Applied Physiology of Renal Disease Flashcards
What are the 4 lab results that Nephrotic Syndrome is characterized by
- > 4g/24 hours proteinuria (normal is 0.3)
- Low serum albumin
- Hyperlipidemia (elevated cholesterol, LDL, triglyc)
- Urine microscopy - OVAL FAT BODIES (maltese crosses) = foamy urine
What are some symptoms are Nephrotic Syndrome?
Edema
Hypercoagulability
Immunocompromised state
What is the dysfunctional part of the glomerulus that causes Nephrotic syndrome
something wrong with the foot processes of podocytes (can be seen as missing foot processes in microscopy)
What are some causes of Nephrotic syndrome?
- membranous nephropathy
- Focal segmental glomerulosclerosis (FSGS)
- Amyloidosis
- MPGN, IgA, lupus (usually present as nephritic though)
- rare - diabetes
Why does Nephrotic syndrome cause edema?
lowered albumin in the blood = lowered oncotic pressure to draw fluid back into the capillaries
Why does Nephotic syndrome cause Hyperlipidemia?
The liver reacts to hypoalbuminemia and starts craning out a bunch of lipids = increased LDL, triglycerides, cholesterol
What is Hyperlipidemia associated with and what 2 things does it cause a signficant increase in risk in?
Nephrotic syndrome
increases risk in: atherogenesis + cardiac risk
What rare dermatological symptom can be seen with nephrotic syndrome
Xanthelasmas (from hyperlipidemia)
What are two nephrotic complications
- Hypercoagulability (DVT, PE) increased liver prod of coagulable factors
- Increased risk of infection (loss of IgG through urine, fragile skin, loss of ZINC + TRANSFERRIN)
What are symptoms of Nephritic Syndrome?
headache, Hx of cough, rash, DARK BROWN URINE, HTN (from sodium retention)
What are some lab signs of Nephritic Syndrome?
Acute kidney failure GFR ~10
Urine: RBCs and small proteinuria
Red cell casts + dysmorphic RBCs (mickey mouse ears)
What part of the glomerulus is injured in Nephritic Syndrome
injury to GBM or endothelial cells
What are causes of nephritic syndromes
Most common: SLE, IgA nephropathy
ANCA related, MPGN, Anti-GBM disease, Post streptococcal GN
How do you differentiate between Nephrotic and Nephritis syndrome?
Nephrotic: insidious, edema, high proteinuria
Nephritic: Abrupt, HTN, increase Jugular venous pressure
What are presenting Sx of End Stage Renal Disease
Altered Mental Status Emaciated/Lethargic Rash Volume Overload Muscle Wasting
What are lab signs of End Stage Renal Disease
Renal failure Acidosis Anemia low Vit D high PTH high Phosphate UREMIC FROST!!!!! - rare in US (chronic kidney disease)
What are the two general functions of the kidney?
- Clearance (toxins, meds, electrolytes)
2. Hormonal (activation of 1,25 hydroxy Vit D, ERYTHROPOIETIN)
What are 3 indications of ESRD
- Uremia
- Bone metabolism problems (hyperparathyroidism)
- Anemia
What are Sx of Uremia
Lethargy Anorexia/weight loss (meats have metallic taste) ASTERIXIS pericarditis itching increased bleeding ***UREMIA IS NOT CAUSED BY UREA
Why does dialysis not work very well with Uremia?
Uremic toxins produced by gut bacteria (p-cresyl, indole) are bound to albumin = not excreted very well
What lab result indicated Uremia
BUN approached ~100mg/dL
What can cause falsely low/high BUN?
falsely low - poor diet
falsely high - steroids, GI bleeding
What are signs of Uremic pericarditis, and what is this a hard indication for?
pericardial pain, rub
unexplained cardiomegaly, hemodynamic instability
Tx: Aggressive Hemodialysis
What 3 things are Uremic Pericarditis associated with
- Underdialysis
- Concurrent viral infections
- systemic disease (Lupus)
