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Renal Exam
 
 

Chronic Kidney Disease

 
 
 
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Overview

  • Signs of Chronic Kidney Disease

  • General Signs

  • Sallow complexion
  • Leukonychia
  • Sarcopaenia
  • Signs Suggesting a Cause

  • Finger prick markings (diabetes)
  • Palpable polycystic kidneys
  • Signs of Complications

  • Acidosis - tachypnoea
  • Fluid overload - hypertension, raised JVP, sacral / pedal oedema, pulmonary crepitations
  • Anaemia - palmar crease pallor, conjunctival pallor
  • Uraemia - scratch marks, confusion, asterixis, pericardial rub
  • Signs of Management

  • Haemodialysis - VasCath, arteriovenous fistula, graft
  • Peritoneal dialysis - Tenkhoff catheter
  • Scars - nephrectomy, renal transplant, parathyroidectomy
  • Palpable renal transplant (usually right lower quadrant)

Aetiology

  • Causes of Chronic Kidney Disease

  • Diabetic nephropathy
  • Hypertensive nephropathy
  • Glomerulonephritis
  • Tubulointerstitial disease - analgesic nephropathy, reflux nephropathy
  • Congenital disease - polycystic kidney disease

Complications

  • Complications of Chronic Kidney Disease

  • Disease-Related

  • Acidosis (poor clearance of hydrogen ions)
  • Fluid overload
  • Electrolyte derangements - hyperkalaemia, hyperphosphataemia
  • Cardiovascular disease - hypertension, increased cardiovascular / cerebrovascular risk
  • Anaemia (EPO deficiency)
  • Mineral bone disease (mediated by FGF23) - secondary hyperparathyroidism, hyperphosphataemia, hypocalcaemia; tertiary hyperparathyroidism
  • Uraemia - encephalopathy, uraemic pericarditis
  • Malnutrition
  • Treatment-Related

  • Lethargy
  • Muscle cramps
  • Restless legs syndrome
  • Access-related complications - thrombosis, infection
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