Essentially you need to know:
- the causes of chronic renal failure
- the forms of renal replacement therapy
- some other points
Causes of CRF Related to Clinical Findings
| Disease | Bedside Findings | Comments |
| Hypertension | ↑ BP, Retinopathy, history of proteinuria, anti hypertensives round the bed. | Hypertension and DM are the commonest causes |
| Diabetes | Finger prick blood glucose scars. Bruising around abdominal insulin injection sites. Lipohypertrophy | |
| Glomerulonephritis | Dipstick evidence of blood and protein | |
| Reflux Nephropathy | None! | Childhood infection history |
| Vasculitis | Vasculitic rash may be evident | e.g. Henoch Schonlein Purpura |
| Wegener’s | History of nosebleed/ evidence of respiratory signs. | cANCA positive, granulomas on biopsy |
| Rheumatoid related vasculitis/ drug therapy | Signs of RA. | Renal impairment could be due to NSAIDs/ DMARDs/ Vasculitis/ Infection/ Glomerulonephritis |
| SLE | Photosensitive rash Arthritis Interstitial lung disease Serositis elsewhere | |
| Tuberous Sclerosis | Developmental Delay Epilepsy Adenoma sebaceous. Cutaneous manefestations also include: subungal fibromas, shagreen patch: thickened leathery patches of skin often around the neck. | Hamartomas can occur anywhere |
| Goodpasture’s | Pulmonary Haemorrhage and Renal Failure. You may get a history of respiratory disease: think Wegener’s Goodpasture’s | Anti – GMB antibodies |
RRT= Renal Replacement therapy
| Form Of RRT | Examples | Comments |
| CAPD: DAILY (Continuous ambulatory peritoneal dialysis) | Scars in the abdomen centrally from the dialysis | Many renal patients “further down” their illness e.g. who’ve had a transplant or been on dialysis for many years have had previous CADP. The little scars are there centrally, so look for them. |
| Haemodialysis 3x a week | Fistula (e.g. ARM/ LEG) Tunnelled lines Central Venous Catheters | Fistula sites are either working and being used: in which case they will have VISIBLE puncture marks in them Working and not being used either a.) they’re not needed yet or b.) the patient has had a transplant and the fistula is a remnant of previous treatment |
| Transplant | E.g. Right iliac fossa/ left iliac fossa | These are either Working fine Not working fine (may have been biopsied-look for a needle puncture over the kidney) Not Working at all: sign of other RRT (see above) Normally you “leave the other kidneys in” unless the failed kidneys are causing problems through Size (ADAPKD) Infection (Cyst disease) Cancer Remember to look / comment on signs of ciclosporin use i.e. gingival hypertrophy and Hypertension and peripheral neuropathy. This will impress the examiners. |
| Remember to also look for Features of nephrotic syndrome (oedema/ hypercholesterolaemia) Enlarged kidneys/ liver/ cerebral aneurysms of the Autosomal Dominant Adult Polycystic Kidney disease Anaemia of Renal disease (patients may be taking subcutaneous erythropoetin) | ||