Investigation of Renal Disease Flashcards
What is the diagnostic structure for renal disease?
- Pre-renal
- Renal
- Post-renal
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What is the hierarchy of investigation - work from least to most invasive?
- History and examination
- Urine tests
- Blood tests
- Radiology
- Renal biopsy
What do you inspect when literally looking at urine?
- clear or cloudy?
- colour?
- smell?
What do you test for in urine strip-testing? (6)
- Protein
- Blood
- Glucose
- pH
- Nitrite
- Leukocytes
What do you look at in urine microscopy?
- Cells
- Casts
- Organisms
- Crystals
What types of crystals can you get forming?
- oxalate
- phosphate
- urate
- cystine
What does Bence-Jones protein indicate?
Myeloma
What is the normal and nephrotic range for 24 hour urinary protein?
- normal < 300mg
- nephrotic >3g
How can you assess renal function?
- serum creatinine conc
- eGFR
- measured 24hr urinary creatinine clearance
- measurement of urinary clearance of tracer
What are the 3 different equations used for eGFR?
- Cockroft-Gault
- MDRD
- CKD-EPI
What is the relationship between GFR and serum creatinine (creatinine clearance)?
- As the glomerular filtration rate increases, serum creatinine decreases
- Creatinine is prod by muscle and filtered by kidney
- If there is increased creatinine, then GFR might be low
What can we look for in blood tests, in relation to renal disease investigation?
- Serum creatinine concentration
- Electrolytes
- Haemoglobin
- Calcium/phosphate
- Parathyroid hormone
- Immunology
- Virology
What is ANCA? What are the two main types?
- Cytoplasmic antineutrophil cytoplasmic antibodies - cause vasculitis
- Autoantibody produced by the body that acts against one of its own proteins
- In the kidneys vasculitis causes leaking of blood and protein into the urine and kidney failure
- cytoplasmic: C-ANCA or PR3-ANCA (attacks proteinase 3)
- perinuclear: P-ANCA or MPO-ANCA (attacks myeloperoxidase)
- can also cause glomerulonephritis
What is anti-glomerular basement-membrane disease?
- AKA Goodpasture’s disease
- inflammation of the small blood vessels in the kidneys and lungs
- autoimmune
- haematuria + proteinuria, tiredness, poor appetite, dec urine prod, leg swelling, breathlessness
- dry cough, coughing up blood
- treatment: plasma exchange
What immunological tests are done in investigating renal disease?
- immunoglobulins - serum protein electrophoresis
- anti-nuclear factor - anti-ds-DNA, Sm, RNP, Ro, La
- Rheumatoid factor
- Complement (C3 & 4)
- Anti-sterptolysin-O titer
