Lecture 17 - Revision Flashcards
What are some nephrotic syndromes?
Minimal change disease
Membranous glomerulonephritis
Focal segmental glomerulosclerosis
What are some nephritic syndromes?
IgA Nephropathy
Rapidly progressing Glomerularnephritis
Goodpastures
Post-streptococcal glomerulonephritis
Answer question 1 and 2 for Amy’s case study:
1 = nephrotic syndrome
2 = U+Es to show hypoalbuminaemia, urine dip to show proteinuria
what investigations can be done to confirm nephrotic syndrome?
Low albumin in blood (hyper hyppoalbuminaemia)
Urine dipstick showing proteinuria
What are the 3 changes seen in nephrotic syndrome?
Proteinuria
Low serum albumin
Oedema
What is the Triad of Nephritic syndrome?
Haematuria
Reduced GFR
Hypertension
What is the main difference in presentation occurs with nephritic or nephrotic syndromes?
Haematuria in nephritic
Oedema in nephrotic
Answer question 3 for Amy:
What would you expect GFR, Urea and electrolytes to be like in nephrotic syndrome?
GFR = normal
U + E = normal
Filtration occurs as normal so GFR fine
Nephron can till function so the secretion and reabsorption of urea and electrolytes in affected
Whihc part of the glomerulus is affected in Minimial change disease?
Are the changes permanent?
The podocytes specifically the foot processes of the podocytes
No they resolve as the disease goes into remission
Why may a child gain weight with minimal change disease?
Podocyte foot processes are damaged, this means albumin is lost in the urine resulting in hypoalbuminaemia
This reduces plasma oncotic pressure
As a result less water is drawn out and filtered into the capillaries
More water remains in interstitium resulting in oedema (water weight)
If a patient has gained 4kg in water weight, how much fluid have they retained?
4L
What can be measured to stage an AKI?
Serum creatinine
Urine output
What is a patients serum creatinine with stage 1,2 and then 3 AKI?
1 = 1.5 - 1.9 x baseline
2 = 2 - 2.9 x baseline
3 = 3 or more x baseline
What is the urine output for a stage 1, 2 and 3 AKI?
1 = <0.5 ml/kg/h for 6-12hrs
2 = <0.5ml/kg/h for >12hrs
3 = 0.3ml/kg/h for more than 24hrs or Anuria for >12hrs
What value do you use to stage a CKD?
GFR
What are the GFR values for G1, G2, G3, G4 and G5 stage CKD?
G1 = >90
G2 = 60 - 89
G3 = 30 - 59
G4 = 15 - 29
G5 = < 15
Look at Mr Jenkins case study:
Answer Q1:
Adult polycystic kidney disease
Cysts develop in childhood
They can fill with blood following trauma and result in severe abdominal pain and macroscopic Haematuria
Cysts can become infected
What can adult polycystic kidneys cause?
(Q2) Mr Jenkins
What history questions may you want to ask a patient with APKD?
Hypertension and CKD
Headaches, visual problems, breathlessness, itchiness due to hyerpphosphateamia
Symtoms related to cysts in other organs
On FHx of vascular disease
Why is it important to take a careful family history with a patient with potential Adult Polycystic Kidney Disease?
Autosomal dominant inherited condition
What immediate management methods would you undertake for Mr Jenkins Q4?
Pain control
IV fluids to inc urine output to help wash clot out of kidney
Avoid contact sports
What non mediate issues need to be addressed in follow up for Mr Jenkins?
Q5
High BP (possibly give Acei, diuretics, angiotensin receptor blockers)
ECG changes constitute with Left Ventricular Hypertrophy
Would you screen a child of a parent who has Polycystic kidney disease?
No just screen on an annual basis for elevated BP
Once in teens do ultrasounds and absence of cysts would rule it out
Repeat in 30s too
What type of inheritance is polycystic kidney disease?
Autosomal dominant
What is metabolic acidosis?
Too much acid is made in the body
Can happen when the kidneys cant remove enough acid from the body
What are the different type of metabolic acidosis?
Diabetic ketoacidosis
Hyperchloremic acidosis
Kidney disease
Lactic acidosis
Poisoning by aspirin, ethylene glycol or methanol
Severe dehydration
What is hyperchloremic acidosis?
Loss of too much sodium bicarbonate from the body leads to more chlorine being reabsorbed
Answer question on slide 24:
A
Why is ammonia an effective urinary buffer?
Wall of renal tubules impermeable to NH4+
What will renal correction of acute hyperkalaemia cause?
Acidosis
What is the triad of signs for diabetes Mellitus?
Polydipsia
Polyuria
Weight loss
What causes Type 1 DM?
Autoimmune B cell destruction leading to absolute insulin deficiency
What leads diabetic ketoacidosis with T1DM?
Cells unable to take up glucose so metabolise fatty acids producing ketones
