nephrology 🏥 Flashcards
pre-renal causes of AKI
hepatorenal syndrome
intra-renal causes of AKI
acute tubular necrosis
nephrotoxic drugs
acute pyelonephritis
intratubular obstruction
coagulopathies
post renal causes of AKI
renal tract obstruction -e.g stones or tumours
presentation of hepatorenal syndrome
renal failure and liver disease
what causes acute tubular necrosis
ischaemic event or nephrotoxic drugs
Rhabdomylosis
Cisplatin
Methotrexate
Ethylene glycol
examples of nephrotoxic drugs
ct contrast medium
NSAIDs
abx
analgesics
ACEis
ARBs
gentamicin
presentation of acute tubular necrosis
muddy brown cast on urinalysis
poor response to fluid challenge
hyponatraemia
how does acute pyelonephritis present
UTI sx
flank pain
messed up kidney function tests
cloudy urine
tx pyelonephritis
ceflasporin
distinguish between nephritic and nephrotic
nephritic - protein and blood in urine
nephrotic - protein in urine
name nephritic contidions
IgA nephropathy
post-strep glomerulonephritis
Granulomatosis with polyangiitis (wegener)
Eosinophilic (churg-strauss)
Anti GMB antibody disease(good pasture syndrome)
Alpert syndrome
how does IgA nephropathy present
Gross haematuria 1-2 days after URTI
how does post strep glomerulonephritis present
7-14 days after a strep infection - unlike IgA nephropathy this occurs weeks after an infection
Usually occurs in children unlike IgA too
Tea urine
how does rapidly progressive glomerulonephritis present
renal failure
haematuria
OLIGOURIA
hypertension
what would a renal biopsy show for progressive glomerulonephritis
severe inflammation with necrotising crescent formation
tx rapidly progressive glomerulonephritis
high dose immunosuppression
causes of rapidly progressive glomerulonephritis
goodpastures syndrome
Wegeners granulomatosis
features of good pastures syndrome
anti glomerular basement membrane antibodies attach the kidney and lungs
Antibodies against type IV collagen results in in pulmonary haemorrhage - haemopytsis and haematuria as the collagen in the lung and glomerular basement membrane are damaged
mx good pastures syndrome
steroids, plasma exchange and cyclophosphamide
name nephrotic syndromes
minimal change nephropathy
membranous glomerulonephritis
describe minimal change nephropathy
80% of nephrotic syndromes in children
typically present with oedema and facial swelling
Proteinuria
mx minimal change nephropathy
high dose prednisolone
describe membranous glomerulonephritis
most common nephrotic syndrome in adults
biopsy will show thickening of basement membrane
circulating phospholipase A2 receptor antibody
tx membranous glomerulonephritis
ACEis
ARBs
What is acute interstitial nephritis
Inflammation of extra-glomerular tissue
How would acute interstitial nephritis present
Characteristic triad is rash, fever and eosinophilia (uncommon)
Tx acute interstitial nephritis
Discontinue drugs and add fluids
treating underlying cause
steroids
What can cause acute interstitial nephritis
PPIs are a common cause
Antibiotics
NSAIDs
Infections
Autoimmune conditions
NOT STEROIDS they are safe
Features of haemolytic uraemic syndrome
Children under 5
Triad; thrombocytopenia, normocytic anaemia, AKI
Caused by enterohaemorrhagic E.coli from undercooked meat or petting farms
Diarrhoea
Mx haemolytic uraemic syndrome
IV Fluids
Features of wegener granulomatosis
cANCA positive
Renal failure
Nasopharyngeal involvement - SADDLE NOSE DEFORMITY
Haemoptysis
Palpable purpura
65-74 y/o
Features of churg strauss syndrome
pANCA positive
Severe asthma
Blood eosinophilia
Sinusitis
Purpura
38-54 y/o
Tx of wegener granulomatosis and churg strauss syndrome
Steroids
Features of alport syndrome
X linked dominant
Nephritis
Hearing loss
Eye problems
In good pastures syndrome what are antibodies made against
Type IV collagen
Complications of nephrotic syndromes to watch out for
Venous thromboembolism
Infection
Hyperlipidaemia
With a patient with minimal change disease what would you see on light microscopy
Normal glomerular architecture
With a patient with minimal change disease what would you see on electron microscopy
Effacement of podocyte foot processes
what is henoch-schonlein purpura
IgA mediated small vessel vasculitis
HSP usually seen in children following an infection
features of henoch-schonlein purpura
palpable purpuric rats with localised oedema over buttocks and extensor surfaces of arms and legs
for post-strep glomerulonephritis what would you see on a biopsy sample
IgG, IgM and C3 immune complex deposition
endothelial proliferation with neutrophils
subepithelial “hump” appearance on electron microscopy
for post-strep glomerulonephritis what would you see on immunofluorescence
a granular or “starry sky” appearance
stage 1 AKI
increase in creatinine to 1.5-1.9x baseline
increase in creatinine by >=26.5 mmol/l
reduction in urine output to <0.5 ml/kg/hour for >= 6 hours
stage 2 AKI
increase in creatinine 2.0 to 2.9x the baseline
reduction in urine output to <0.5 ml/kg/hour for >= 12 hours
stage 3 AKI
increase in creatinine to >= 3x baseline
increase in creatinine to >=353.6mmol/l
reduction in urine output to <0.3ml/kg/hours for >= 24 hours
pt requires renal replacement therapy
indications for dialysis
persistent hyperkalaemia
uraemia
fluid overload
features of Pyelonephritis
UTI sx and The patient may be vomiting, febrile, and complain of loin pain.
Clinical examination will reveal pyrexia and renal angle tenderness.
mx of pyelonephritis
The patient should be admitted to hospital for intravenous antibiotics (broad-spectrum cephalosporin/a quinolone/gentamicin)
whats a common complication of peritoneal dialysis
peritoneal dialysis peritonitis
typically caused by staph epidermidis
presents with abdominal pain, fever and a cloudy dialysis bag
A 56-year-old man with nephrotic syndrome presents to his GP complaining of swelling around the eyes and swelling of the scrotum and the legs. What is the most likely cause of this?
hypoalbuminaemia
what is rapidly progressive glomerulonephritis
a spectrum of conditions associated with severe glomerular injury
characterised by a nephritic picture associated with a rapid and progressive loss of renal function
patients are often significantly oliguric
can be broadly grouped into 3 categories
