Medicine Tips 2 Flashcards
Haemolytic uraemic syndrome
Triad of acute renal failure, microangiopathic haemolytic anaemia and thrombocytopenia
Causes - E. coli 0157:H7, tumours, pregnancy, SLE, HIV, ciclosporin, COCP
Ix - FBC (anaemia, thrombocytopaenia, fragmented blood film), U&Es (AKI), stool culture
Mx - supportive (fluids, blood transfusion, dialysis)
Nephritic syndrome
Haematuria, oliguria and hypertension
Rapidly progressive glomerulonephritis, IgA nephropathy
Nephrotic syndrome
Proteinuria, oedema and hypoalbuminaemia
Minimal change disease, membranous glomerulonephritis, focal segmental glomerulonephritis
Fibromuscular dysplasia
Renovascular disease in young people
Hypertension that is resistant to treatment and a declining renal function
Mixed nephritic and nephrotic syndrome
Haematuria, hypertension, protienuria and oedema
Diffuse proliferative glomerulonephritis, membranoproliferative glomerulonephritis
Rapidly progressive glomerulonephritis
AKA Crescentic glomerulonephritis
Rapid onset, often presents as AKI
Causes - Goodpasture’s, ANCA positive vasculitis (microscopic polyangiitis, granulomatosis with polyangiitis, eosinophilic granulomatosis with polyangiitis)
IgA nephropathy
Young adult with haematuria following an URTI
Diffuse proliferative glomerulonephritis
Post-streptococcal glomerulonephritis
Most common form of renal disease in SLE
Presents as nephritic syndrome/AKI
Membranoproliferative glomerulonephritis
Type 1: cryoglobulinaemia, hepatitis C
Type 2: partial lipodystrophy
Minimal change disease
Child with nephrotic syndrome
Causes - Hodgkin’s, NSAIDs
Good response to steroids
Membranous glomerulonephritis
Presents with proteinuria/nephrotic syndrome/CKD
Causes - infections, rheumatoid drugs, malignancy
1/3 resolve, 1/3 respond to cytotoxics, 1/3 develop CKD
Focal segmental glomerulosclerosis
Idiopathic or secondary to HIV, heroin
Presents with proteinuria/nephrotic syndrome/CKD
Hyperkalaemia management
ECG - prolonged PR segment, broad QRS complex, flattened P wave, tented T wave
10mL of 10% calcium chloride + 10 units of IV actarapid & 25g IV glucose + calcium resonium with lactulose 15g tds
Fractional sodium excretion
(urine sodium/plasma sodium) / (urine creatinine/plasma creatinine) x 100
Fractional urea excretion
(urine urea /blood urea ) / (urine creatinine/plasma creatinine) x 100
Pre-renal uraemia
Urine sodium - <20mmol/L Fractional sodium excretion - <1% Fractional urea excretion - <35% Urine:plasma osmolality - >1.5 Urine:plasma urea - >10:1 Specific gravity - >1020 Urine - 'bland' sediment Response to fluid challenge - Yes
Acute tubular necrosis
Urine sodium - >30mmol/L Fractional sodium excretion - >1% Fractional urea excretion - >35% Urine:plasma osmolality - <1.1 Urine:plasma urea - <8:1 Specific gravity - <1010 Urine - brown granular casts Response to fluid challenge - No
Primary open-angle glaucoma
Slow rise in intraocular pressure, visual field defect, optic disc cupping, hazy cornea, sees haloes, semi-dilated pupil
Mx - prostaglandin analogues (latanoprost), beta-blockers (timolol), alpha2-adrenoceptor agonist (brimonidine), carbonic anhydrase inhibitors (dorzolamide), muscarinic receptor agonist (pilocarpine)
