28. Acute nephritic syndrome. Acute renal injury. Flashcards
Acute Nephritic Syndrome
Common Causes
Hemolytic-Uremic Syndrome
Henloch-Schönlein Purpura
IgA-Nephropathie
Post-Streptokokkal glomerulonephritis
Hämolytisch-Urämisches Syndrom
- Thrombotische Mikroangiopathie
-
TRIAS:
- microangiopathic hemolytic anemia
- thrombocytopenia
- renal injury
- Typisch: Durch Shiga-Toxin ausgelöst
- Atypisch: Ohneinfektiöse Ursache (familiär)
- Treatment:
- supportive
- volume repletion
- hypertension control
- managing renal insuficiency (dialysis etc.)
Purpura Schönlein Henoch-Nephritis
- Idiopatisch, oft nach URI
- genetische Prädisposition
- Klinik:
- Makro- oder Mikrohämaturie
- Proteinurie
- Renale Hypertonie
- Ödeme
IgA-Nephropathie
meist idiopathisch
Nierenbiopsie ► IgA-Ablagerungen
Proteinurie > 1g/Ta: ACEi + Sartane, (GCS)
Post-Streptokokkal Glomerulonephritis
- Mögliche Symptome:
- Grippale Beschwerden
- Flankenschmerz
- Blutiger Urin, Oligurie
- Hypertonie
- Ödeme
- Blut:
- Retentionsparameter
- ADB & Antistreptolysin Titer
- C3-Komplement
- Urin:
- Nephritisches Sediment
- Mikro/Makrohämaturie
- Sono ► Vergrößerte Nieren
Acute Renal Injury
Etiology
- Prerenal: Hypoperfusion
- Dehydration, hemmorrhage, septic shock, burns, HF, cirrhosis
- Intrarenal: Glomerular/vascular injury
- Acute tubular necrosis, nephrotoxicity, infection, nephritis, glomerular injury, vascular injury
- Postrenal: Obstructions
Acute Renal Injury
Prerenal
Laboratory
Urine output is low
High osmolarity
Urinanalysis is normal
Ultrasound is normal
Acute Renal Injury
Intrarenal
Laboratory
Low, normal or high urine output
RBCs, WBCs, protein, casts in Urinanalysis
Osmolarity about 300
Increased echogenicity, decreased corticomedullary differentiation
Acute Renal Injury
Postrenal
Laboratory
Low or normal Urine Output
Variable Urinanalysis
Hydronephrosis on US
Acute Renal Injury
Treatment
Fix electrolyte imbalance
Substitute water
no ACEi
Fix hypo/hypervolemia
Fix hypertension (diuretics, ccb, vasodilators)
Acute dialysis?
