Nephrology Flashcards
Difference between Nephrotic and Nephritic syndrome?
Nephrotic;Edema,hypoalbuminemia and proteinuria
Nephr “itis”: Hematuria,HTN,Oliguria=HOOitis
Examples of Nephritic syndrome
IgA nephropathy
Post streptococcal GN
EXAMPLES OF Nephrotic syndrome
- Focal segmental Gn
- Membranous GN(classical spike and dome appearance on electron microscopy. )
In children / young adults -
3. minimal change glomerulonephritis(fusion of podocytes and effacement of foot processes ON ELECTRON MICRO)
Rapidly progressive GN is secondary to?
SLE and Goodpastures syndrome
TREATMENT OF IGA NEPHROPATHY aka BERGERS DIS
isolated hematuria/
no or minimal proteinuria (less than 500 to 1000 mg/day)/
normal glomerular filtration rate (GFR);
no treatment needed, other than follow-up to check renal function
persistent proteinuria (above 500 to 1000 mg/day)/ normal or only slightly reduced GFR;
ACE inhibitors
falling GFR/
failure to respond to ACE inhibitors;
immunosuppression with corticosteroids
60-year-old man
visible hematuria for the past three weeks.
ache in the left loin
left varicocele.
feeling intermittently hot and sweaty
Diag?
3-year-old girl
blood in her urine.
loin mass.
MSU shows no evidence of a urinary tract infection.
family history is her grandmother who has chronic kidney disease.
Diag?
RCC;
classical triad: haematuria, loin pain, abdominal mass
pyrexia of unknown origin
left varicocele (due to occlusion of left testicular vein)
Wilms’ nephroblastoma is one of the most common childhood malignancies. It typically presents in children under 5 years of age, with a median age of 3 years old.
Features are similar to RCC in adults;
abdominal mass (most common presenting feature)
flank pain
painless haematuria
other features: anorexia, fever
metastases are found in 20% of patients (most commonly lung)
21-year-old female complains of dysuria for the past week, despite just completing a three day course of trimethoprim. Urine dipstick is positive for blood + and leucocytes +. A MSSU shows no organism.
There are leucocytes which means it is some kind of infection, not a UTI because MSU shows no org
in a young girl it could be STI
CHLAMYDIA;
asymptomatic in around 70% of women and 50% of men
IN women: AND men: urethral discharge, dysuria
THINGS TO BE DONE TO PREVENT CONTRAST INDUCED NEPHROTOXICITY
- use of intravenous 0.9% sodium chloride at a rate of 1 mL/kg/hour for 12 hours pre- and post- procedure. There is also evidence to support the use of isotonic sodium bicarbonate
- should have metformin withheld for a minimum of 48 hours and until the renal function has been shown to be normal. This is due to the risk of lactic acidosis.
renal transplant will increase his risk of which cancer
SCC of skin
Due to the immunosuppressive medications being used to prevent transplant rejection; which are cyclosporin,tacrolimus and steroids
After transplant monitoring of SE is required;
Cardiovascular disease - tacrolimus and ciclosporin can cause hypertension and hyperglycaemia. Tacrolimus can also cause hyperlipidaemia.
Renal failure - due to nephrotoxic effects of tacrolimus and ciclosporin and recurrence of original disease in transplanted kidney
Malignancy - patients should be educated about minimising sun exposure to reduce the risk of squamous cell carcinomas and basal cell carcinomas
painless, visible haematuria.
Cause?
TCC of bladder
20 yrs old
facial and ankle swelling.
frothy’ urine.
A urine dipstick shows protein +++.
so young person with edema,proteinuria;Nephrotic synd;in young so ?
CAUSES?
MCD
majority of cases are idiopathic, but in around 10-20% a cause is found:
drugs: NSAIDs, rifampicin
Hodgkin’s lymphoma, thymoma
infectious mononucleosis
MCD on renal biopsy?
normal glomeruli; on light microscopy
electron microscopy; shows fusion of podocytes and effacement of foot processes
Tx of MCD?
- majority of cases (80%) are steroid-responsive
- cyclophosphamide is the next step for steroid-resistant cases
