T3 L12: Clinical presentation of renal disease

• How to diagnose kidney disease?

  History

  Examination:

  • High BP (RAAS driven)
  • Fluid overload
  • Pallor
  • Rash

  Blood and urine tests:

  • Urea & creatinine elevated
  • Dipstick protein / blood

  Imaging:

  • USS renal tract
  • CT kidneys ureter bladder
  • Nuclear medicine DMSA and MAG3
• What are the characteristics of acute renal disease presentations (AKI - acute kidney injury)?

  Patient unwell

  Oliguria / anuria (passing less urine than normally / no urine)

  Disturbances of acid-base balance or electrolytes or fluid balance
• What are the characteristics of chronic kidney disease presentations (CKD)?

  Patient often asymptomatic

  BP might be high

  Often have other conditions like diabetes or vascular disease
• What are other details relating to presentations of kidney disease?

  • can affect all age groups - More common as get older
  • affects patients from South Asian and African or Caribbean backgrounds more often
  • Patients develop renal disease at younger age and often progress more quickly
  • Hypertension causes kidney disease - Kidney disease causes hypertension (RAAS related)
• Why can patients be asymptomatic for a while?

  significant extra capacity and well tolerated

  • >50% fall in GFR before kidney function tests become abnormal
  • Symptoms only really start when GFR<20

  
• How many stages are there of CKD?

  5

  
• When should you suspect (and check) for kidney diseae?

  Patients living with:

  • Hypertension
  • Diabetes
  • Previous acute kidney injury
  • Cardiovascular disease (IHD/PVD/CCF)
  • Gout
  • Unwell with infection (chest/urine/bowel/skin/biliary system etc.)
  • Trauma
  • Neglect
  • Low BP
  • Heart failure exacerbation

  Or if you have incidentally found blood/protein in urine
• Presentation 1: What is the diagnosis?

  Nephrotic Syndrome

  Symptoms:

  • generalised oedema
  • low serum albumin
  • Protinuria (presents as frothy urine)
  • high cholesterol
  • risk of clotting

  
• Presentation 2: What is the diagnosis?

  Diabetic nephropathy

  as disease progresses:

  • swelling legs
  • nausea/vomiting (waste products build up)
  • tiredness/itching

  
• CKD= syndrome of signs/symptoms and blood tests NOT specific disease.
• Presentation 3: What is the diagnosis?

  Acute Kidney injury secondary to gastroenteritis

  Treatment: IV fluid

  
• One in five emergency admissions to hospital will have AKI
• Presentation 4: What is the diagnosis?

  Nephritic syndrome

  Inflamed kidneys:

  • blood and protein on dipstick
  • Hypertension
  • AKI
  • reduced urine output

  IgA vasculitis (Henoch-Schonlein purpura)

  often vasculitis affecting skin / kidneys / bowels

  often strep throat

  usually self limiting

  
• Presentation 5: What is the diagnosis?

  Obstruction due to stone

  
• What renal disease is this USS showing?

  autosomal dominant polycystic kidney disease

  Presents:

  • CKD / acute loin pain

  
• What type of imaging can be used in renal disease?

  CT scan: stones/tumours

  MRI scan: arteries

  Nuclear medicine: scars/obstruction

  USS: size / shape