Chronic Kidney Disease

Reference: Davidson 23rd; P-419

Explanation: Microalbuminuria is the most sensitive test for detecting early diabetic nephropathy. Davidson explains that albumin excretion increases in the early stages of kidney damage, even before significant declines in GFR or rises in serum creatinine are seen. Harrison emphasises that early detection through microalbuminuria allows for timely interventions to slow disease progression.

Dyspnea but chest is clear—pulmonary embolism, metabolic acidosis (diabeti ketoacidosis, renal failure, lactic acidosis salicylate poisoning), severe anemia, shock, pneumocystis jiroveci pneumonia, psychogenic.

Dyspnea with stridor (indicates upper airway obstruction)—foreign body or tumor, acute epiglottitis, anaphylactic reaction, laryngeal trauma, laryngeal fracture.

Reference: Davidson 23rd; P-417

Clinical features

The typical presentation is for a reduced eGFR to be found incidentally during routine blood tests, often during screening of high-risk patients, such as those with diabetes or hypertension. Most patients with slowly progressive disease are asymptomatic until GFR falls below 30 mL/ min/1.73 m 2 and some can remain asymptomatic with much lower GFR values than this. An early symptom is nocturia, due to the loss of concentrating ability, but this is non-specific. When GFR falls below 15–20 mL/ min/1.73 m2 , symptoms and signs are common and can affect almost all body systems, but are often non-specific and may not immediately raise suspicion of kidney disease (Fig. 18.22). They typically include tiredness or breathlessness, which may, in part, be related to renal anaemia or fluid overload. With further deterioration in renal function, patients may suffer pruritus, anorexia, weight loss, nausea, vomiting and hiccups. In very advanced renal failure, respiration may be particularly deep (Kussmaul breathing) due to profound metabolic acidosis, and patients may develop muscular twitching, fits, drowsiness and coma.

In polycystic kidney disease erythropoietin production isn’t hampered, even there is increased production.

Lindsay’s nails
White/brown ‘half-and-half’ nails
Found in-  Chronic kidney disease

Macleod 14/box 3.4

Explanation: Chronic kidney disease (CKD) refers to an irreversible deterioration in renal function that usually develops over a period of years Initially, it manifests only as a biochemical abnormality but, eventually, loss of the excretory, metabolic and endocrine functions of the kidney leads to the clinical symptoms and signs of renal failure, collectively referred to as uraemia