Renal System - History Taking
By Dr. Usama Ragab Youssif
Lecturer of Medicine, Zagazig University
Email: usamaragab@medicine.zu.edu.eg, usama.ragab.zu@gmail.com
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definition of hydronephrosis,
causes and types of hydronephrosis
pathophysiology of hydronephrosis
clinical manifestation and diagnostic test for hydronephrosis
management
Urolithiasis is a common disease that is estimated to
produce medical costs of $2.1 billion per year in the United States alone.
Renal colic affects approximately 1.2 million people
each year in USA and accounts for approximately 1% of
all hospital admissions.
Most active emergency departments (EDs) manage
patients with acute renal colic every day.
definition of hydronephrosis,
causes and types of hydronephrosis
pathophysiology of hydronephrosis
clinical manifestation and diagnostic test for hydronephrosis
management
Urolithiasis is a common disease that is estimated to
produce medical costs of $2.1 billion per year in the United States alone.
Renal colic affects approximately 1.2 million people
each year in USA and accounts for approximately 1% of
all hospital admissions.
Most active emergency departments (EDs) manage
patients with acute renal colic every day.
Pyelonephritis
It is the inflammation of the kidney & upper urinary tract that usually results from the bacterial infection of the bladder.
Pyelonephritis can be classified in several different catagories:
-acute pyelonephritis
-chronic pyelonephritis
-xanthogranulomatous pyelonephritis
The urethra's main job in males and females is to pass urine outside the body. This thin tube also has an important role in ejaculation for men. When a scar from swelling, injury or infection blocks or slows the flow of urine in this tube, it is called a urethral stricture. Some people feel pain with a urethral stricture.
Hematuria for undergraduates
this is a presentation i prepared for medical students about hematuria, hope u like it
for more urology resources visit:
www.uronotes2012.blogspot.com
Pyelonephritis
It is the inflammation of the kidney & upper urinary tract that usually results from the bacterial infection of the bladder.
Pyelonephritis can be classified in several different catagories:
-acute pyelonephritis
-chronic pyelonephritis
-xanthogranulomatous pyelonephritis
The urethra's main job in males and females is to pass urine outside the body. This thin tube also has an important role in ejaculation for men. When a scar from swelling, injury or infection blocks or slows the flow of urine in this tube, it is called a urethral stricture. Some people feel pain with a urethral stricture.
Hematuria for undergraduates
this is a presentation i prepared for medical students about hematuria, hope u like it
for more urology resources visit:
www.uronotes2012.blogspot.com
continuation on the urinary tract disorders. congenital and acquired disorders well covered. pyelonephritis also forms part of the text. thanks for reading. remeber to like and follow
Symptoms and Signs of different Diseases in UrologyAbdullah Mohammad
How would you approach a Urological Patient? This presentation will tell you how to take a history and examination along with symptoms and common signs of different diseases in urology
easy description of common lut disorders. improvements on the slides accepted. text includes congenital and acquired disorders. more so the causes of bladder outlet obstructions. also management of the disorders are breifly described.
Diabetic Peripheral Neuropathy and Vitamin B12 IssueUsama Ragab
Diabetic Peripheral Neuropathy and Vitamin B12 Issue
By Dr. Usama Ragab Youssif
Diabetic neuropathies are the most prevalent chronic complications of diabetes
Central and Peripheral Precocious PubertyUsama Ragab
Precocious Puberty
By Dr. Usama Ragab Youssif
Precocious puberty (PP) is defined as the development of pubertal changes (2ry sexual characters), at an age younger than the accepted lower limits for age of onset of puberty.
Algorithms for Diabetes Management for StudentsUsama Ragab
Algorithms for Diabetes Management for Students
By Usama Ragab Youssif
Lecturer of Medicine - Zagazig University
Agenda
Type 2 Diabetes 101
Incretin based therapy
Algorithms of management
Email: usamaragab@medicine.zu.edu.eg, usama.ragab.zu@gmail.com
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Classification & Diagnosis of Diabetes.pptx
By Dr. Usama Ragab Youssif
Lecturer of Internal Medicine Zagazig University
Email: usamaragab@medicine.zu.edu.eg, usama.ragab.zu@gmail.com
SlideShare: https://www.slideshare.net/dr4spring/
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Mobile: 00201000035863
Clinical Endocrinology Round
By Dr. Usama Ragab Youssif
Lecturer of Medicine
Zagazig University
Acromegaly
Cushing
Diabetes
Thyroid
Addison
Techniques and clinical insights
Functional Bowel Disorders
By Dr. Usama Ragab
Esophageal Disorders
Gastroduodenal Disorders
Bowel disorders
Centrally Mediated Disorders of GI Pain
Gallbladder and Sphincter of Oddi Disorders
Anorectal disorders
Childhood Functional GI Disorders: Neonate/Toddler
Childhood Functional GI Disorders: Child/Adolescent
Heat, Cold and High Altitude Related illnessUsama Ragab
Heat, Cold and High Altitude Related illness
By Dr Usama Ragab
Lecturer of Medicine
Topics are heat and cold related illness and high altitude medical disorders
Imeglimin, What is new?
