Haematuria and proteinuria Flashcards
What does proteinuria indicate vs haematuria?
Proteinuria indicates that there is glomerular disease e.g. glomerulonephritis, DM, amyloidosis, myeloma
Haematuria indicates bleeding that could be occuring anywhere in the renal tract e.g. malignancy, calculi, IgA nephropathy, alport syndrome
What can falsely trigger the dipstick reaction for haematuria?
Myoglobin gives a false positive
How should haematuria and proteinuria be investigated?
Should dipstick urine, A:Cr, MSU and culture to look for infection, urine microscopy to look for casts
Blood tests for U and E, LFT, Bone profile, eGFR calculation, CRP, clotting screen, Autoimmune - ANCA, anti-GBM, ANA, anti-dsDNA, HIV, hepatitis
Imaging including ultasound of urinary tract, cystsoscopy, IV urogram, renal biopsy may be indicated
What are the 5 main types of nephritic glomerulonephritis?
IgA nephropathy - IgA immune complex deposition causes damage to glomerulus
Henoch-Schonlein purpura (HSP) - small vessel vasculitis with IgA deposition in joints and kidney
Post-streptococcal GN - occurs after throat or skin infection, strep antigen deposits in glomerulus
Anti-GBM (goodpastures) - autoantibodies against type IV collagen cause damage to glomerular and alveollar basement membranes
Rapidly prograssive GN - renal failure in days of weeks due to vasculitis, lupus or ant GBM disease
What are the 4 main types of nephrotic glomerulonephritis?
Minimal change disease - 25% of adult nephrotic syndrome, most are idiopathic but some are in association with drugs (NSAIDs, lithium)
Focal segmental glomerulosclerosis (FSGS) - commonest type of glomerulonephitis seen on renal biopsy, primary (idiopathic) or secondary to HIV, heroin, lithium
Membranous nephropathy - 25% of adult nephrotic syndrome, primary is idiopathic or secondary due to malignancy, infection and immunological disease
Membranoproliferative glomerulonephritis - 10% of adults with nephrotic syndrome
What is the triad of nephrotic syndrome?
Proteinuria (A:Cr 250mg/mmol)
hypoalbuminaemia (usually <30g/L)
oedema
What is the pathophysiology of nephrotic glomerulnephritidies?
The podocytes are damage resulting in protein being leaked through the filtration barrier. The filtration barrier is made up of podocytes, GBM and endothelial cells
What is the diagnosis and treatment of IgA nephropathy?
Diagnosis - made by renal biopsy and deposition of IgA in mesangium
Treatment - ACE-i/ARB to reduce proteinuria and protect renal function. Corticosteroids and fish oil can be used in more persistant disease
What is the diagnosis and treatment of Henoch-Schonlein purpura (HSP)?
Small vessel vasculitis causing deposition of IgA in skin/gut/joints and kidney
Tend to present with purpuric rash on extensor surfaces typically legs, abdominal pain, flitting polyarthritis and nephritis.
Diagnosis is made through clinical judgement, biopsy will be the same as in IgA nephropathy
Treatment is the same as for IgA nephropathy and steroids can be used for GI involvement
What is the diagnosis and treatment of post-streptococcal GN?
Presentation varies from haematuria to acute nephritis. Diagnosis is made based on history of strep infection and presence of anti-DNAse B and decreased C3. Treatment is supportive and antibiotics to clear the nephritogenic bacteria
What is the diagnosis and treatment of anti-GBM disease?
Diagnosis is made by presence of anti-GBM in circulation and/or kidney
Treatment is through plasma exchange, corticosteroids and cyclophosphamide
What is the diagnosis and treatment of Rapidly progressive GN?
Diagnosis - Breaks in basement membrane allow influx of inflammatory cells that are seen as cresents on biopsy
Treatment - corticosteroids and cyclophosphamide, can use plasma exchange if aetiology anti-GBM
What does cyclophosphamide do?
It is a chemotherapy drug used to suppress the immune system
What is the diagnosis and treatment of minimal change disease?
Diagnosis is made by electron microscopy - light microscopy is normal but electron microscopy shows podocyte foot process effacement (reduction)
Treatment - Predisolone (75% respond) further immunosuppressants can be used in non responders (cyclophosphamide)
What is the diagnosis and treatment of focal segmental glomerulosclerosis?
Diagnosis is made through biopsy to show focal sclerosis in certain segments, may miss early disease if biopsy sample has less than 10 glomeruli
Treatment is ACE-i/ARB and blood pressure control, corticosteroids can be used in primary only, calciuneurin inhibitors can be considered second line
