Manifestations of renal disease

A resource for medical students and others learning about clinical approaches to diseases of the urinary system (kidney, bladder). By Neil Turner (University of Edinburgh). Shortcut to this page: bit.ly/2uIwWWq

Covering:

  • Symptoms and signs: Most kidney diseases create few specific symptoms until late. And they cause upset fluid balance, which presents its signs in the general examination and cardiovascular system.
  • History and examination: There are some extra Qs to ask when taking a history. For examination, there are only a few additional features to add to what you’ve already covered in general examination, plus the examination of the cardiovascular system and abdomen.

In addition to the text and video below, look at the handout (4 pages), and your proforma for recording your findings.

How does renal disease present?

Urinary symptoms are a common reason for GP consultations. Urinary Tract Infection (UTI) is common in infants and the elderly, and at other ages more common in women. Problems with continence are common in children, and in older men (prostate gland enlargement in particular) and women (bladder dysfunction in particular). There are less common but important neurological causes too.

But for a nephrologist concerned about loss of kidney function, symptoms match severity quite poorly. (8.20 mins)

How do you spot/ identify renal disease?

When it creeps up over a period, even advanced chronic renal impairment may be virtually asymptomatic. Diseases not causing those symptom clusters are often identified through tests. (10.20 mins)

More about haematuria and proteinuria at edrep.org (glomerulonephritis 1)

Examination

Principles (4 mins). Remember that the kidneys are far back in the abdomen.

 

Fluid imbalance and other signs

Fluid (= salt and water) overload is common. It can look like heart failure: beware ‘hypertensive heart failure’ – if you think you’re seeing it, check renal function! (4.59 mins)

 

How to examine

(7 min) highlights from previous antique video – includes patients, so restricted access  (click to view – UoE login required).

Further info

  • Haematuria and Proteinuria in the edrep textbook (edrep.org/textbook). (Don’t forget Schistosomiasis). The textbook has pages also on UTI.
  • Assessment of JVP (advanced) (edrep.org) An important element of clinical examination, but difficult to learn. Practice everywhere, including in your renal attachment, as you’ll see JVPs at all levels there.
  • Our website edren.org has detailed info for patients at edren.org/info. These give more than enough info for students about most renal conditions.
  • Our educational site has a Resources page (edrep) with particular info on UTI, glomerulonephritis, AKI, and some other common or more obscure topics.
  • Two other sites recommended for excellent resources:
    • NHS Choices – start at patient level but contain reviewed good sense. Form an excellent introduction to a topic and are perfect for ‘what advice would you give to a patient’.
    • NICE Clinical Knowledge Summaries – a level above, provide evidence for recommendations. Make sure you explore all the heading on the left hand menu, and explore related topics. There is a lot of high quality information in these articles (but not many jokes or pictures).
  • Healthcare professionals with kidney disease (this site) – some truly impressive stories