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
RISK FACTORS OF KIDNEY DISEASES

Modifiable risk factors:

-Smoking
-High blood pressure
-Obesity

Non-modifiable risk factors:

-Age over 50 years
-Family history of kidney disease
-Aboriginal or Torres Strait Islander
heritage
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
DIAGNOSTIC OF KIDNEY DISEASES (cont)

3. Complications
Coronary Heart Disease
Hyperuricemia

4. Associated Clinical Conditions

Dyslipdemia
Diabetes Mellitus
Prostate Hyperthropy
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