Kidney Disease PDF

KIDNEY DISEASE Dr.Murtadha Kadhim The kidneys are two bean-shaped organs, each about the size of a fist. They are located just below the rib cage, one on each side of your spine. Healthy kidneys filter about a half cup of blood every minute. what a kidney can do remove waste products from the bo...

KIDNEY DISEASE Dr.Murtadha Kadhim The kidneys are two bean-shaped organs, each about the size of a fist. They are located just below the rib cage, one on each side of your spine. Healthy kidneys filter about a half cup of blood every minute. what a kidney can do remove waste products from the body. remove drugs from the body. balance the body's fluids. release hormones that regulate blood pressure. produce an active form of vitamin D that promotes strong, healthy bones. control the production of red blood cells. What are the first signs of kidney problems? Decreased urine output, although occasionally urine output remains normal. Fluid retention, causing swelling in your legs, ankles or feet. Shortness of breath. Fatigue. Confusion. Nausea. Weakness. Irregular heartbeat. What are the two most common causes of kidney disease? In the United States, diabetes and high blood pressure are the leading causes of kidney failure, accounting for 3 out of 4 new cases. Macroscopic examination Colour - Normal- pale yellow in colour due to pigments urochrome,urobilin and uroerythrin. Cloudiness may be caused by excessive cellular material or protein, crystallization or precipitation of salts upon standing at room temperature or in the refrigerator. If the sample contains many red blood cells, it would be cloudy as well as red. WHY TEST RENAL FUNCTION? To asses the functional capacity of kidney Early detection of possible renal impairment. Severity and progression of the impairment. Monitor response to treatment Monitor the safe and effective use of drugs which are excreted in the urine URINE ANALYSIS Urine examination is an extremely valuable and most easily performed test for the evaluation of renal functions. It includes physical or macroscopic examination, chemical examination and microscopic examination of the sediment. Volume - Normal- 1-2.5 L/day - Oliguria- Urine Output < 400ml/ day Seen in - Acute glomerulonephritis - Renal Failure - Polyuria- Urine Output > 2.5 L/ day Seen in - Increased water ingestion - Diabetes mellitus and insipidus. - Anuria- Urine output < 100ml/ day Seen in renal shut down BLOOD EXAMINATION Done to measure substance in blood that are normally excreted by kidney. Their level in blood increases in kidney dysfunction. As markers of renal function creatinine, urea, uric acid and electrolvtes are done for routine analysis. Serum creatinine Creatinine is a breakdown product of creatine phosphate in muscle, and is usually produced at a fairly constant rate by the body depending on muscle mass Creatinine is filtered but not reabsorbed in kidney. - Normal range is 0.8-1.3 mg/dl in men and 0.6-1 mg/dI in women. - Not increased above normal until GFR<50 ml/min Increased serum creatinine: - Impaired renal function - Very high protein diet - Anabolic steroid users - Vary large muscle mass: body builders, giants, acromegaly patients - Rhabdomyolysis/crush injury Blood urea - Urea is major nitrogenous end product of protein and amino acid catabolism, produced by liver and distributed throughout intracellular and extracellular fluid. - Urea is filtered freely by the glomeruli. - Many renal diseases with various glomerular, tubular, interstitial or vascular damage can cause an increase in plasma urea concentration. The reference interval for serum urea of healthy adults is 10-40 mg/dI. GLOMERULAR FUNCTION TESTS The GFR is the best measure of glomerular function. - Normal GFR is approximately 125 mL/min - When GFR decreases to 30% of normal> moderate renal insufficiency. Patients remain