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Genitourinary MBCHB2 > Lecture 15: Renal disease > Flashcards

Lecture 15: Renal disease Flashcards

1
Q

What can happen to glomerular function?

A

Can become leaky or blocked

Problems with glomeruli = Blood or protein in urine

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2
Q

What happens to a blocked glomeruli?

A

AKI or CKD

  • Increased creatinine
  • Low GFR
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3
Q

Describe normal renal-protein handling:

A
  • Kidneys handle <150mg/24h urinary protein

Barriers to urinary protein

  • Glomeruli
  • Tubules - reabsorb and degrades most of filtered protein
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4
Q

What is Haematuria? and what can it be from? and whats important to remember?

A
  • Blood in urine

Can be from: glomerular disease, tumour, infection

Important to consider there is a spectrum of degrees of blood in the urine

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5
Q

What happens with a leaky filter?

A
  • Leaking of blood or protein through glomerulus

- Kidney function may be normal

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6
Q

What is the main type of protein in the urine?

A

Albumin

Other types of proteins in small amounts

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7
Q

How is protein in the urine measured?

A
  • 24hr urine
  • Albumin:Creatinine
  • Protein:Creatinine
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8
Q

What is microalbuminuria?

A
  • 30-300mg albumin/24hrs normally

Albumin:Creatinine ratio

  • 2.5mg/nmol (normal)
  • 2.5-25 mg/nmol (MICROALBUMINURIA)
  • > 25mg/nmol (PROTEINURIA)
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9
Q

What are the causes of microalbuminuria?

A
  • Diabetes mellitus
  • Fever
  • Exercise
  • HF
  • Poor glyceamic control
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10
Q

What is nephrotic syndrome?

A
  • > 3.5g/day urinary protein
  • Low serum albumin
  • Oedema

Frothy urine, Hypercholesterolaemia, Blood clots

Renal function normally impaired.

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11
Q

What are the mechanisms for oedema?

A
  • Increased albumin excretion
  • Liver cant keep up producing albumin
  • Reduction in oncotic pressure (protein in blood)
  • Egression of fluid into interstitial space
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12
Q

What is starling equation?

A

Starlings equation:
Flux = Cap. permeability (intravascular hydrostatic P - interstitial hydrostatic P)

Cap hydrostatic P: Pushes fluid out of vessel if high
Cap oncotic P: Pulls fluid into vessel if high (derived from plasma proteins)

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13
Q

What happens to starlings forces in nephrotic syndrome?

A

Nephrotic syndrome = low albumin

  • Low oncotic P and high hydrostatic P
  • Water pushed from intravascular compartment into tissue
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14
Q

How does nephrotic syndrome altered blood lipid profile?

A

Low plasma oncotic P -> Increased lipoprotein produced by liver -> Increased cholesterol production.

Meanwhile:

Reduced metabolism VLDL-LDL -> Increased triglycerides

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15
Q

What are some possible consequences of nephrotic syndrome?

A

Thromboembolism risk increases

Malnutrition risk increases

Risk of infection increases

  • Reduction of AB production
  • Decreased complement pathway

i. e
- Increased bacterial infections
- Increased chickenpox in children

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16
Q

What happens to renal function in nephrotic syndrome?

A

Can be normal, can be AKI or CKD.

SPECTRUM

17
Q

What else can cause leaking glomeruli?

A
  • Majority due to glomeruli disease

- Other major cause is diabetes (mainly protein in urine)

18
Q

Describe the timecourse of GFR in a person with diabetic nephropathy:

A

GFR increases to a hyperfiltration state before it declines over time and continues to

Meanwhile a microalbuminuria develops and then an over proteinuria

CONTROLLING BLOOD PRESSURE CAN LIMIT DECREASE IN GFR AND PROTEINURIA

19
Q

What happens in acute tubular necrosis?

A

Tubular epithelium are damaged and then become necrotic because of ischeamic injury. These cells slough away and block the tubule, decreasing GFR

20
Q

What are the signs and symptoms of acute glomerulonephritis?

A 
Leaky glomeruli: Blood +/- protein
Nephrotic syndrome:
- Unwell
- oliguric
- hypertensive
- volume overload
- Signs of other multi-system disease i.e heamoptysis, rash, arthritis, fever
- MSU - Blood/proteins i.e red cell casts
21
Q

What are red cell casts in glomerulonephritis?

A

Damaged RBC b/c passed the glomerulus

22
Q

Whats nephrotic syndrome versus nephritic syndrome:

A

Nephritic syndrome:

  • Inflammation
  • Blood in urine
  • RBC casts
  • AKI

Nephrotic syndrome

  • Oedema
  • Proteinuria
  • Variable renal function
23
Q

Whats the diagnosis of proteinuria?

A
  • May be associated with AKI or CKD but may have normal kidney function
  • Need to find cause of proteinuria i.e is it diabetes or glomerulonephritis
  • Generally need kidney biopsy
24
Q

What is the treatment of proteinuria?

A

Key treatment is management of blood pressure!!

25
Q

What are the origins of haematuria?

A

Bleeding from somewhere in urinary tract:

  • Glomerular
  • Collecting systems
  • Focal lesion
26
Q

How obvious is glomerular haematuria?

A

Often not obvious to the eye and a dipstick test must be done. Often associated with proteinuria (not always)

ALWAYS CHECK PROTEIN AND BP IF BLOOD IN URINE

27
Q

What are the symptoms of haematuria from collecting system?

A
  • Usually macroscopic (cant see blood)
  • No/little proteinuria

Loin-groin pain
Clots
Vomiting/nausea
Anuria

28
Q

Describe the focal lesions as a cause of haematuria:

A
  • Macro/Microscopic
  • Often asymp.
  • Can occur anywhere in urinary tract
  • Commonest renal cell carcinoma
  • Back ache
  • Mass
29
Q

What is the most common sort of renal cancer?

A

Renal cell carcinoma

Generally related to smoking

30
Q

What are the macroscopic features of renal cell carcinoma?

A
  • Well circumscribed mass
  • Mottled red, yellow and brown
  • Part cystic
  • May invade renal vein
31
Q

Whats the spread of renal cell carcinoma?

A

Lungs
Bone
Liver
Brain

32
Q

Summarise heamaturia in the glomeruli:

A
  • May have proteinuria (often)
  • May have renal failure
  • Hypertension (common)
  • Usually microscopic (often)
33
Q

Summarise haematuria in the collecting systems:

A
  • Stones
  • Infections
  • MSU?
34
Q

Summarise proteinuria:

A

Usually glomerular

  • Leaky glomerulus
  • Sometimes have renal impairment but not necessarily
  • Reduction in BP will often reduce proteinuria
  • Biopsy useful to help make diagnosis i.e diabetes, red cell casts

Genitourinary MBCHB2 (26 decks)

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