Renal Diseases Review

The patient is a 41 year-old male who has a longstanding history of hypertension and diabetes and
presents with a complaint of pruritis, lethargy, lower extremity edema, nausea and emesis. He denies any
other medical illnesses.
On physical exam the patient is a well-developed, well-nourished male in moderate distress. Blood
pressure 180/110, pulse 80, respirations 24 and he was afebrile. Body weight 76.5 kg. HEENT was
remarkable for fundoscopic findings of A-V nicking and copper wire changes consistent with
hypertensive injury. Cardiac exam had an S1, S2 and S4. The remainder of the exam was remarkable for
2+ lower extremity edema and superficial excoriations of his skin from scratching.
Laboratory Data
Chemistry Normal Values Urinalysis
Sodium 133 136-146 mmol/L
Potassium 6.2 3.5-5.3 mmol/L
Chloride 100 98-108 mmol/L
Total CO2 15 23-27 mmol/L
BUN 170 7-22 mg/dl
Creatinine 16.0 0.7-1.5 mg/dl pH 6.0

Specific gravity 1.010
Glucose 108 70-110 mg/dl Protein 1+
Glucose negative
Calcium 7.2 8.9-10.3 mg/dl Acetone negative
Occult blood negative
Phosphorus 10.5 2.6-6.4 mg/dl Bile negative
Waxy casts
Alkaline Phosphatase 306 30-110 IU/L
Parathyroid Hormone 895 10-65 pg/ml
Hemoglobin 8.6 14-17 gm/dl
Hematocrit 27.4 40-54 %
Mean cell volume 88 85-95 FL

24-hour urine protein and creatinine - volume 850 ml, protein 600
mg/dl and creatinine 180 mg/dl
Renal ultrasound- Right kidney 9 x 6.0 cm, Left kidney 9.2 x 5.8 cm
Both kidneys illustrate hyperechogenicity and no hydronephrosis.
Q1. "presents with a complaint of pruritis, lethargy, lower extremity
edema, nausea and emesis." what does the symptoms suggest to you?
Uremia
Symptoms of uremia are are non-specific. You have to keep
this possibility in mind whenever there is consideration for
renal disease.
•Lethargy
•Nausea and vomiting
•Fatigue
•Lethargy
•Pruritus
2. What are the fundus changes in a hypertensive?
2. What are the fundus changes in a hypertensive?
•AV nicking
•Hemorrhage
•Papilloedema
3. What are the fundus changes of a diabetic?
•Exudates
•Hemoorhage
•Neo-vascularization
•Aneurysms
What does S4 signify? What cardiac findings will you expect to
find in a hypertensive?
Pressure work
•Apical impulse low and out
•Sustained apical impulse
•Loud A2 component over aortic area
•S4
What are the possibilities for his symmetrical 2+ lower
extremity edema?
•Congestive heart failure
•Hypoalbuminemia
•Water retension from renal failure
6. What is the significance of the finding " superficial
excoriations of his skin from scratching." ?
Uremia leads to pruritus and explains the excoraitions from

scratching.
7. Why was a renal ultrasound ordered? What information can
you gather from renal untrasound studies?
To determine kidney
•size
•echogenicity
•rule out obstruction
8 .How does the results of the renal ultrasound influence your
thinking on the diagnosis? What is the normal size of the
kidney? Is his kidney size normal? What does small or large
kidney signify?
Size:
•Normal
•Large: Consider
•Small: Consider
1. Which of the following symptoms do you expect to see in a patient
diagnosed with acute pyelonephritis?
1. Jaundice and flank pain
2. Costovertebral angle tenderness and chills
3. Burning sensation on urination
4. Polyuria and nocturia
2. You have a patient that might have a urinary tract infection (UTI).
Which statement by the patient suggests that a UTI is likely?
1. “I pee a lot.”
2. “It burns when I pee.”
3. “I go hours without the urge to pee.”
4. “My pee smells sweet.”
4. Which patient is at greatest risk for developing a
urinary tract infection (UTI)?
1. A 35 y.o. woman with a fractured wrist
2. A 20 y.o. woman with asthma
3. A 50 y.o. postmenopausal woman
4. A 28 y.o. with angina
12. An 18 y.o. student is admitted with dark urine,
fever, and flank pain and is diagnosed with acute
glomerulonephritis. Which would most likely be in
this student’s health history?
1. Renal calculi
2. Renal trauma
3. Recent sore throat
4. Family history of acute glomerulonephritis
15. Clinical manifestations of acute
glomerulonephritis include which of the following?
1. Chills and flank pain
2. Oliguria and generalized edema
3. Hematuria and proteinuria
4. Dysuria and hypotension
16. You expect a patient in the oliguric phase of renal
failure to have a 24 hour urine output less than:
1. 200ml
2. 400ml
3. 800ml
4. 1000ml
17. The most common early sign of kidney disease is:
1. Sodium retention
2. Elevated BUN level
3. Development of metabolic acidosis
4. Inability to dilute or concentrate urine
18. A patient is experiencing which type of
incontinence if she experiences leaking urine when
she coughs, sneezes, or lifts heavy objects?
1. Overflow
2. Reflex
3. Stress
4. Urge
20. The most indicative test for prostate cancer is:
1. A thorough digital rectal examination
2. Magnetic resonance imaging (MRI)
3. Excretory urography
4. Prostate-specific antigen
22. A patient diagnosed with sepsis from a UTI is
being discharged. What do you plan to include in her
discharge teaching?
1. Take cool baths
2. Avoid tampon use
3. Avoid sexual activity
4. Drink 8 to 10 eight-oz glasses of water daily
24. Which finding leads you to suspect acute
glomerulonephritis in your 32 y.o. patient?
1. Dysuria, frequency, and urgency
2. Back pain, nausea, and vomiting
3. Hypertension, oliguria, and fatigue
4. Fever, chills, and right upper quadrant pain radiating to
the back
30. A patient with diabetes mellitus and renal failure
begins hemodialysis. Which diet is best on days
between dialysis treatments?
1. Low-protein diet with unlimited amounts of water
2. Low-protein diet with a prescribed amount of water
3. No protein in the diet and use of a salt substitute
4. No restrictions

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The patient is a 41 year-old male who has a longstanding history of hypertension and diabetes and

Sodium 133 136-146 mmol/L

Potassium 6.2 3.5-5.3 mmol/L

Chloride 100 98-108 mmol/L

Total CO2 15 23-27 mmol/L

BUN 170 7-22 mg/dl

Creatinine 16.0 0.7-1.5 mg/dl pH 6.0

Parathyroid Hormone 895 10-65 pg/ml

Hemoglobin 8.6 14-17 gm/dl

Hematocrit 27.4 40-54 %

Mean cell volume 88 85-95 FL

Uremia leads to pruritus and explains the excoraitions from

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