Renal

Question 1

What general signs should you look for in a patient with renal enlargement?

Answer 1

1. Anaemia – due to chronic kidney disease or renal cell carcinoma causing haematuria
2. Hypertension
3. Scars – chest (previous tunnelled haemodialysis lines)
4. Raised JVP and peripheral oedema

Question 2

What signs of end stage renal failure/renal transplantation should you look for in a patient with renal enlargement?

Answer 2

1. AV fistula
2. Tunnelled dialysis line
3. Peritoneal dialysis catheters
4. Signs of immunosuppression
5. Renal transplant

Question 3

What are the complications of immunosuppression to look out for?

Answer 3

1. General - Dysplastic skin lesions, warts, oral candida
2. Steroids - Finger prick glucose marks, hypertension, weight gain, interscapular fat pad, purpura, acne
3. Tacrolimus - Finger prick glucose marks, hypertension.
4. Cyclosporin - Hypertension, gum hypertrophy, tremor, evidence of renal transplant

Question 4

What are the abdominal signs of you look for in a patient with renal enlargement?

Answer 4

1. Nephrectomy scar (Rutherford-Morrison - reverse hockey stick)
2. Palpable kidney – ballotable masses, can get above, no notch,
3. Hepatomegaly (Polycystic kidney disease)
4. Audible bruit over kidney (RAS - renal artery stenosis)

Question 5

What are the other signs of you look for in a patient with renal enlargement?

Answer 5

*Neurological Signs*

• Due to previous berry aneurysm rupture
• Stroke
• Von Hippel Lindau syndrome (an inherited disorder characterized by the abnormal growth of both benign and cancerous tumors and cysts)

Question 6

What symptoms should you ask about in a patient presenting with renal enlargement?

Answer 6

1. Abdominal Pain
2. Haematuria
3. Oliguria/Anuria
4. Recurrent UTIs
5. HTN

N.B. can be asymptomatic and picked up incidentally

Question 7

What are the causes of unilateral renal enlargement?

Answer 7

1. PKD – other kidney may not be palpable or may have had contralateral nephrectomy
2. Renal Cell Carcinoma
3. Unilateral Hydronephrosis
4. Simple Renal Cysts – these can be massive

Question 8

What are the causes of bilateral renal enlargement?

Answer 8

1. PKD
2. Bilateral Renal Cell Carcinoma
3. Bilateral Hydronephrosis
4. Tuberous Sclerosis (causes renal angiomyolipoma - most common benign tumour of the kidney; and renal cysts)
5. Amyloidosis

Question 9

What are the symptoms of ESRF?

Answer 9

1. Fatigue
2. Nausea
3. Pruritus
4. Anorexia
5. Headaches
6. Reduced Urine Output - Oliguria
7. Oedema – may be perceived as weight gain