By Dr. Usama Ragab Youssif
Lecturer of Medicine - Zagazig University
Agenda
Mitochondrial function and dysfunction
Mitochondrial (dys)function in diabetes
Diabetes core defects and Imeglimin
Imeglimin drug development and approval
Imeglimin and Heart
Diabetes and Gut interplay
By Dr. Usama Ragab Youssif
In Gastro Canal Association Annual Conference
Agenda
Diabetes as the main player
Gut as the main player
Diabetes and gut in a separate game
Gut as game changer
Tips and tricks: diabetes drugs
Guidelines in Obesity management
By Dr. Usama Ragab Youssif
Obesity-related counseling should be offered to those with BMI ≥25 kg/m2
A 3% to 5% weight loss can result in meaningful reductions in triglycerides, blood glucose, hemoglobin A1c, and the risk of developing type 2 diabetes
Set an initial weight loss goal of 5% to 10% of current body weight over 6 mo
After 6 mo, focus on weight maintenance before attempting further weight loss
Participating in a weight loss program long-term can help improve weight maintenance
Intensification Options after basal Insulin RevisitedUsama Ragab
Intensification Options revisited
By Dr. Usama Ragab Youssif
Add an OAD
Add a short-acting insulin at mealtime
Switch to premixed insulins
Novel insulin combinations
Basal insulin/GLP-1 RA combinations
Insulin Lispro Revisited
By Dr. Usama Ragab Youssif
The discovery of insulin was one of the most dramatic and important milestones in medicine - a Nobel Prize-winning moment in science.
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TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
5. History of present illness= منمق طبي كالم
Chronologically arranged
Long
Medical terms
= symptomatology of urology system
6. The history should incorporate symptoms and signs
Arising locally from the kidneys and urinary tract.
Resulting from impaired salt and water handling.
Caused by failing renal excretory and metabolic function.
Relating to a systemic disease, causing or contributing to renal dysfunction.
7. Sometimes, kidney is silent…
Abnormal BP, urinalysis, or eGFR.
Clinically useful syndromes.
Biochemistry, radiology, and/or histopathology are completing the puzzle
Diagnostic treatment e.g., cessation of a nephrotoxic drug or volume restoration
8. Local Symptoms in any system
Pain Swelling
Disturbance
of function
Loss of
function
9. Local symptoms of urinary tract disease
• Pain: Loin pain, ureteric colic, suprapubic pain.
Onset, course, duration.
Character.
Site, radiation.
What increase and what decrease
Association.
• Swelling
Edema
Local swelling = surgical consultation
• Disturbance of function (next slide)
• Loss of function= renal failure, ED
• Patient with new kidney
10. Disturbances of function
• Obstructive symptoms.
• Irritative symptoms.
• Volume abnormalities:
polyuria, oligurea and anuria.
• Change in urine appearance;
color abnormalities: e.g.
hematuria,
hemoglobinuria...etc...
Obstructive symptoms Irritative symptoms
•
Hesitancy; or abdominal
strain.
•
Poor stream
•
Intermittent stream
•
Terminal dribbling
•
Acute retention of urine
•
Sense of incomplete
emptying
•
Burning on micturition;
dysuria.
•
Urgency
•
Daytime frequency
•
Nocturia
•
Urge incontinence
12. 1- Dysuria, frequency & urgency
Dysuria means pain on passing urine rather than difficulty in doing
so
Frequency means that the urine is passed more often than normal
without an increase in the total volume.
Urgency is a strong desire to pass urine, which may be followed by
incontinence if the circumstances are not suitable (very common)
•Dysuria, frequency and urgency are associated with irritation
of the bladder and urethra by infections, tumor or stone.
•Dysuria alone may be due to urethritis.
•Urgency alone may be due to anatomical change as in
gynecological disorder or neurological diseases e.g. prolapse.
•Frequency alone may be due to anxiety or abnormal bladder
muscle tone (Detrusor instability) e.g. during examinations.