asymptomatic with only biochemical evidence of a decline in GFR As the GFR decreases further > severe renal insufficiency characterized by profound clinical manifestations of uremia and biochemical abnormalities, such as acidemia; volume overload; and neurologic, cardiac, and respiratory manifestations _ When GFR is 5% to 10% of normal =ESRD Thank you Vital signs Dr.Murtdha khadim jwad 1. Tempertaure 2. pulse rate 3. Respiratory rate 4. blood pressure 5. O2 saturation Temperature calculated by Thermometer how you can measure body temperture ?! Sublingual route Axillary route Rectal route Pulse rate (60-100 BPM) Respiratory rate Blood pressure 120/80 mmhg Oxygen saturation More than 94% Respiratory Examination Prepare patient • Introduction • Position semi-recumbent at 45º with whole chest exposed General Inspection General signs: • Cachexia, cyanosis, sputum pot contents, rate & depth of breathing, stridor/wheeze, use of accessory muscles. Ask to cough & note character (dry, barking, productive, bovine). Hands & Wrist Peripheral cyanosis Clubbing (many causes including): • • • Cyanotic congenital heart disease Infective endocarditis Atrial myxoma • • Lung Ca Chronic lung suppuration o Lung abscess or empyema o Bronchiectasis or CF Idiopathic pulmonary fibrosis Pleural mesothelioma Asbestosis • • • • • • • • • • IBD Cirrhosis Coeliac disease SB lymphoma Thyrotoxicosis (acropachy) Idiopathic/familial Rarely: o Pregnancy o 2º Hyperparathyroidism Tar staining of fingers Wrist tenderness (HPOA- Hypertrophic pulmonary osteoarthopathy) Wasting & weakness (test strength of spreading digits) of small muscles (?lung Ca affecting brachial plexus) Wrist flap (Extend both for 30s – ?CO2 narcosis) Radial Pulse • Rate & rhythm. ?Tachycardia ?Pulsus paradoxus Face Eyes: Horner’s – ipsilateral ptosis, small pupil, enophthalmos, ↓facial sweating (apical lung Ca) Sinuses: Tenderness Nose: Patency Mouth: Cyanosis Voice: Hoarseness (recurrent laryngeal nerve palsy) Neck Trachea - ?midline Posterior Chest Inspect • • • Scars – thoracotomy? Shape of chest o Barrel chest: ↑AP diameter compared to lateral diameter – asthma, COPD o Pectus carinatum (pigeon chest): localised outward bowing of sternum/costal cartilages – rickets, chronic childhood respiratory disease o Pecus excavatum (funnel chest): localised depression of distal sternal – development defect o Harrison’s sulcus: linear depression of lower ribs just above costal margin – asthma, rickets Spine deformity Palpate • • • Cervical LN Chest expansion o Upper lobes – watch clavicles from behind & above to see if R=L o Lower lobes – encircle chest & check ↑thumb separation (>5cm) on breathing Tactile vocal fremitus (“99”) Percuss • Back & axillae: stony dull for effusion, hyperresonant for hyperexpansion, PTX Auscultate • • • Breath sounds o Vesicular (normal over lung) o Bronchial (normal over trachea) Adventitious sounds o Stridor o Wheezes – exp>insp usually. Imply airway narrowing. Fixed wheeze - ?lung Ca o Crackles (high freq = crepitations, low freq = rales)
Early inspiratory crackles – COPD
Late/pan-inspiratory crackles • Fine – pulmonary fibrosis • Medium - LVF • Coarse - Bronchiectasis, retention of secretions Vocal resonance o Muffled over normal lung, aegophony or whispering pectoriloquy over consolidation Anterior chest Inspect • • • Radiotherapy marks Subcutaneous emphysema Upper chest expansion Percuss • • • • • Supraclavicular regions, clavicles, ant chest Liver upper edge (usually 5icsmcl) Auscultate As shown. Note a pleural rub (pleurisy, PE, pneumonia) or displaced apex beat Assess for Right Heart Failure Inspect JVP – if elevated then: • • • • Check for Pemberton’s sign for SVC obstruction (arms over head >1min → facial plethora) Auscultate the heart Palpate/Percuss the liver Examine the legs for oedema Other Temperature Recent chest x-ray PEFR/Spirometry