Nephritic syndrome Flashcards
Microscopic heamaturia - how many times do you need to pick this up before you Investigate?
> trace on 3 occasions
false positives of heamaturia include?
Haemaglobinuria, myoglobinuria
stix positive + microscopy negative
Associated proteinuria =?
glomerular disease
causes of haematuria? - systemic
clotting disorders
most common cause of renal frank haematuria ?
Glomerulonephritis
2 types of renal tumour?
Wilm’s - nephroblastoma
- Cysts
- sarcomas
common causes of haematuria? (5)
Malignancies - sarcomas Stones UTI Trauma Urethritis
how may it present? - case
10 years old 7 day history of sore throat, pyrexia and vomiting Abdominal/lumbar pain, no radiation GP treated as UTI Day 7 of illness “red” urine Some urgency, frequency but no dysuria
Hypertension BP 130 /85 Water handling problem Raised JVP Peripheral oedema Pallor Abdomen – non tender, no organomegaly
Urine
Frank
dipstix Blood 3+, protein 3+
Red cells on microscopy
how to approach a diagnosis of nephritic syndrome?
- blood tests - raised creatinine
- electrolytes - hyponatraemia and hyperkalaemia
- FBC - Mild anaemia, no haemolysis
- Albumin low
- urine work up to exclude UTI
Clinical features of glomerulonephritis
Haematuria and proteinuria Reduced GFR Oliguria Fluid overload Raised JVP oedema Hypertension Worsening renal failure = Rapidly Progressive GN
= cause of AKI
Endothelial cell injuries include?
- post infectious glomerulonephritis (PIGN),
- Haemolytic Uraemic Syndrome, - Membranoproliferative - - Glomerulonephritis (MPGN), Lupus, ANCA vasculitis
investigations for nephritic syndrome?
- Renal USS
- infectious/sore throat - swab for group A strep
- immunology work up complement C3 AND C4
- ANA and ANCA
Features of Acute Post-Infectious Glomerulonphritis
- cause?
site?
age 3-5
- group a strep - beta hemolytic
throat infection , skin
Pathogenesis of nephritic syndrome?
- Antigen “Mimicry”
- Ab-Ag complexes
How to diagnose Acute Post-Infectious Glomerulonphritis?
differentials (4)
Bacterial culture
positive ASOT
low C3 normalises
- lupus, MPGN, HSP / IgA nephropathy,
Treating Acute Post-Infectious Glomerulonphritis?
- Antibiotic - penicillin
- Support renal functions
- Electrolyte / acid base
Overload / hypertension
Diuretics
IgA often presents after a?
URTI
- Older children and adults
Clinical signs of IgA Nephropathy? (3)
- Recurrent macroscopic haematuria
- Chronic microscopic haematuria
- Varying degree of proteinuria
Step 1 in IgA nephropathy pathogenesis
increased levels of Gd-IgA1
Step 2 in IgA nephropathy pathogenesis
production of anti-IgA1 antibodies
IgA or IgG
Step 3 in IgA nephropathy pathogenesis
IMMUNE COMPLEXES FORM
- FORM IN SITU
Step 4 in IgA nephropathy pathogenesis
complexes in the mesangium cause local immune activation and injury
what is caused/ what conditions are a result of antigens deposited in the kidneys? (6)
complement activation cytokine release matrix production mesangial proliferation glomerular sclerosis interstitial fibrosis
How to diagnose IgA nephropathy ?
clinical pictire
- renal biopsy if needed
treatment of IgA nephropathy - mild
ACEI - for proteinuria and hypertension
treatment of IgA nephropathy - severe?
immunosuppresion (KDIGO)
IgA related vasculitis - clinical feature
- what do you need to diagnose?
Mandatory palpable purpura
- Abdominal pain
2. Renal involvement
3. Arthritis or arthralgia
4. Biopsy - IgA depostition
what vessels does IgA vasculitis affect
arterioles
capillaries
venules
Cause of IgA vasculitis ?
Viral URTI in 70%
Streptococcus, drugs
what cells are injured in IgA conditions?
Mesangial
Treatments of IgA Vasculitis?
analgesia -Joints, gut
antacids, Glucocorticoid therapy - gut symptoms
severe - immunospression