13. 2- Polyuria
This means an increase in urinary output> 3L/d regardless the
frequency of micturition.
Severe polyuria will cause thirst, which may be the presenting
symptom. Normal urine volume = 600 mL- 1800 mL.
14. Different cause of polyuria (Major
Polyuria syndrome)
1- Renal
- Chronic interstitial nephritis.
-Polyuric phase of acute tubular
necrosis
- Diuretic therapy.
- DI.
- RTA, Fanconi syndrome
2- Endocrinal
- D.M.; osmotic diuresis
- Cushing → K dieresis, HTN,
hyperglycemia
- Conn's → K diuresis (↓ K→
nephrogenic DI)
- Hypothalamic & pituitary D.I.
- Hyperparathyroidism (Ca diabetes)
3- Sickle cell disease 4- Functional
15. Patient with polyurea, polydipsia
Low specific gravity
Water deprifation test for 12 h.
No response
DI
Give ADH
Good response
Pituitary DI
No reponse
Nephrogenic DI
Good response
Psychogenic polydipsia
High specific gravity
If there is +ve sugar
in urine
DM
16. 3- Oliguria & Anuria
Oliguria: Urine output <400 mL/d (which is the minimal volume of
urine which is necessary to excrete the waste products); this varies
with diet, physical activity and metabolic rate as well as renal
function.
Anuria: means that urine volume is <100 ml /24hrs; it raises the
possibility of urinary tract obstruction (if obstruction is excluded,
consider bilateral renal infarction due to thrombosis of the renal
arteries or a descending aorta).
17. 4- Hematuria
• Presence of blood in urine
attributed to bleeding
from the urinary tract
You must ask whether it is painless or painful
18. Notes on
hematuria
When there is also frequency or dysuria
the bleeding mostly from bladder.
Hematuria that clears during micturition
arises from urethra
Hematuria all through usually arises
from the kidney.
Terminal hematuria is also of bladder
origin as in cases of bilharziasis.
21. 5- Pneumaturia
• It means sensation of passing
bubbles in the urine; this is
usually caused by vesicocolic
fistula (malignancy).
22. 6- Alteration of the force of micturition
A poor urinary
stream is common
in old males due
to senile prostate.
Demonstrate how
near he has to
stand to an
imaginary toilet.
This also can occur
with a urethral
stricture (less
common).
23. 7- Nocturia
• The need to pass urine at night or during
the sleeping hours may be a lifelong habit,
but a newly developing habit it may be due
to:
Prostatic obstruction → residual urine
→ irritation → desire
Heart failure
24. 8- Incontinence
(Types and causes)
• It is defined as inability of the urinary
bladder to retain urine.
Many females suffer from urinary
incontinence provoked by the stress
of laughing, sneezing or coughing,
this is due to gynecological disorders
e.g. prolapse
Retention with overflow leads to
incontinence (see neurogenic
bladder).
Urgency may also lead to
incontinence (urge incontinence).
25. 9- Urogenital pain
Renal Pain
• Patient could withstand it
• It is described as dull aching pain in
the loin.
• As in hydronephrosis and staghorn
stone, it is intermittent in polycystic
kidney due to spontaneous bleeding
into a cyst.
• Also renal pain occurs with acute
pyelonephritis.
Ureteric pain (colic)
• Patient in agony
• It is a more severe pain due to
obstruction of the ureter by stone or
blood clot. The pain radiates
downward to the groin and genitalia
(loin to groin).
• Once a stone reaches the bladder, it
becomes usually asymptomatic unless
it enters the urethra to cause dysuria.
• The ureteric colic is usually severe and
sustained associated with nausea and
vomiting; parasympathetic effect.
26. 10- Other
urinary
symptoms
Strangury: It is severe suprapubic pain
associated with inability to pass urine
(or dribbling), dysuria and urgency. It is
usually due to acute bladder neck
obstruction by a stone or blood clot.
Urgency: It is a sudden need to pass
urine.
27. 10- Other
urinary
symptoms
(cont.)
Hesitancy: It is a delay in initiating urine
flow; more in females, more prone to
postural syncope
Double micturition is when a patient,
soon after emptying the bladder wants to
do so again. This occurs in patients with
vesicoureteral reflux as they have a large
residual urine volume in the bladder.
28. 11- ED
Ask about the desire
With reduced libido With preserved libido
1. Hypogonadism
2. Depression
1. Psychological problems, including
anxiety, first experience
2. Vascular insufficiency (atheroma)
3. Neuropathic causes (e.g. diabetes
mellitus, alcohol excess, multiple
sclerosis)
4. Drugs (e.g. β-blockers, thiazide
diuretics)
29. 12- Edema
Usually involves the face (at first), the
ankles and legs.
