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Haematuria and proteinuria Flashcards

1
Q

Three main kinds of renal disease

A

Generalised parenchymal (GFR abnormality)
Collecting system abnormality
Focal lesions

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2
Q

Presentation of generalised parenchymal problem

A

Haematuria, proteinuria, acute nephritis syndrome, chronic renal failure

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3
Q

Presentation of collecting system abnormality

A

Infection, polyuria, renal colic, chronic renal failure

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4
Q

Presentation of focal lesions

A

Haematuria, backache

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5
Q

What is the barrier to proteins passing into the urine

A

The glomeruli

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6
Q

Why is treating hypertension essential if a patient has proteinuria?

A

The increased pressure causes more protein to leak out of the glomeruli and also can cause more damage to the glomeruli making it even more leaky.

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7
Q

Describe the main protein in proteinuria and how it is measured

A

Mainly albumin
Measurement via 24 hour urine.
Surrogate measures to a 24 hr urine are protein: creatinine ratio or a albumin:creatinine ratio

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8
Q

What is microalbuminuria

A

A moderate increase in the level of protein in the urine

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9
Q

Causes of microalbuminuria

A 
Diabetes mellitus
Fever
Exercise
Heart failure
Poor glycaemic control
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10
Q

Signs of nephrotic syndrome

A 
>3.5g/day of urinary protein
low serum albumin 
Oedema
Frothy urine
Hypercholesterolaemia
Blood clots/DVT
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11
Q

What is the mechanism for oedema in nephrotic syndrome

A

Increased protein loss causes low serum albumin. This decreases the oncotic pressure within capillary beds and resulting egression of fluid into the interstitial space

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12
Q

Describe starlings equation in relation to nephrotic syndrome

A

Hydrostatic pressure pushes fluid out and oncotic pressure draws fluid in. With reduction of protein oncotic pressure is reduced so the balance is towards fluid being pushed out into interstitial space

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13
Q

What causes increased cholesterol secondary to nephrotic syndrome

A

The low plasma oncotic pressure is detected by the liver which responds by increasing lipoprotein production–> increased cholesterol

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14
Q

What other three pathologies are associated with nephrotic syndrome

A

Thromboembolism
Infection
Malnutrition

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15
Q

Why is there increased risk of infection with nephrotic syndrome

A

Reduction in antibody production and decreased complement pathway

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16
Q

What specific infections come with increased risk if nephritic syndrome present

A

Bacterial infections and chicken pox

17
Q

What is nephrotic syndrome

A

Kidney disease characterised by proteinuria and oedema.

18
Q

Spectrums of renal function in nephrotic syndrome

A

Can be normal, can have acute kidney injury or can have chronic kidney injury

19
Q

What is the major cause of chronic kidney injury

A

Diabetes

20
Q

What is nephritic syndrome

A

The clinical manifestations of rapidly progressing glomerulonephritis. Includes being unwell, oligouric, hypertensive, volume overload, oedema

21
Q

What is glomerulonephritis

A

Inflammation of the glomerulus typically results in one or both of nephrotic/nephritic syndromes

22
Q

Most patients with rapidly progressing acute glomerulonephritis will have some other multi system disease- name signs

A

Haemoptysis (coughing blood)
Rash
Arthritis
Fever

23
Q

Key for diagnosis of acute glomerulonephritis

A

Blood in urine/ red cell casts (bleeding from kidney)

24
Q

Origins of haematuria

A

Glomerular
Collecting system
Focal lesion (malignant, inflammatory, infection)

25
Q

If you have haematuria and proteinuria what can you be pretty certain the origin of bleeding is

A

Glomerular

26
Q

Is haematuria from the collecting system typically macroscopic or microscopic

A

Macroscopic e.g. from kidney stone.

27
Q

Symptoms of kidney stones

A

Loin to groin pain
Haematuria
Vomiting/nausea
Anuria

28
Q

Haematuria and focal lesions. Type of haematuria and symptoms

A

Can cause macro/microscopic haematuria
Often asymptomatic
Can cause backache
Mass (unusual as diagnosis before it gets big enough)

29
Q

How are renal cell carcinomas typically diagnosed

A

CT scan

30
Q

Incidence and aetiology of renal cell carcinoma

A 
90% of all renal cancers
More common in males 2:1
Peaks in 60s
Smokers
Genetic (von Hippel-Lindau disease)
31
Q

Symptoms of renal carcinoma

A 
Symptoms occur late
Haematuria
Flank pain
Palpable abdo mass
Ectopic hormone production- polycythemia (EPO), hypertension (renin),cushings syndrome (cortisol), masculisation/feminisation

GU (9 decks)

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