Presentation of renal disease Flashcards Preview

Year 2 > Presentation of renal disease > Flashcards

Flashcards in Presentation of renal disease Deck (53):
1

How might heavy proteinuria present in terms of the urine?

"Frothy" urine

2

Accelerated hypertension is a medical emergency. T/F

True

3

Relate the functions of the kidney to clinical symptoms/signs which result from the loss of each function

Excretion of urea - uraemia

Fluid balance - retention & oedema

Electrolyte balance - hyperkalaemia & arrhythmia

Acid-base balance - metabolic acidosis & kassmall's respiration

Vitamin D metabolism/phosphate excretion - renal bone disease & vascular calcification

Erythtopoietin - anaemia

Drug excretion - drug toxicity

Barrier to protein loss - proteinuria and nephrotic syndrome

4

Define uraemia

Serum urea over 40

5

Pericarditis occuring from renal disease is a result of what being elevated?

Urea

6

How does renal bone disease present?

Asymptomatic
Pathological fracture

7

Name two drugs which can cause drug toxicity in renal disease?

Gabapentin
Digoxin

8

What clinical and biochemical signs may indicate renal disease?

Microscopic haematuria
Proteinuria
Reduced GFR
Raised blood pressure

9

How does Alport syndrome present?

Haematuria
Proteinuria
High BP
Oedema
Deafness
Family history

10

What systemic diseases are related to kidney disease?

Vascular disease
Diabetes mellitus
Connective tissue disorder

11

What systemic symptoms may the patient present with which are related to kidney disease?

Uraemia
Fluid retention (oedema)
Anaemia
Bone pain

12

What local symptoms may the patient present with in kidney disease?

Loin pain
Macroscopic haematuria
UTI

13

How do most patients with renal disease present?

Asymptomatic

14

What questions are important to ask a patient with suspected renal disease?

Appetite
Weight loss
Nausea & vomiting (dehydration can cause AKI)
Dyspepsia
Dyspnoea
Urinary symptoms
Joint pain
Arthralgia
Skin rash

15

List the lower urinary tract symptoms

Frequency
Urgency
Hesitancy
Polyuria
Nocturia

16

What aspects of a patients past medical history would be relevant to a renal history?

Kidney disease
Diabetes
Vascular disease
Previous surgery
TB
Rheumatological conditions

17

What aspects of a family history are relevant to a renal history?

Kidney disease
Hypertension

18

Which aspects of a drug history are relevant to a renal history?

ACE/ARB
Diuretic
NSAIDs
Antibiotics (gentamicin, trimethoprim - high potassium)
PPI
Radiology contrast (contrast nephropathy)
Over the counter

19

ACE inhibitors are used to treat which biochemical derangement (in relation to the kidney)? In which condition is this commonly found?

Proteinuria
Diabetic nephropathy (microalbuminuria+)

20

List the systemic signs of kidney disease

Pyrexia
Skin rash
Murmur
Arrhythmia
Pericardial rub
Retinopathy (BP & DM)
Bruits
ENT (vasculitis)
Rheumatoid
Raised JVP
Oedema
Gout

21

List the local signs of kidney disease

Tenderness
Bruits
Palpable kidneys

22

What clinical measurement is it always important to ask about in the context of kidney disease?

Blood pressure!

23

Define accelerated hypertension. What sign is seen in the eye in accelerated hypertension? What happens to the organs?

Diastolic BP over 120
Papilloedema
Decompensation (encephalopathy, fits, renal failure, heart failure, etc)

24

What is leukonychia a sign of in relation to the kidney?

Acute illness
Profound hypoalbuminaemia

25

What are gouty tophus a sign of in relation to the kidney?

Chronic kidney disease

26

What are splinter haemorrhages a sign of in relation to the kidney?

Subacute bacterial endocarditis associated with nephritis
Vasculitis

27

Vasculitic skin rashes are blanching or non-blanching? What might it be associated with in terms of the kidney?

Non-blanching
Acute glomerulonephritis

28

Purpura found on extensor surfaces of the skin and buttocks are typically what type of vasculitis?

Henloch-schonlein purpura

29

Malar rash is associated with which connective tissue disease?

SLE

30

What are the two causes of "smoky" (dark red/brown) urine?

Haematuria (old blood) in nephritic syndrome
Myoglobin (muscle breakdown & dehydration)

31

Explain the biochemical markers used in urinalysis

Specific gravity (1.01-1.02) - concentration of urea
Haematuria - RBC/free Hb/myoglobin
Proteinurea
pH (4.5-7)
Leukocytes + nitrites - UTI

32

What tests can be carried out to determine the level of protein in the urine?

24 hr urine collection (

33

Classify the levels of proteinuria

Asymptomatic low grade (3g)

34

Isomorphic RBC in urine would indicate blood coming from where?

Lower urinary tract
If dysmorphic then coming from kidney

35

Describe urinary cast analysis

Hyaline - benign
RBC - pathological (nephritic)
Leukocyte - infection or inflammation
Granular - indicative of chronic disease

36

How are urinary casts formed?

Precipitation of Tamm-Horsfall mucoprotein secreted by renal tubules

37

Formation of urinary casts are increased when?

Low urine flow
low pH

38

You can use microscopy to determine composition of urinary tract stones. T/F

True - can determine crystals

39

What is a sign of hyperkalaemia on ECG?

Peaked T waves

40

What is the best measure of kidney function?

GFR

41

What is stable chronic kidney disease?

Kidney function low but not deteriorating

42

What is progressive chronic kidney disease?

Kidney function declining steadily

43

What is acute kidney injury?

Decline in GFR over hours/days/weeks
+/- oliguria
In a patient with normal/impaired baseline renal function

44

Define oliguria

45

Patients with acute kidney injury don't need dialysis. T/F

False - they may need dialysis temporarily or long term

46

What is nephrotic syndrome?

Proteinuria >3g
Hypoalbuminuria
Oedema (periorbital common)

47

Can you have proteinuria >3g per day and not be nephrotic?

Yes - albumin has to have dropped

48

What is associated with nephrotic syndrome?

Hypercholesterolaemia

49

Do patients with nephrotic syndrome have normal renal function?

Often

50

Why do patients with nephrotic syndrome get periorbital oedema?

Oedema is dependent and since they don't get pulmonary oedema (as in heart failure) they are able to lie flat - oedema collects in face

51

Do patients with nephrotic syndrome get pulmonary effusions?

Yep they can do

52

What causes nephrotic syndrome?

Glomerulonephritis
Uncontrolled diabetes
Lead poisoning

53

What is nephritic syndrome? What are the symptoms and signs?

Nephritis caused by acute kidney injury
Olguria
Oedema/retention (oedema or pulmonary oedema)
Hypertension
Haematuria
Proteinuria

Decks in Year 2 Class (72):