Presentation of Renal Disease

Question 1

how can kidney disease cause uraemia and what can this cause?

Answer 1

failure of excretion of nitrogenous waste (urea)
can cause
- pericarditis
- encephalopathy
- neuropathy
- asterixis
- gastritis

Question 2

failure of specific functions of the kidneys can cause specific symptoms, give 7 examples of this

Answer 2

fluid balance = fluid retention and oedema
electrolyte balance = hyperkalaemia and arrhythmia
acid-base balance = metabolic acidosis and kussmaul’s breathing
vi D metabolism/phosphate excretion = renal bone disease and vascular calcification
production of erythropoietin = anaemia
drug excretion = drug toxicity
barrier to loss of proteins = proteinuria and nephrotic syndrome

Question 3

how may kidney disease be diagnosed in an asymptomatic patient?

Answer 3

dipstick showing microscopic haematuria and/or proteinuria
reduced eGFR on screening
raised BP
incidental finding on abdo imaging
screening because of family history

Question 4

systemic symptoms

Answer 4

//

Question 5

local/renal

Answer 5

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Question 6

important parts of renal systemic enquiry?

Answer 6

apetite and weight loss
nausea and vomiting
dyspepsia (increased peptic ulcer risk)
dyspnoea
urinary symptoms
joint pains/arthralgia
skin rashes (increased vasculitis risk)

Question 7

important drugs in relation to renal disease?

Answer 7

anti-hypertensives
NSAIDs
antibiotics
- gentamicin
- trimethoprim
- penicillins
PPIs
radiology contrast
over the counter/herbal remedies etc

Question 8

what systemic signs may be related to other systemic disease caused by renal problem?

Answer 8

pyrexia
skin rash
heart murmurs
consolidation
ENT
retinopathy
neuropathy
arterial bruits
rheumatoid

Question 9

what systemic signs may be related to loss of renal function?

Answer 9

pallor
arrhythmia
pericardial rub
raised JVP
lung crepitations
oedema
gout

Question 10

local/renal signs?

Answer 10

tenderness in loins or upper abdomen
arterial bruits
palpable kidneys

Question 11

what is accelerated hypertension?

Answer 11

medical emergency
diastolic BP >120
papilloedema
end organ decompensation
- encephalopathy
- fits
- cardiac failure
- acute renal failure

Question 12

sign of hypoalbuminaemia? (or hyperalbuminaemia?)

Answer 12

leukonychia

Question 13

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Answer 13

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Question 14

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Answer 14

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Question 15

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Answer 15

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Question 16

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Answer 16

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Question 17

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Answer 17

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Question 18

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Answer 18

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Question 19

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Answer 19

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Question 20

what can be detected on urinalysis (dipstick)?

Answer 20

specific gravity ….

Question 21

normal protein level for 24 hr urine collection?

Answer 21

<150mg/day

Question 22

normal protein/creatinine ratio?

Answer 22

50mg/mmol : 0.5g/day

??? - ratio????

Question 23

asymptomatic low grade proteinuria?

Answer 23

<1g per day

Question 24

heavy proteinuria?

Answer 24

1-3g per day

Question 25

nephrotic range for proteinuria?

Answer 25

> 3g per day

Question 26

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Answer 26

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Question 27

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Answer 27

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Question 28

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Answer 28

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Question 29

how might renal disease present on ECG?

Answer 29

LVH (due to severe hypertension)

tented T waves (due to hyperkalaemia)

Question 30

what is acute kidney injury?

Answer 30

decline in GFR over hours/days/weeks
with or without oliguria (<400ml urine output per day)
in a patient with normal or impaired baseline renal function

Question 31

triad of features in nephrotic syndrome?

Answer 31

proteinuria (>3g per day)
hypoalbuminaemia
oedema
also get hypercholesterolaemia and often have normal renal function

Question 32

how does oedema occur in nephrotic syndrome?

Answer 32

loss of proteins (albumin, globulins etc) out of the blood and into the urine causes loss of oncotic pressure pulling fluid into the blood and therefore fluid leaks out into the surrounding tissues

Question 33

features of nephritic syndrome?

Answer 33

acute kidney injury
oliguria
oedema/fluid retention
hypertension
active urinary sediment
RBCs, RBC and granular casts and proteinuria