History and Examination of the Renal System

Introduction

• Speaker: Dr. Ryan
• Focus: History and examination of the renal system
• Aim: Explore a clinical case, history taking, examination techniques, urine analysis, and chronic kidney disease.

Outline of the Talk

1. Clinical Case
2. History Taking
3. Examination Approach
4. Interpretation of Urine Dipstick Changes
5. Discussion on Chronic Kidney Disease
6. Investigations in Renal Disease
7. Encouragement from Scripture

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Clinical Case

• Evaluation of acute kidney injury (AKI) post-cardiopulmonary bypass.
• Neuromicroscopy findings suggestive of cholesterol emboli are crucial for diagnosis.

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History Taking

• Mnemonic: "Salt Makes Good Food"
• Key areas to inquire:
  • Medication history (diabetes, hypertension, HIV)
  • Changes in urine appearance (hematuria, volume changes)
  • Urine output classifications:
    • Polyuria: >3L/24hrs
    • Oliguria: <400mL/24hrs
    • Anuria: <100mL/24hrs
• Urinary symptoms:
  • Hesitancy, dribbling, urinary retention, renal colic
  • Painful micturition, fever, discharge
  • Symptoms of chronic kidney disease (CKD):
    • Oliguria, nocturia, anorexia, pruritus, edema

Genital History Taking

• Inquire about:
  • Menstrual history (for females)
  • Impotence, libido, infertility (for males)
  • Pregnancy history and complications (for females)

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Examination Techniques

• Kidney Location: Retroperitoneal, behind the 11th rib
• Nephron Structure:
  • Afferent and efferent arterioles, glomerulus, renal artery/vein
• Examination Steps:
  • Observe for general signs: power, fatigue, bruising, hydration status
  • Check skin, nails, arms (for vascular access), and face
  • Abdominal examination including palpation for kidneys
  • Signs of fluid overload: JVP elevation, peripheral edema

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Urine Dipstick Interpretation

• Key parameters: specific gravity, pH, glucose, blood, protein
• Urine color changes can indicate various conditions:
  • Pale/Colorless: Overhydration, diabetes insipidus
  • Orange: Concentrated urine, bilirubin
  • Brown: Bilirubin or myoglobin
  • Pink/Red: Hematuria, kidney stones

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Chronic Kidney Disease (CKD)

• Stages of CKD:
  • Stage 1: Normal GFR > 90
  • Stage 2: GFR 60-89
  • Stage 3: GFR 30-59
  • Stage 4: GFR 15-29 (prepare for dialysis)
  • Stage 5: End-stage renal disease (requires dialysis)
• Common causes: Diabetes, hypertension, glomerulonephritis
• Clinical features: Small kidneys on ultrasound, anemia, bone disease

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Investigations for Renal Disease

• Biochemical Tests:
  • Serum creatinine, electrolytes, urinalysis
• Imaging:
  • Abdominal ultrasound, CT scans for stones or masses
• Biopsy: For parenchymal disease diagnosis

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Conclusion

• Acknowledgment of the importance of thorough history taking and examination in renal cases.
• Encouragement from scripture regarding aging and reliance on faith.
• Appreciation for viewers' support on YouTube.

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References

• Scripture references for encouragement.