T3 L12: Clinical presentation of renal disease

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