papilloedema
End organ decompensation: encephalopathy, fits, cardiac failure, acute renal failure
What can be seen in hypertensive fundoscopy?
Flame haemorrhages
Cotton wool spots
Blurred optic disc
