CKD patients with blood urea of less than 150 mg%, usually without any complaints or symptoms and are often found by chance on routine examination. Clinical picture more evident when the blood urea more than 200 mg%. At the initial level of CKD with a GFR less than 25% of normal, clinical picture is very minimal, only albuminuria, hyperuricaemia, and hypertension.
Clinical picture of severe CKD accompanied by azotemia extremely complex syndrome, including abnormalities of various organs such as:
a. abnormalities hemopoeisis
Anemia nomokrom normositer (MCHC 32-36%) and normositer (MCV 78-94 CU).
b. Gastrointestinal disorders
Nausea and vomiting are often a major complaint of most patients with chronic renal failure, especially in the terminal stage, Hiccup, azotemia stomatitis is characterized by dry mucous lesions accompanied by extensive ulceration stomatitis is called bright-red, parotid gland enlargement, and pancreatitis.
c. eye disorders
Vision loss (amaurosis azotemia) in only a minority of patients. Optic nerve disorder that causes symptoms of nystagmus, miosis, and pupil asymmetry. Abnormalities of the retina (retinopathy), keratopathy.
d. skin disorders
Itchy, dry and scaly skin.
e. Serous membrane abnormalities
Pleuritis, pericarditis is often encountered in chronic renal failure, especially in the terminal stage.
f. neuropsychiatric disorders
Mild mental disorders such as emotionally unstable, dilution, insomnia, depression. Severe mental disorders such as confusion, dilution, and not infrequently with symptoms of psychosis. Mild or severe mental disorders are often found in patients with or without hemodialysis, and depending on the basic personality (personality).
Neurological disorders such as muscular twitching or muscle spasms are often found in patients already heavy, plunging into a coma. The attack is accompanied grandma focal abnormalities often found in the terminal stage.
g. Cardiopulmonal system disorders
Congestive heart failure, hypertension, peripheral vascular calcification, pericarditis, pulmonary azotemia (uremic lung)
a. History and physical examination diagnosis
a. History and physical examination diagnosis
History should be directed to collect all complaints relating to the retention or accumulation of toxins azotemia, Chronic Renal Failure etiology, course of disease, including all factors that can aggravate kidney physiology. It is also necessary data about the patient's disease history, and also data showing a gradual decline in renal physiology.
b. laboratory tests
1) Examination of renal physiology
Examination of urea & serum creatinine and serum uric acid is sufficient as screened for renal physiology. There was also the examination of creatinine clearance and radionuclide (gamma camera imaging) is almost close to the actual renal physiology.
2) Routine Urinalysis
Albuminuria more than 3.5 grams per day and non-selective accompanied by abnormalities of sediment (erythrocytes Uriah, leukosituria and silinderuria) more often found in glomerulonefropati (primary or secondary).
3) Microbiology urine (CFU per ml of urine)
Worsening of renal physiology that hard to explain UTI should be suspected as a cause by CFU per ml of urine more than 105.
4) Blood Chemistry
Hypercholesterolaemia are often found in idiopathic nephrotic syndrome (primary). Hyperuricaemia is not always associated with uric acid nephropathy due to chronic hyperuricaemia in parallel with a reduction in renal physiology. If found gaps serum urea and creatinine (without hiperkatabolisme factor), have suspected the possibility of obstructive nephropathy (lithiasis).
Examination of electrolytes (serum and urine) are essential for the diagnosis of CKD is associated with nephropathy (hypocalcaemia & hypokalemia) and nephrocalcinosis. examined serum Na+, K+, HCO32- , Ca2+ , PO42-, Mg2+.
Several checks imunodiagnosis to glomerulonephropathy include: ACB, ANA, HBsAg, Krioglobulin, CICx, examination of serum complement, imunofluoresen network
7) Additional ecamination
a) Plain abdominal: for identification of anatomical changes in renal
b) Ultrasonography (USG): accuracy higher than a plain photo abdomen. Useful to assess renal anatomy or identification.
c) Nephrotomogram: important for evaluation of obstructive nephropathy due mainly radiolucent stones or other causes.
d) Pielography retrograde: it is important for evaluation of obstructive nephropathy is difficult to determine why.
e) Pielography antegrade: for therapeutic and diagnosis of urinary tract obstruction.
f) Micturating cysto urography (MCU): indication of when the suspected possibility of vesicoureteric reflux.