NEPHROLOGY Flashcards
What nephropathy classically presents as visible haematuria following recent URTI?
IgA Nephropathy- young boy with macroscopic haematuria and proteinuria- Mesangial deposition of IgA immune complexes- rapidly after a recent URTI
Haemolytic Uraemic Syndrome
Describe who HUS is typically seen in and describe the clinical triad- MAT?
Seen in young children
M- Microangiopathic Haemolytic Anaemia
A- Acute Kidney Injury
T- Thrombocytopenia
Haemolytic Uraemic Syndrome
Describe the cause of Primary (Aytpical) and Secondary (Typical) HUS?
Primary HUS (atypical)- due to COMPLEMENT DYSREGULATION
Secondary HUS (typical)-
* classically Shiga toxin-producing Escherichia coli (STEC) 0157:H7
this is the most common cause in children, accounting for over 90% of cases
* pneumococcal infection
* HIV
* rare: systemic lupus erythematosus, drugs, cancer
Haemolytic Uraemic Syndrome
Describe the investigations for HUS and what they are looking for?
FBC:
* Anaemia (Microangiopathic haemolytic anaemia)- characterised by a Hb level <than 8g/dL with a** negative Coombs Test**
* thrombocytopenia
* fragmented blood film: schistocytes and helmet cells
U+E’s:
* AKI
Stool Culutre:
* Evidence of STEC infection
* PCR for Shiga Toxin
Haemolytic Uraemic Syndrome
Describe the management of HUS?
- treatment is supportive e.g. Fluids, blood transfusion and dialysis if required
- there is no role for antibiotics, despite the preceding diarrhoeal illness in many patients
- the indications for plasma exchange in HUS are complicated
as a general rule plasma exchange is reserved for severe cases of HUS not associated with diarrhoea
Acute Pyelonephritis
Descfribe the most common cause of acute pyelonephritis?
commonly caused by ascending infection: **E.Coli **from Lower Urimary Tract
also due to bloodstream spread of infection: sepsis
Acute Pyelonephritis
Describe the clinical features associated with Acute Pyelonephritis?
- Fever/Rigors
- Loin Pain
- N+V
- Symptoms of cystitis: dysuria and urinary frequency
AKI
Describe the NICE guidlines for the criteria to diagnose AKI in adults?
NICE recognise any of the following criteria to diagnose AKI in adults:
↑ creatinine > 26µmol/L in 48 hours
↑ creatinine > 50% in 7 days
↓ urine output < 0.5ml/kg/hr for more than 6 hours
AKI
Describe the importance of urine dipstick to establish cause of AKI?
Help identify if its pre-renal, renal and post-renal
Pre-renal AKI: no distinguishing features on urine dip» managed with aggressive fluid resuscitation
Intra-renal AKI: damage to the glomerulus or tubu;les: would show protein and possibly blood
Post-Renal AKI: obstructive causes (prostate/bladder cancer)» may show blood on urine dip but no protein» obstruction may be resolved by catheterisation
AKI
What can increase the risk of an AKI?
- Emergency surgery, ie, risk of sepsis or hypovolaemia
- Intraperitoneal surgery
- CKD, ie if eGFR < 60
- Diabetes
- Heart failure
- Age >65 years
- Liver disease
- Use of nephrotoxic drugs
- NSAIDs
- aminoglycosides
- ACE inhibitors/angiotensin II receptor antagonists
- diuretics
AKI
Describe the staging criteria for AKI?
