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Approach To Kidney Disease

This document outlines an approach to evaluating patients presenting with kidney disease. It discusses obtaining a thorough history, including family history of kidney disease, exposures, medications and recent infections. Physical examination may reveal hypertension, edema, rashes or joint abnormalities. Laboratory tests include urinalysis to check for proteinuria, hematuria and urine casts. Imaging like ultrasound and CT scans can identify obstructive causes or masses. Common kidney conditions addressed include nephritic syndrome, nephrotic syndrome, obstructive uropathy, hypertension, nephrolithiasis, acute kidney injury and chronic kidney disease. Urinary tract infections are also discussed.

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john ray gonzales
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167 views28 pages

Approach To Kidney Disease

This document outlines an approach to evaluating patients presenting with kidney disease. It discusses obtaining a thorough history, including family history of kidney disease, exposures, medications and recent infections. Physical examination may reveal hypertension, edema, rashes or joint abnormalities. Laboratory tests include urinalysis to check for proteinuria, hematuria and urine casts. Imaging like ultrasound and CT scans can identify obstructive causes or masses. Common kidney conditions addressed include nephritic syndrome, nephrotic syndrome, obstructive uropathy, hypertension, nephrolithiasis, acute kidney injury and chronic kidney disease. Urinary tract infections are also discussed.

Uploaded by

john ray gonzales
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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Approach to the Patient

with Kidney Disease


JOHN RAY GONZALES MD
Hematuria
 > 3 RBC /HPF
History
 Hematuria on patients > 40 years old, consider it a sign of malignancy until proven otherwise
 Bladder cancer
 Hypercalciuria and hyperuricosuria are common in children

History of renal dysfunction in the family


 Polycystic kidneys
 Alport’s disease
 Thin basement membrane disease
Other information
 History of travel
 Exposure to chemicals
 Smoking history
 Medication history
Recent infections
Nephritic Syndrome
 Glomerular hematuria
 Active urine sediments
History and review of systems
1. Glomerular hematuria
2. Tea-colored, dark brown, smoky urine
3. Foamy/frothy urine
4. Hearing or visual symptoms
Physical examination
Hypertension
Edema
Rash
Joint abnormality
Laboratory examination
1. Urinalysis
Proteinuria
RBC cast
Blood chem
CBC
BUN
Crea
ESR
CRP
Complement levels
ANA
ANCA
Nephrotic syndrome
1) High grade protenuria
2) Hypoalbuminemia
3) Lipiduria
4) Edema
5) Hyperlipidemia
History
DM
Viral infections
Medications
Autoimmune
Physical
examination
Edema
Ascites
 Xanthoma
Nail findings
Laboratory exam
Urinalysis
Microscopy
Blood examination
Chest xray
Doppler of renal veins
Kidney biopsy
Obstructive uropathy
1) Acute
2) Sub-acute
3) Chronic
History and Review of Systems
Pain
Frequency
Urgency

Physical examination
Palpate the bladder
Laboratory test
Urinalysis
Creatinine

Imaging
Ultrasound
CT scan
Hypertension
History
Smoking
Alcohol use
Medications

Symptoms of target organ dysfunction


Symptoms of secondary hypertnsion
Investigation
Imaging
Chest xray
Doppler of renal vessels
Nephrolithiasis
History
Site of pain
Urinary symptoms
Diet
Medications
Occupation

Physical examination
Fever
Costovertebral angle tenderness
Laboratory
Urinalysis
◦ Urine pH

Uurine microscopy
Acute Kidney Injury
Chronic Kidney Disease
Urinary Tract Infection
Most common bacterial infection
Can be asymptomatic

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