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104 - Nutrition, Metabolism and Excretion
Theme 3: The Excretory System and Renal Function
T3 L12: Clinical presentation of renal disease
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Cards (16)
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