Nephrology Flashcards
Visible haematuria following recent URTI?
IgA Nephropathy
Commonest causes of glomerulonephritis worldwide?
IgA Nephropathy (Berger’s disease)
IgA nephropathy associations?
- Alcoholic cirrhosis
- Coeliac disease/dermatitis herpetiformis
- Henoch-Schonlein puurpura
IgA nephropathy pathophysiology?
- Mesangial deposition of IgA immune complexes
- Considerable pathological overlap with Henoch-Schonlein purpura (HSP)
- Histology = mesangial hypercellularity, positive immunofluorescence for IgA & C3
IgA nephropathy presentation?
- Young male, recurrent episodes of macroscopic haematuria
- Typically associated with a recent respiratory tract infection
- Nephrotic range proteinuria is rare
- Renal failure unusual
Differentiating between IgA nepropathy and Post-streptococcal glomerulonephropathy?
PSG = low complement levels, proteinuria, interval between URTI and symptom onset
PSG vs. IgAN time after URTI?
- IgAN = 1-2 days
- PSG = 1-2 weeks
IgA nephropathy?
- No treatment, just renal function f/up = Isolated haematuria, no/minimal proteinuria, and normal GFR
- ACEi = persistent proteinuria >500, normal/slightly reduced GFR
- Steroids = active disease (falling GFR) or failure to respond to ACEi
IgA nephropathy prognosis?
- 25% ESRF
- Marker of good prognosis = frank haematuria
- Markers of poor prognosis = male, proteinuria >2, HTN, smoking, hyperlipidaemia, ACE genotype DD
CKD diet?
Low sodium, phosphate, potassium, protein (to reduce renal strain as is excreted by kidneys)
Prevention of contrast-induced nephropathy?
Volume expansion with 0.9% NaCl
Contrast media nephrotoxicity definition?
25% increase in creatinine occurring within 3 days of the intravascular administration of contrast media
When dose contrast-induced nephropathy occur?
2-5 days after administration
Contrast nephrotoxocity RFs?
- Known renal impairment
- Age > 70 years
- Dehydration
- Cardiac failure
- Nephrotoxics e.g. NSAIDs
High risk for contrast-induced nephropathy and metformin?
Hold metformin for 48 hours until renal function shown to be normal
Minimal change disease presentation?
Nearly always as nephrotic syndrome, accounting for 75% of cases in children and 25% in adults
Minimal change disease cause?
Majority are idiopathic, in 10-20% a cause is found:
1. Drugs: NSAIDs, rifampicin
2. Hodgkin’s lymphoma, thymoma
3. Infectious mononucelosis
Minimal change disease pathophysiology?
- T-cell and cytokine-mediated damage to the glomerular basement membrane → polyanion loss
- Resultant reduction of electrostatic charge → increased glomerular permeability to serum albumin
Minimal change disease features?
- Nephrotic syndrome
- Normotension (HTN is rare)
- High selective proteinuria = Only intermediate-sized proteins such as albumin and transferrin leak through the glomerulus
Minimal change disease biopsy?
- Normal glomeruli on light microscopy
- EM shows fusion of podocytes and effacement of foot processes
Minimal change disease Rx?
- Oral corticosteroids = 80% responsive
- Cyclophosphamide = if steroid resitant
Minimal change disease prognosis?
- 1/3 have one episode
- 1/3 have infrequent relapses
- 1/3 have frequent relapses which stop before adulthood
Most common inherited cause of kidney disease?
ADPKD
ADPKD Type 1?
- 85% cases
- Chromosome 16
- Presents with renal failure earlier
- Polycystin-1