Kh approach to pt with kidney problem

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Approach to a Patient with Kidney Problem

DR. R.K. MANDOT DMCONSULTANT NEPHROLOGIST & TRANSPLANT PHYSICIAN

KIDNEY HEALTH, AHMEDABAD


Detection of Kidney Problem

• Presentation of s/s that indicate an underlying renal disorder

• Presence of systemic disease known to involve the kidney

• F/H of inherited renal disease

• Asymptomatic urinary abnormality or altered RFT


Presenting Complaints of Kidney Disease

• Abnormalities of micturition

• Pain presentations

• Alteration in the appearance of urine

• Alteration in the amount of urine

• General symptoms of abnormal renal function


Abnormalities of Micturition

• Dysuria• Frequency & Nocturia• Stranguary• Pneumaturia • Urgency

• Hesitancy• Decreased stream• Dribbling of urine• Retention of urine• Incontinence of urine


Alteration in Amount of Urine

• Polyuria – over 3000 ml/d

• Oliguria – less than 300 ml/d

• Anuria – negligible urine


Pain Presentations

• Acute obstruction of ureters due to stone or blood clot – colicky pain radiates from

loin to groin and to the testicles in a male.

• Renal pain – pain felt in the flank, hypochondrium or iliac fossa.

• Cystitis – burning sensation or discomfort over suprapubic region

• Prostatitis – perineal or rectal pain


Alteration in Appearance of Urine

• Hematuria – red or smoky brown urine

• Proteinuria – frothy urine

• Coco cola coloured urine

• Turbid urine

• Urine color gets darker on standing


CKD Symptoms

• Generally absent in stages 1 & 2

• May be minimal in stages 3 & 4

• General Symptoms• Cold Intolerance • Shortness of breath• Palpitations • Cramping, Muscle pain• Depression, anxiety • Fatigue• Sexual dysfunction


Signs of CKD Stages 1 To 4


Renal Syndromes

• Renal failure acute / chronic / rapidly progressive

• Nephrotic syndrome

• Nephritic syndrome

• Asymptomatic urinary abnormality proteinuria / hematuria / pyuria

• Renal vascular disease


Renal Syndromes

• Infections of the urinary tract

• Obstruction of the urinary tract

• Urinary tract calculi & nephrocalcinosis

• Malignancy

• Congenital abnormalities

• Cystic kidney diseases


Renal Syndromes

• Allows narrowing of D/D

• Can help direct work up & treatment

• Each syndrome is associated with multiple diseases

• One disease may be associated with multiple syndromes (SLE, IgA nephropathy)

• Individuals may simultaneously have more than one syndrome


History Taking

• P/H of similar illness• Preceding throat or skin infection• Recurrent UTI• Renal stone• Childhood enuresis• HT, DM, hyperuricemia• Tuberculosis • HIV, HBsAg, HCV status• Past surgery or biopsy


History Taking

• Family history DM, HT Inherited renal disease – ADPKD, Alport’s synd• Social history• Smoking and alcohol abuse• Medications – steroids, immunosuppressants, NSAID’s, OTC drugs, herbal

preparations, alternative medicines, antihypertensives


Physical Examination

• High BP

• Jugular venous distention

• Chest crepitation • Pericardial rub

• Edema • Renal bruit • Prostate examination

• Abdominal pain


Renal Function Tests Required For


RFTs Give Information Regarding…..


Classification of RFTs

• Urine analysis

• Tests for assessment of glomerular function

• Tests to measure renal plasma flow

• Tests for assessment of tobular function


Urine Analysis


Test for Assessment of Glomerular Function


Renal Clearance Test

What is meant by clearance test?

Renal clearance of substance is defined as the volume of plasma from which the substance is completely

cleared by the kidneys per minute


Renal Clearance Test


Clinical Significance of GFR

• GFR is determined not just by the number of functioning nephrons but the functional

capacities of these nephrons.

• Does not detect early renal disease

1. Determines extent of nephron damage in known case of renal disease

2. Monitor effectiveness of treatment

3. Determine feasibility of giving medications


Tests for Assessment of Glomerular Function


Proteinuria


Micro-albuminuria

• It is identified when small quantity of albumin (30-300 mg/d) is seen in Urine .

• The test is not indicated in patients with overt proteinuria (positive dipstick).

• Early morning mid stream urine sample is preferred.

• It is an early indicator of onset of nephropathy


Micro-albuminuria

• Micro albuminuria is an early indication of nephropathy in patients with diabetes

mellitus & hypertension.

• All diabetics & hypertensive should be screened for microalbuminuria.

• The test should be done at least once in an year


Tests For Assessment Of Glomerular Function


Tests For Tubular Function

• Urine concentration Test

• Urine dilution Test

• Specific proteinuria or tubular proteinuria

• Glycosuria

• Amino Aciduria


CYSTATIN C


Other Investigations


Renal Biopsy


Radiology & Imaging


Diagnostic Procedures


Diabetic Patients


Non - Diabetic Patients

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Kh approach to pt with kidney problem

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