Nephrology Flashcards
Normalized kidney despite abnormal function
- Diabetes mellitus
2.Glomerulonephritis
3. Acute kidney injury
4. Multiple myeloma
Indications
Renal biopsy indications
- Acute kidney injury & Chronic kidney disease of uncertain etiology
- Nephrotic syndrome or proteinuria (protein: creatinine ratio >100mg/mol) in adults
- Nephrotic syndrome in children with atypical features or is not responding to treatment (high doe glucocorticoid)
- Nephritic syndrome (Lupus nephritis)
- Renal transplant dysfunction
- Rarely performed in isolated haematuria or isolated low grade proteinuria in the absence of impaired renal function or evidence of multisystem disorder.
In Lupus nephritis, do biopsy when proteinuria>500mg in 24h urine sample
Contraindications
Renal biopsy contraindications
- Disordered coagulation or thrombocytopenia (aspirin & other antiplatelet agents increase bleeding risk)
- Uncontrolled hypertension
- Kidneys <60% predicted size
- Solitary kidney (except transplants)
Complications
Renal biopsy
- Pain, usually mild (vasovagal syncope may occur in some cases)
- Bleeding into urine, usually minor but may produce clot colic & obstruction (or clot retention)
- Bleeding around the kidney, occasionally massive & requiring angiography with intervention, or surgery
- Arteriovenous fistula, rarely significant clinically
- Perinephric abcess
Cause of haematuria
Initial haematuria
An anterior (penile) urethral source
Cause of haematuria
Terminal haematuria
Bladder neck or prostatic urethral source
Cause of haematuria
Total haematuria
Bladder or upper tract source
Cause of haematuria
Painful haematuria
- Trauma -Most common
- Stone
- UTI
- Renal infarction
- Renal vein thrombosis
- Papillary necrosis
- Loin pain haematuria syndrome
Cause of haematuria
Painless haematuria
- Glomerulonephritis especially nephritic
presentation -Most common - Interstial nephritis
- Vasculitis
- BEP
- Prostate cancer
- Tumour in urogenital tract
Cause of haematuria
Visible haematuria
Mallignancy
UTI
Stones
IgA nephropathy
Causes of haematuria
Non visible haematuria
Tumour
Glomerular bleeding
BPH
Prostatitis
Urethritis
Causes of haematuria
Transient haematuria
Excercise
Menstruation
Sexual activity
Viral illness
Trauma
Haematuria
Glomerular bleeding
- IgA nephropathy (causes massive haematuria in children)
- Thin basement membrane disease
- RPGN
- Alport syndrome (causes massive haematuria in children)
- Mild focal GN of other causes (e.g; lupus nephritis)
- Other GN (variably present in membranous and diabetic nephropathy)
In these cases, the RBC passes through damaged glomerulus and becomes dysmorphic, i.e; showa budding, spiculations and other surface abnormalities. (RBC Casts)
Haematuria
Non glomerular bleeding
- Stone
- Tumor
- Severe infection
- Renal infarction
- Bleeding disorders
- Renal cysts
- Vascular malformation
- UTI
- Medullary sponge kidney
- Renal vein thrombosis
- Schistosomiasis
- Factitious haematuria
- Interstitial disorders
RBC s of normal morphology found in urine R/M/E
Proteinuria
Normal amount of protien found in urine
<150mg in urine ( Tamn harsfall protein)