There can be associated with ascites as
in the case of the nephrotic syndrome.
Anasarca= generalized edema.
30. 13- Renal failure
• The patient may complain of
nonspecific symptoms and
consult diverse of physicians
before being diagnosed.
31. Past History
Urinary tract problems as a child (e.g.,
infections, nocturnal enuresis).
Previously documented renal or urinary tract
disease of any kind. Ask specifically about
infections, stone disease, and, in ♂, prostatic
disease.
Hypertension. When diagnosed? Who is
responsible for follow-up? Current and
historical treatment? Level of control? Self-
monitoring with home BP monitor?
32. Past History
(cont.)
Cardiovascular risk factors or disease (e.g. IHD, CVA,
PAD, dyslipidaemia).
Other relevant systemic disease (e.g. diabetes
mellitus, connective tissue disorder, gout,
inflammatory bowel disease, sarcoidosis).
Insurance or employment medicals can provide
invaluable historical benchmarks. Can they recall a
past BP check or providing a urine specimen? Have
they had blood tests in the past?
33. Social History
Smoking: general CV risk in (and progression of) CKD, renovascular disease, urothelial
malignancy (74-fold risk), pulmonary haemorrhage in Goodpasture ’ s disease.
Physical activity.
Occupational history: risk factors for urothelial malignancy. Hydrocarbon exposure has
been implicated in glomerular disease, particularly anti-GBM disease.
Hepatitis and HIV risk factors.
A patient’s understanding of their kidney disease should be evaluated, and they should
be encouraged to be involved in decisions about their care.
35. May provide clues to an underlying systemic
condition
Skin rashes, photosensitivity, mouth ulcers e.g., SLE
Painful, stiff, or swollen joints e.g., RA, SLE
Myalgia.
Raynaud’s phenomenon e.g., vasculitis
Constitutional manifestation e.g., CTD
Thromboembolic episodes e.g., APS
Red or painful eyes e.g., RA, vasculitis
36. May provide clues to an underlying systemic condition (cont.)
ENT: Sinusitis,
rhinitis,
epistaxis e.g.,
GPA
Sicca
symptoms
(dry eyes, dry
mouth).
Haemoptysis
e.g., GPS
Hair loss e.g.,
SLE, vasculitis
37. Drug and treatment history
Antihypertensive therapy — past and present. Any important tablet
intolerances or side effects.
Analgesics — ask specifically about common NSAIDs (by their over-
the-counter names, if necessary). Then ask again.
Any ‘one-off ’ courses of therapy that may not be mentioned as part
of regular treatment, e.g. recent antibiotics (interstitial nephritis).
38. Drug and
treatment
history (cont.)
Oral contraceptive (increase BP).
Steroids, immunosuppressive agents —
type and duration.
Non-prescription, recreational
(cocaine, IVDU), and herbal medicines.
Current or historical exposure to
important nephrotoxic drugs.
40. Family History
• Consanguinity
• Similar conditions
• Essential HTN: more
common if one or both
parents affected.
• DM (types 1 and 2): more
common if close relative
affected.
41. Sexual,
gynecological
& obstetric
history
Decreased libido and impotence are extremely
common in CKD.
Irregular menses and subfertility are frequently
encountered in ♀. Amenorrhea is common in
ESRD.
Previous pregnancies and any complications (UTI,
proteinuria, i BP, pre-eclampsia). Miscarriages,
terminations? Were infants healthy and born at
term?
42. Sexual,
gynecological
& obstetric
history (cont.)
In CKD, maternal and fetal outcomes are
importantly related to GFR, degree of
proteinuria, and BP.
Cytotoxic drugs used in the treatment of
glomerular disease can induce premature
menopause in ♀ or infertility in ♂. This may
influence treatment in a ♀ of childbearing age.
Risk factors for sexually transmitted disease
when appropriate (HIV, hepatitis B and C can
all cause glomerular disease).
43. Dietary
History
Changes in appetite and weight.
Dietary habits (alcohol, vegan, ethnic diet,
protein or creatine supplements).
Dietary advice is an important part of the
management of many renal disorders (i BP,
AKI, CKD, the nephrotic syndrome, stone
disease, dialysis).
44. Ethnicity & Renal Diseases
• IgA nephropathy: Caucasians and certain Asian populations
(China, Japan, and Singapore).
