Disease Flashcards
What are the features of nephrotic syndrome?
presence of proteinuria (>3.5 g/24 hours), hypoalbuminaemia (<30 g/L), and peripheral oedema. Hyperlipidaemia and thrombotic disease are also frequently seen. Despite heavy proteinuria and lipiduria, the urine contains few cells or casts.
What are the differentials for nephrotic syndrome?
Minimal change disease Focal Segmental Glomerulosclerosis Membranous Nephropathy Diabetic Nephropathy Multiple myeloma-associated ALL amyloidosis IgA nephropathy
What are the features of minimal change disease?
common in children (occasionally found in adults), can be secondary to Hodgkin’s lymphoma
What are the signs of minimal change disease?
typically not hypertensive, otherwise physical examination is non-specific
What investigations would you consider for minimal change disease?
serial creatinine and estimated GFR: typically normal
renal biopsy: normal by light microscopy, but podocyte effacement on electron microscopy
What are the symptoms of focal segmental glomerulosclerosis (FSGS)
asymptomatic, or may have oedema and other symptoms of renal dysfunction, hx HIV, reflux nephropathy, morbid obesity, chronic glomerular hyperfiltration from a solitary kidney, or any other cause of extensive nephron loss (e.g., renal obstruction, prior glomerulonephritis), or hx of drug use (e.g., pamidronate, heroin)
What are the signs of FSGS?
may be hypertensive, otherwise physical examination is non-specific
What first line investigations would you consider for FSGS?
serial creatinine and estimated GFR: may be abnormal
renal biopsy: focal and segmental sclerosis of the glomeruli
What other investigations would you consider for FSGS?
HIV test: positive
What are the symptoms of membranous nephropathy?
may be primary or secondary (associated with malignancy, hepatitis, lupus, certain drugs)
What are the signs of membranous nephropathy?
physical examination is non-specific
What first line investigations would you consider for membranous nephropathy?
renal biopsy: characteristic thickening of basement membranes seen on biopsy, as well as subepithelial electron-dense deposits
What other investigations would you consider for membranous nephropathy?
CXR or chest CT for lung cancer: mass consistent with lung tumour
occult blood in stool: haem-positive stool
hepatitis serologies: positive
rapid plasma reagin (RPR) syphilis test: positive
What are the symptoms of diabetic nephropathy?
long-standing history of diabetes often in conjunction with symptoms suggestive of diabetic retinopathy (impaired vision) or slowly progressive renal dysfunction (e.g., fatigue, swelling of the extremities)
What are the signs of diabetic nephropathy?
diabetic retinopathy (microaneurysms, hard and soft exudates, microinfarcts, macular oedema, increased tortuosity of veins, and neovascularisation) seen on funduscopic examination
What first line investigations would you consider for diabetic nephropathy?
HbA1c: often elevated
renal biopsy: diagnostic
What other investigations would you consider for diabetic nephropathy?
urinalysis: may show microscopic haematuria
What are the symptoms of IgA nephropathy?
episodes of dark urine that often occur along with pharyngitis; may be a history of liver disease, seronegative arthropathy, coeliac disease, Henoch-Schonlein purpura (especially in children), purpuric skin lesions, melaena, or bright red blood per rectum
What are the signs of IgA nephropathy?
rarely presents with oedema, otherwise physical examination is non-specific
What first line investigation would you consider for diabetic nephropathy?
renal biopsy: IgA deposits seen on immunofluorescent examination of renal biopsy
What are the differentials for dysuria?
cystitis urethritis pyelonephritis vulvovaginitis balanitis acute prostatitis
What are the features of cystitis?
rapid onset, history of previous UTI, sexual activity/spermicide/diaphragm use (higher risk in women), post-menopausal status (women), history of BPH (men), instrumentation, urinary frequency/urgency, cloudy or malodorous urine, haematuria
suprapubic discomfort, absence of costovertebral tenderness
How would you approach cystitis?
urine dipstick: leukocyte esterase-positive; positive for RBCs; occasionally positive for nitrites
urine microscopy: leukocytes and/or bacteria
urine culture: >10^5 colony forming units (cfu)/mL
pregnancy test: positive or negative
renal ultrasound: abnormalities such as dilation of the renal pelvis or ureters, or distension of thick-walled bladder; renal abscess: area of radiolucency to the renal parenchyma with local hypoperfusion on colour Doppler; perinephric abscess: hypoechoic fluid
What are the features of urethritis?
gradual onset (over days), most common in young patients, sexual activity, urinary frequency/urgency, urethral discharge (common in men, rare in women), post-coital or intermenstrual bleeding
variable (watery or thick) discharge, suprapubic discomfort (may be present if associated with pelvic inflammatory disease in women)
How would you approach someone with urethritis?
urine dipstick: leukocyte esterase-positive; positive for RBCs
nucleic acid amplification test: positive for Chlamydia trachomatis or Neisseria gonorrhoeae
urethral or vaginal culture: positive for C trachomatis or N gonorrhoeae
serum rapid plasma reagent or VDRL: excludes syphilis
HIV serology: excludes HIV in high-risk groups
What are the features of pyelonephritis?
fever, rigors, myalgia, headache, nausea, vomiting, flank pain, urinary frequency/urgency, diabetes, immunosuppression, history of anatomical abnormality
fever, costovertebral angle tenderness, deep right or left upper quadrant tenderness
How would you approach someone with pyelonephritis?
urine dipstick: nitrite- and/or leukocyte esterase-positive; positive for RBCs
urine microscopy: leukocytes and/or bacteria
urine culture: >10^5 colony forming units/mL
renal ultrasound: abnormalities such as dilation of the renal pelvis or ureters, or distension of thick-walled bladder; renal abscess: area of radiolucency to the renal parenchyma with local hypoperfusion on colour Doppler; perinephric abscess: hypoechoic fluid
CT renal tract: excludes hydronephrosis, abscess, and renal calculi
What are the differentials of visible haematuria?
Benign prostatic hyperplasia UTI Acute pyelonephritis Bladder cancer prostate cancer kidney stone instrumentation of the urinary tract menstruation
What are the differentials of non-visible haematuria?
Menstruation Cystitis Pyelonephritis Acute prostatitis Benign prostatic hyperplasia nephrolithiasis (flank or groin pain, non-specific or may find flank tenderness, helical CT of urinary tract without contrast: visible stone present, IV urography: filling defect) Trauma
What are the features of good pasture’s disease (antiglomerular basement membrane disease)?
reduced urine output haemoptysis oedema male sex 20-30yrs old or 60-70yrs recent URTI SOB cough, fever, nausea, crackles on lung examination
What are the features of nephritic syndrome?
presence of acute kidney injury (renal dysfunction), hypertension, and an active urinary sediment (red cells and red cell casts).
