The document discusses the approach to evaluating and diagnosing patients with potential kidney problems. It outlines signs and symptoms of kidney disease including abnormalities in urination, pain presentations, changes in urine appearance and volume. It also describes tests used to evaluate kidney function including urine analysis, glomerular filtration rate (GFR) and tests of tubular function. The evaluation process involves taking a medical history, physical examination, renal function tests, imaging and other diagnostic procedures depending on individual patient presentation and symptoms.

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Approach to a Patient with Kidney Problem
DR. R.K. MANDOT DM
CONSULTANT NEPHROLOGIST & TRANSPLANT PHYSICIAN
KIDNEY HEALTH, AHMEDABAD

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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

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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

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Abnormalities of Micturition
• Dysuria
• Frequency & Nocturia
• Stranguary
• Pneumaturia
• Urgency
• Hesitancy
• Decreased stream
• Dribbling of urine
• Retention of urine
• Incontinence of urine

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Alteration in Amount of Urine
• Polyuria – over 3000 ml/d
• Oliguria – less than 300 ml/d
• Anuria – negligible urine

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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

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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

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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

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Signs of CKD Stages 1 To 4

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Renal Syndromes
• Renal failure acute / chronic / rapidly progressive
• Nephrotic syndrome
• Nephritic syndrome
• Asymptomatic urinary abnormality proteinuria / hematuria / pyuria
• Renal vascular disease

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Renal Syndromes
• Infections of the urinary tract
• Obstruction of the urinary tract
• Urinary tract calculi & nephrocalcinosis
• Malignancy
• Congenital abnormalities
• Cystic kidney diseases

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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

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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

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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

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Physical Examination
• High BP
• Jugular venous distention
• Chest crepitation • Pericardial rub
• Edema • Renal bruit • Prostate examination
• Abdominal pain

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Renal Function Tests Required For

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RFTs Give Information Regarding…..

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Classification of RFTs
• Urine analysis
• Tests for assessment of glomerular function
• Tests to measure renal plasma flow
• Tests for assessment of tobular function

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Urine Analysis

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Test for Assessment of Glomerular Function

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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

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Renal Clearance Test

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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

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Tests for Assessment of Glomerular Function

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Tests for Assessment of Glomerular Function

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Proteinuria

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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

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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

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Tests For Assessment Of Glomerular Function

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Tests For Tubular Function
• Urine concentration Test
• Urine dilution Test
• Specific proteinuria or tubular proteinuria
• Glycosuria
• Amino Aciduria

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CYSTATIN C

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Other Investigations

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Renal Biopsy

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Radiology & Imaging

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Diagnostic Procedures

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Diagnostic Procedures

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Diagnostic Procedures

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Diagnostic Procedures

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Diagnostic Procedures

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Diagnostic Procedures

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Diagnostic Procedures

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Diagnostic Procedures

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Diagnostic Procedures

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Diagnostic Procedures

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Diagnostic Procedures

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Diabetic Patients

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Diabetic Patients

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Non - Diabetic Patients

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Non - Diabetic Patients

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