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INVESTIGATIONS IN RENAL MEDICINE

Criteria for diagnosis of ckd-NKF/KDOQI . Kidney damage for greater than or equal to 3 months,as defined by structural or functional abnormalities of kidney,with or without decreased GFR,manifest by either: -pathological abnormalities -markers of kidney damage,including abnormal

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INVESTIGATIONS IN RENAL MEDICINE

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    6. 6 Ckd classification

    8. Urine colour/appearance

    12. Dipstick

    19. Dipstick Urinalysis Positive dipstick indicates presence of Hb, Mb or blood Hb has pseudoperoxidase activity RBC haemolyse with reagent and release Hb

    20. >90% sensitive in the diagnosis of microscopic haematuria Specificity is lower when compared to microscopy due to Hb-uria and Mb-uria False positives are due to: Menstrual blood Dehydration (raised sp gravity e.g. EMU) Exercise (bladder contusions) Blood-Dipstick urinalysis

    21. Dipstick Urinalysis

    27. Non-dysmorphic RBCs in urine (black arrows) and Dysmorphic RBCs (white arrow)

    33. Identifies radiodense site of calcification (kidney stones – renal calculi). Can be in kidney, renal pelvis, ureters or bladder. Cheap, simple, routine and available in most academic centres. However, shadows from bowels/bones can obscure site of calculi.

    34. Direct inspection of interior of bladder. Can also be followed by urodynamic studies where you can monitor changes in pressure during filling and emptying. Can also follow visual inspection with injection of contrast media for further tests. Not particularly pleasant for the individual! Can show you exactly where the problem is in the urinary tract, and you can take biopsies whilst you are in there. Cheap and usually available in most academic centres.

    37. Examples of renal ultrasound images

    39. CT scanning

    40. Also called nuclear magnetic resonance (NMR). Not usually used, but can image renal masses not identified by previous methods and can monitor renal arteries. Image based on radiofrequency (RF) pulse returned from RF-stimulated protons in magnetised tissues Avoids contrast agent. Accurate for only main vessels and their blood flows. Expensive, limited availability. Very versatile and can measure from many angles/planes, has good contrast. Doesn’t use ionising radiation – less chance of biological damage. Can’t use near pacemakers and cannot image bone or calcium.

    45. Use angiography to monitor blood vessels as in heart. Can also use digital subtraction angiography (DSA). DSA uses small doses of contrast medium to monitor blood flow in renal vessels (venous or arterial). Inject it into larger artery or vein near kidneys. Mainly used to monitor extrarenal or intrarenal arterial disease. Arteriography still the gold standard in renal imaging, but MRI and CT are getting better all the time. Invasive, but becoming more routine. Less discomfort for subject, since doesn’t go through the more embarrassing “plumbing” system! (Usually insert catheter through small incision in groin – (e.g. femoral vein).

    48. Scintigraphy

    58. THANK YOU FOR YOUR ATTENTION

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