• Diabetic nephropathy: black, Mexican American, Pima Indian
(a native American tribe in Southern Arizona, beloved of
epidemiologists and geneticists). An increasing problem in
the immigrant Asian population in the UK.
• SLE: Asian and black patients (and more aggressive disease).
• Hypertension and hypertensive renal failure: black patients.
• In the UK, the incidence of end-stage renal disease (ESRD) is
73x higher in South Asian and black patients than in
Caucasians.
45. Approach to the patient on
renal replacement therapy
When managing a dialysis or transplant patient, there are a few direct questions that
will help you to get to grips with (and reassure the patient that you are familiar with)
their treatment. It will also facilitate discussion with the patient ’ s renal unit.
46. All dialysis patients
How long have they been on
dialysis?
How much urine do they pass,
if any?
What is their dry (aka flesh,
target, post-dialysis) weight?
What is their daily fluid
allowance?
Do they adhere to a renal
diet?
Do they know the cause of
their ESRD?
Do they receive EPO
injections?
Have they always been on the
same modality of dialysis?
Are they ‘listed ’ for deceased
donor transplantation?
Have they previously received
a transplant?
How are they coping with
dialysis?
47. The patient on haemodialysis
Where does the haemodialysis treatment take place?
How many times per week and how many hours
What is the patient’s current access for dialysis (e.g. an arteriovenous fistula)
What is their usual fluid gain between treatments?
Do they know their blood pressure at the end of session
48. The patient on peritoneal dialysis
(CAPD) or
automated
overnight (APD)?
How many
exchanges do they
perform?
How many litres is
each exchange?
Do they have fluid in
at the moment?
Do they need
assistance to
perform
Do they measure
their own blood
pressure at home?
Exit site of their
dialysis catheter
clean and dry?
Are the dialysis bags
clear or cloudy
When was their last
episode of
peritonitis?
49. The transplant patients
When and where was
the transplant
performed?
What
immunosuppression is
the patient taking?
Who is responsible for
their follow-up?
Do they know their
baseline SCr?
Was the transplant
from a living or
deceased donor?
Do they use sunblock
and attend a skin
clinic?
Do they know if they
had any rejection
episodes?
Do they know the
cause of their end-
stage renal disease?
What mode of dialysis
were they on prior to
transplantation?
Asymptomatic patients often require assessment, following the discovery of an abnormal BP, urinalysis, or eGFR.
Symptoms, signs, and investigation findings are organized into clinically useful syndromes.
Biochemistry, radiology, and/or histopathology are almost always required for accurate diagnosis (although a thorough clinical assessment will lessen over-reliance on expensive and potentially invasive tests).
Diagnosis is often suggested by treatment, e.g., cessation of a nephrotoxic drug or restoration of adequate circulatory volume.
A poor urinary stream is common in old males due to senile prostate.
The force of the stream can be determined by asking the patient to demonstrate how near he has to stand to an imaginary toilet.
This also can occur with a urethral stricture (less common).
Heart failure, the diuresis resulting from:
The improvementin renal blood flow which occurs with recumbency.
Absorption of the edema fluid
Digitalis has some diuretic action.
Patient may receive diuretics.
Capacity of the bladder = 500 – 600 mL
The renal parenchyma is pain free and renal pain is associated with conditions causing stretching of the renal capsule (Fascia of Zucker Candle) (Gerota Fascia) and renal pelvis.
Renal colic (ureteric colic) is usually due to ureteric obstruction bycalculus or blood clot.
Usually involves the face (at first), the ankles and legs.
There can be associated with ascites as in the case of the nephrotic syndrome.
When swelling becomes generalized there is collection of fluid in the abdominal, pleural and even the pericardial space. This is referred to as anasarca (generalized edema).
The importance of the drug history cannot be overstated — it will often tell a story of its own. Ask candidly about compliance.
The importance of the drug history cannot be overstated — it will often tell a story of its own. Ask candidly about compliance.
In CKD, maternal and fetal outcomes are importantly related to GFR, degree of proteinuria, and BP.
Cytotoxic drugs used in the treatment of glomerular disease can induce premature menopause in ♀ or infertility in ♂. This may influence treatment in a ♀ of childbearing age. Pre-treatment sperm banking can be offered in ♂.
Risk factors for sexually transmitted disease when appropriate (HIV, hepatitis B and C can all cause glomerular disease).
How many times per week do they dialyse and how many hours is each treatment?
What is the patient’s current access for dialysis (e.g. an arteriovenous fistula, a PTFE graft, or a tunnelled dialysis catheter)?
Are their exchanges performed manually during the day (CAPD) or automated overnight (APD)?