Flashcards in Presentation of renal disease Deck (53):
How might heavy proteinuria present in terms of the urine?
Accelerated hypertension is a medical emergency. T/F
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
Serum urea over 40
Pericarditis occuring from renal disease is a result of what being elevated?
How does renal bone disease present?
Name two drugs which can cause drug toxicity in renal disease?
What clinical and biochemical signs may indicate renal disease?
Raised blood pressure
How does Alport syndrome present?
What systemic diseases are related to kidney disease?
Connective tissue disorder
What systemic symptoms may the patient present with which are related to kidney disease?
Fluid retention (oedema)
What local symptoms may the patient present with in kidney disease?
How do most patients with renal disease present?
What questions are important to ask a patient with suspected renal disease?
Nausea & vomiting (dehydration can cause AKI)
List the lower urinary tract symptoms
What aspects of a patients past medical history would be relevant to a renal history?
What aspects of a family history are relevant to a renal history?
Which aspects of a drug history are relevant to a renal history?
Antibiotics (gentamicin, trimethoprim - high potassium)
Radiology contrast (contrast nephropathy)
Over the counter
ACE inhibitors are used to treat which biochemical derangement (in relation to the kidney)? In which condition is this commonly found?
Diabetic nephropathy (microalbuminuria+)
List the systemic signs of kidney disease
Retinopathy (BP & DM)
List the local signs of kidney disease
What clinical measurement is it always important to ask about in the context of kidney disease?
Define accelerated hypertension. What sign is seen in the eye in accelerated hypertension? What happens to the organs?
Diastolic BP over 120
Decompensation (encephalopathy, fits, renal failure, heart failure, etc)
What is leukonychia a sign of in relation to the kidney?
What are gouty tophus a sign of in relation to the kidney?
Chronic kidney disease
What are splinter haemorrhages a sign of in relation to the kidney?
Subacute bacterial endocarditis associated with nephritis
Vasculitic skin rashes are blanching or non-blanching? What might it be associated with in terms of the kidney?
Purpura found on extensor surfaces of the skin and buttocks are typically what type of vasculitis?
Malar rash is associated with which connective tissue disease?
What are the two causes of "smoky" (dark red/brown) urine?
Haematuria (old blood) in nephritic syndrome
Myoglobin (muscle breakdown & dehydration)
Explain the biochemical markers used in urinalysis
Specific gravity (1.01-1.02) - concentration of urea
Haematuria - RBC/free Hb/myoglobin
Leukocytes + nitrites - UTI
What tests can be carried out to determine the level of protein in the urine?
24 hr urine collection (
Classify the levels of proteinuria
Asymptomatic low grade (3g)
Isomorphic RBC in urine would indicate blood coming from where?
Lower urinary tract
If dysmorphic then coming from kidney
Describe urinary cast analysis
Hyaline - benign
RBC - pathological (nephritic)
Leukocyte - infection or inflammation
Granular - indicative of chronic disease
How are urinary casts formed?
Precipitation of Tamm-Horsfall mucoprotein secreted by renal tubules
Formation of urinary casts are increased when?
Low urine flow
You can use microscopy to determine composition of urinary tract stones. T/F
True - can determine crystals
What is a sign of hyperkalaemia on ECG?
Peaked T waves
What is the best measure of kidney function?
What is stable chronic kidney disease?
Kidney function low but not deteriorating
What is progressive chronic kidney disease?
Kidney function declining steadily
What is acute kidney injury?
Decline in GFR over hours/days/weeks
In a patient with normal/impaired baseline renal function
Patients with acute kidney injury don't need dialysis. T/F
False - they may need dialysis temporarily or long term
What is nephrotic syndrome?
Oedema (periorbital common)
Can you have proteinuria >3g per day and not be nephrotic?
Yes - albumin has to have dropped
What is associated with nephrotic syndrome?
Do patients with nephrotic syndrome have normal renal function?
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
Do patients with nephrotic syndrome get pulmonary effusions?
Yep they can do
What causes nephrotic syndrome?