Intrinsic Causes of AKI

Question 1

Intrinsic AKI happens in the glomeruli or tubulo-interstitiam

Answer 1

Intrinsic AKI happens in the glomeruli or tubulo-interstitiam

Question 2

Tubero-interstitial disease:

ATN is a type. What does it stand for?

There is also tubular obstruction by casts.

• What does blockage from a paraprotein suggest?
• What does blockage from myoglobin suggest?
• What does blockage from urate suggest?

THIS JUST CAUSES KIDNEY IMPAIRMENT !

Answer 2

Myeloma - paraprotein

Rhabdomyolysis - myoglobin

Tumour lysis - Urate

THIS JUST CAUSES KIDNEY IMPAIRMENT !

Question 3

Tubero-interstitial disease:

It could also be interstitial nephritis caused by an allergic response to meds. What meds can cause this?

Answer 3

NSAID’s
PPI’s - omeprazole
Penicillins

Question 4

Rapidly progressive Glomerulonephritis (Crescentic):

Immune complex glomerulonephritis:

• What autoimmune disease can cause this?
• What type of nephropathy occurs?
• You can also get it 2-3 wks after infection!

Vasculitis:

• Goodpastures - what Ab do you measure?
• Small vessel vasculitis - what Ab do you measure? what is an example of this?

Acute post-streptococcal glomerulonephritis

• How long after a sore throat/skin infection does this occur making it different from IgA?
• What other worrying feature found in IgA is not found in this?

Nephritic syndrome is the name given to a collection of different signs and symptoms that occur as a result of inflammation in the kidneys. This inflammation causes the kidneys to work less effectively. It also causes protein and red blood cells to leak from the bloodstream into the urine.

SO BASICALLY THE ANOTHER TERM FOR INTRINSIC KIDNEY DISEASE. THEY GET BLOOD AND PROTEIN!

Answer 4

Lupus

Anti-GBM

Several weeks after

Gross haematuria

Other symptoms included malaise, a slight fever, nausea and a mild nephritic syndrome of RAISED BP, gross haematuria, and smoky-brown urine.

Question 5

Causes of blood and protein on dipstick except glomerulonephritis? - 5

Heavy proteinuria is only seen with glomerular pathology!!!!***

Answer 5

UTI
Catheter
Renal infarction 
Stone 
Tumour

Question 6

History:

What would suggest pre-renal AKI?

What would suggest post-renal AKI?

Answer 6

D&V
Symptoms of infection
Bleeding

Obstructive urinary symptoms
Visible haematuria?

Question 7

History - Intrinsic:

Vasculitic features? - 5

What does back pain suggest?

Answer 7

Rash 
Malaise 
Arthritis 
Haemoptysis 
Epitaxis 

Rhabdomyolysis

Also, complications may occur in early and later stages. The “classic triad” of rhabdomyolysis symptoms are: muscle pain in the shoulders, thighs, or lower back; muscle weakness or trouble moving arms and legs; and dark red or brown urine or decreased urination.

Question 8

Investigations:

What is tested to identify the following?:

• Rhabdomyolysis (What does the urine look like?)(What substance released from muscle cause nephrotic obstruction?)
• Myeloma - 2
• Tumour lysis syndrome
• Goodpastures (vasculitis)
• Small cell Vasculitis
• Lupus
• IgA nephropathy

Answer 8

CK - DARK URINE - LOOKS LIKE COCA-COLA
Myoglobin

Serum/urine electrophoresis
Free light chains (paraprotein)

Anti-GBM

C3, C4, anti-dsDNA

IgA

Question 9

IgA nephropathy - what may the patient have before they develop IgA nephropathy?***

What is another name for IgA nephropathy?

What 2 other symptoms will they have?

They may also get a Henoch-Schönlein purpura;

Nephritic syndrome is the name given to a collection of different signs and symptoms that occur as a result of inflammation in the kidneys. This inflammation causes the kidneys to work less effectively. It also causes protein and red blood cells to leak from the bloodstream into the urine.

Answer 9

An URTI or gastroenteritis

Visible Haematuria (severe) (tea-coloured/brown urine) and Flank Pain

Berger’s Disease

Other clinical features like mild fevers, hypertension and oedema may also be present in some patients.