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DIAGNOSTIC AND THERAPEUTIC

APPROACH IN KIDNEY DISEASES


How we diagnose the kidney disease ?
We have to know the symptom and sign of kidney disease
Symptom :
1. Associated with urine :
a. urine volume :
- small volume of urine (anuria, oligouria)
- high volume of urine (polyuria)
- frequent urinated

b. Specification of urine
- smell of urine
- frothy urine
- red color (bloody) / haematuria
c. Associated with passing process of the urine
- pain (dysuria)
- no urine (anuria / retention urine)
- frequent small volume (polakisuria)
- insensible urinated (incontinentia urine)
- difficult on passing the urine (stranguria)

2. Symptom unassociated with urine :


a. edema
b. pale (anemic)
c. back pain (renal colic, ureter colic)
3. History of disease
a. diabetes mellitus
b. gastroenteritis
c. repeated infection of throat
d. systemic lupus erythematosus
4. Family history
a. kidney stone
b. hypertension

Who is at higher risk of kidney disease?


Age > 50 years
Diabetes
High blood Pressure
Smoking
Obesity
Family history of kidney disease

PHYSICAL EXAMINATION :
1. Blood pressure
- hypertension ?
2. Edema, ascites ?
3. Lumbal mass
4. Ballottement
- bimanual palpation
5. Percussion pain in angulus costovertebrae
6. Bruit (hearth sound) in abdominal area

SUPPORTING EXAMINATION :
Urine examination
Urine volume :
- anuria (< 100 ml / 24 hrs
- oligouria (<400 ml / 24 hrs)
- polyuria (>3000 ml/24 hrs)

Macroscopic urine
- red color (haematuria)
- frothy urine (proteinuria)
- dirty urine (pyuria)
Microscopic urine
- haematuria
- leucosuria
- albuminuria
- cylinder / cast

KIDNEY FUNCTION TEST


Kidney function identified by glomerular filtration rate
(GFR) : is an amount of blood can be filtered by the
kidney in a minute
Normal value of GFR is : 100 120 ml/mnt for men
85 100 ml/mnt for women
Laboratory test
- blood urea
- blood urea nitrogen (BUN)
- plasma creatinin

Glomerular filtration rate (GFR), indirectly represent


by measuring the Creatinin Clearence Test (CCT)
Formula for CCT :
1. Van Slyke formula
Urine Cratinin X urine vol/mnt
CCT =

ml/mnt
Plasma Cretainin

2. Cockroft Gault formula


(140 age) X body weight
CCT =

ml/minute
72 X Plasma Creatinin

Note : in women X 0.85

IMAGING TEST
1. Radiologic examination
- Plain photo abdomen
- Intra Venous Pyelography
- Retrograde Pyelography
- Antegrade Pyelography
2. Ultrasonographic examination
To investigate the structure of kidney

3. Computerized Tomography Scanning


More detail about the structure
4. Radioisotope Renography
Use a radioisotope material
5. Renal arteriography
To investigate the renal artery

KIDNEY BIOPSY
Indications :
-

Nephrotic syndrome
Nephritic syndrome
Asymptomatic haematuria
Unknown cause of Acute Kidney Injury
Rejection on kidney transplantation

To be continued by : Hystopathological examination


- light microscopic
- immunofluorescence

DIAGNOSTIC OF KIDNEY DISEASES


1. Clinical diagnostic
Chronic Kidney Disease
Acute Kidney Injury
Urinary Tract Infection
Nephrotic Syndrome
2. Etiology
Chronic Glomerulonephritis
Kidney stone

3. Complication
Hypertensive heart disease
Hyperkalemia

4. Associated clinical conditions


Dyslipidemia
Infection

TREATMENT OF KIDNEY DISEASES


1. Conservative
- diet
- life style modification
- medical treatment
2. Active
- surgical treatment
3. Renal replacement therapy
- haemodialysis
- peritoneal dialysis
- kidney transplantation