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

DIAGNOSTIC AND THERAPEUTIC APPROACH IN KIDNEY DISEASES

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