Glomerular, Polycystic, Nephrolithiasis Flashcards
Damage of the renal glomeruli by deposition of inflammatory proteins in the glomerular membranes as the result of an immunologic response
Glomerulonephritis
60% of glomerulonephritis cases are in what age group
children ages 2-12
Causes of GN are divided into 2 groups:
Focal (less than 1/2 glomeruli affected)
Diffuse (affects most glomeruli)
Clinical features of GN
Hematuria
Oliguria / anuria
Edema of face and eyes in AM,
edema of feet and ankles PM
HTN is common
Causes of FOCAL (< 1/2 glomeruli) GN in children
Benign hematuria
Henoch-Schonlein purpura
Mild postinfectious GN
IgA nephropathy
Hereditary nephritis
Causes of FOCAL (<1/2) GN in adults
IgA nephropathy
Hereditary nephritis
SLE
Causes of DIFFUSE GN in children
Postinfectious GN
Membranoproliferative GN
Causes of DIFFUSE GN in adults
SLE
Membranoproliferative GN
Rapidly Progressive GN
Postinfectious GN
Vasculitis
Henoch-Schonlein purpura
Focal GN found in children
IgA nephropathy
Focal GN found in both children and adults
Hereditary nephritis
Focal GN found in both children and adults
SLE
causes focal GN in adults
Membranoproliferative GN
causes DIFFUSE GN in children and adults
RPGN
causes DIFFUSE GN in adults
Vasculitis
causes DIFFUSE GN in adults
Lab that detects post infectious GN 60-80% of the time
Antistreptolysin - O
Urinalysis in GN
Hematuria / Acanthocytes
RBC casts
Proteinuria
Other diagnostic lab value found in GN
Serum complement (C3) levels are often decreased
Excretion of > 3.5g protein in 24 hrs.
Nephrotic syndrome
Characteristics of nephrotic syndrome
Proteinuria (3.5g +)
Hypoalbuminemia
Lipiduria
Hypercholesterolemia
Edema
Why are patients with nephrotic syndrome at risk of thrombosis?
Due to loss of proteins S and C and antithrombin III
Symptoms of nephrotic syndrome
Malaise Abdominal distension Anorexia Facial edema Oliguria Scrotal swelling SOB Weight gain
Signs of nephrotic syndrome
Ascites
Edema
Hypertension
Orthostatic Hypotension
Retinal sheen ?
Skin striae
Tx nephrotic syndrome
ACE-I, early in course of disease
Diuretics for edema
Anticoagulants, if needed
Steroids, esp in children, if indicated. Stronger immunosuppressants if relapse (cyclo’s, etc)
ADPKD
Most common form of PKD
Bilateral
Symptoms develop during 4th decade of life
ARPKD
Less common
Begins in utero
can lead to fetal / neonatal death
surviving infants > short life, renal/hepatic failure
ACKD
Acquired cystic kidney disease
occurs in ppl w long term renal disease
more common in African American men
ADPKD, clinical features
back and flank pain
headaches (risk of aneurysm)
nocturia
Hematuria, HTN, UTI’s, weight loss
Renal colic, N/V
ADPKD urinalysis
Proteinuria, hematuria, pyruria, bacteruria
ADPKD diagnostic method of choice
Ultrasonography (fluid filled cysts)
3 anatomical points at which kidney stones can lodge
- Ureteropelvic junction (UPJ stones)
- Uretervesicular junction (UVJ BLADDER stones)
- Ureter at levels of iliac vessels
4 major types of stones
Calcium (75-85%)
Uric acid (5-8%)
Cystine (<1%) - genetic
Pain from a stone in the upper ureter radiates
to anterior abdomen
pain from a stone in the lower ureter radiates
ipsilateral groin, testicle or labia
Pain from a stone in the UVJ radiates
lower pelvic pain
urinary frequency / urgency
Imaging modality of choice for kidney stones
Helical CT
no contrast needed
ultrasound for pregs and kids
Gold standard Tx for large kidney stone (>10 mm)
Ureteral stent or percutaneous nephrostomy
Medications for calcium stones
Hydrochlorothiazede, to decrease urine calcium excretion
Medication for uric acid stones
Allopurinol to decrease uric acid excretion
