Case 24 - GN and PKD

Question 1

What are the features of nephrotic syndrome?

Answer 1

Proteinuria (>3.5g in 24 hrs) - frothy urine.
Hypoalbuminaemia.
Oedema.
Hyperlipidaemia.
Hypercoagulable state (loss of anti-thrombin III) - PE / DVT risk.

Question 2

What are the features of nephritic syndrome?

Answer 2

Haematuria (+++ blood). 
Red cell casts. 
Sedement in urine. 
Pyuria. 
Proteinuria (++ protein). 
Low urine volume ( decreased GFR).
Hypertension (mild). 
More inflammation present.

Question 3

How do you detect proteinuria?

Answer 3

Urine ACR / urine PCR.
(Urine creatinine can be affected by large protein meals).
(Dilution of urine can affect results).

Question 4

What level is moderate proteinuria and how is it detected?

Answer 4

30-300mg albumin in urine over 24 hrs.
Not detected on dipstick.
Detected using lab ACR.

Question 5

What level is severe proteinuria and how is it detected?

Answer 5

> 300mg albumin in urine over 24 hrs.
Detected on urine dipstick.
Monitored using PCR.

Question 6

How do abnormalities in the glomerulus present?

Answer 6

• Isolated haematuria / proteinuria / haematoproteinuria (consider urological disease).
• Nephrotic syndrome.
• Acute GN (acute nephritic syndrome).
• Rapidly progressive glomerulonephritis.
• CKD including ESRD.

Question 7

Investigations to identify a renal syndrome?

Answer 7

• History and examination.
• Bloods.
• Urine testing.
• Kidney USS.

Question 8

Investigations to determine the type of renal disease?

Answer 8

Renal biopsy.

Question 9

Causes of renal disease.

Answer 9

Primary / idopathic.
Secondary:
- autoimmune (eg. SLE).
- Infections ( eg. malaria, Hep. B / C, HIV)
- Drugs (eg. NSAIDs, peniciliamine).
- Heavy metals (eg. gold, mercury)
- Tumours (eg. lung / colon / multiple myeloma).