Nephrology Flashcards
What is PIGN?
A glomerulonephritis that occurs following URTI characterized by low C3, proteinura, hematuria, hypertension, edema and elevated creatinine
What is the management of PIGN?
Sodium and water restrict, Furosemide (loop diuretic), occasionally Nifedipine or calcium channel blocker
What is the nutcracker syndrome?
Compression of left renal vein between the aorta and superior mesenteric artery causing hematuria and can cause flank/abdo pain
What are the characteristics of nephritic syndrome?
Proteinuria Hematuria Azotemia (elevated Cr/urea) RBC casts Oliguria HTN
What are the characteristics of nephrotic syndrome?
Hypoalbuminemia (<25g/L)
Edema
Lipidemia
Proteinura (3g/L or 3+ on urine dipstick)
What are the risks of nephrotic syndrome?
Infection by encapsulated organisms due to loss of immunoglobulins and complement, increased risk of thrombosis due to loss of anti-thrombin through urine
What are the causes of nephrotic syndrome?
Minimal change disease, focal segmental glomerulosclerosis, membranous nephropathy, medications (NSAIDs, lithium, etc.), infections (HIV, Hepatitis B, Hepatitis C), malignancy (leukemia/lymphoma)
Causes of heme-negative red urine
Doxorubicin, Nitrofurantoin, Rifampin, beets, methemoglobin, Porphyrin
What is IgA nephropathy?
Gross, painless hematuria that tends to occur concomitant with infection. Due to IgA deposits in the kidney, some may present with microscopic hematuria +/- proteinuria only. C3 is normal and some patients may have elevated IgA levels
What is the prognosis of IgA nephropathy?
The higher the prevalence of proteinuria, especially between episodes, the worse the prognosis. Risk of ESRD is 20%
What is HSP (IgA vasculitis)?
A small vessel vasculitis causing deposits of IgA in multiple organs, particularly kidneys. It is characterized by non-thrombocytopenia palpable purpuric rash, nephritic syndrome, GI manifestations and arthralgia/arthritis. Nephritis tends to be the last manifestation presenting at 8 weeks after initial presentation
What is hemolytic uremic syndrome?
Classic triad of microangiopathic hemolytic anemia, thrombocytopenia, renal dysfunction
What is hemolytic uremic syndrome triggered by?
Classically by e.coli O157:H7 that produces shiga toxin. Presents as bloody diarrhea. Can also be triggered by Strep pneumo, HIV, HHV-6, etc. and strep pneumo triggered is DAT positive
What are the indications for dialysis?
Acidosis Electrolyte abnormalities Intoxications Oliguria/overload of fluids Uremia
What are insensible losses?
400mL/m2/day
What is Alport syndrome?
Mutation in one of the genes (COL4) encoding one of the alpha chains of type 4 collagen. X-linked disorder. Leads to SNHL, microscopic hematuria and eventual proteinuria and renal disease, retinopathy/anterior lens capsule
What are the abnormal ranges for proteinuria?
For 24 hour collection, >4mg/m2/day is abnormal
For protein:creatinine ratio >20mg/mmol is abnormal
For albumin:creatinine ratio >30mg/mmol is abnormal
C-P-A: 4 - 20 - 30
What are the concerning organisms for spontaneous bacterial peritonitis in nephrotic syndrome?
Some Nasty Killers Have Serious Capsule Protection
Strep pneumo Neisseria meningitides Klebsiella pneumoniae Haemophilus influenzae type B Salmonella typhi Cryptococcus neoformans (fungi) Psuedomonas aeruginosa
What is thin basement membrane nephropathy?
Also known as benign familial hematuria, defect in COL4A3 or COL4A4 causing microscopic hematuria that may be intermittent or persistent. Usually have no other signs of significant renal disease but in some families it can
What are the criteria to make the diagnosis of SIADH?
Euvolemic hyponatremia with low serum osmolality, high urine osmolality, high urine sodium. Also have low plasma uric acid and low plasma BUN
What do you see in psychogenic polydypsia?
Hyponatremia but low urine osmolality as your kidney’s are working appropriately and excreting the excess water as much as possible, they are just getting overwhelmed
What is seen in cerebral salt wasting?
Urine output is high as water is following the salt you’re losing. Urine sodium and urine osmolality are both high. Serum sodium low and intravascularly deplete. Seen in ICU patients, brain bleeds
What is anion gap formula? The osmolar gap?
AG = Na - (Cl +HCO3) OG = 2(Na) - glucose - BUN
What is the formula to calculate a urine anion gap?
Urine AG = (Na + K) - Cl
What are the types of RTAs and features?
Type 2 (Proximal tubule) - low potassium, lose amino acids, glucose, phosphate, uric acid. Urine pH <5.5. Fanconi syndrome causes Type 1 (Distal tubule) - low potassium, high urine pH as acidification is affected. Secrete calcium into urine and have low urine citrate, so get nephrocalcinosis. Type 4 (Collecting tubule) is a hypoaldosteronism- high potassium, urine pH <5.5
What is cystinosis?
Autosomal recessive lysosomal storage disorder. Cystine accumulates in lysosome and most common cause of Fanconi syndrome in children (type 2 RTA, low phosphate, uric acid, glucose, poor growth, FTT)
What is Bartter syndrome?
Looks like chronic furosemide use, genetic defect causes decreased activity in one of several electrolytes transporters in the thick ascending loop of Henele causing impaired NaCl absorption, polyuria and polydipsia, volume depletion, activation of RAAS, hypokalemia, metabolic alkalosis, high urine calcium
