Nephrology Flashcards
5 kidney functions
waste handling - urea and creatinine water handling salt balance acid base control - HCO3 Endocrine - bp,bone, activate vit D, erythropoeitin
3 parts of glomerular filtration barrier
fenestrated endothelium
GBM
podocytes
(mesangial cells)
proteinuria signifies…
glomerular injury
What is nephrotic syndrome?
nephrotic range proteinuria
hypoalbuminaemia
oedema
nephrotic syndrome in terms of starlings forces
oncotic vs hydrostatic
lose protein which keeps water in
typical presentation of nephrotic syndrome
swollen face and legs gastroenteritis 10 days prior periorbital and pitting oedema ascites frothy urine
testing for proteinuria
dipstix - >3
protein creatinine ration
24 hour urine collection
patient diagnosis of nephrotic syndrome
oedema
proteinuria
bloods - low albumin
Nephrotic syndrome types
MINIMAL CHANGE
FSGC/MPGN
typical features of minimal change disease
age 2-5 years
normal blood pressure
resolving microscopic haematuria
normal renal function
atypical features of minimal change disease
autoimmune
abnormal renal function
steroid resistant
When to consider renal biopsy with MCD
atypical features
Treating nephrotic syndrome
prednisolone for 8 weeks
side effects from glucocorticoids
cushings syndrome
BEHAVIOUR
Pathogenesis of nephrotic syndrome
interaction between lymphocytes and podocytes
Outcome of nephrotic syndrome
95% remission in 2-4 weeks
80% relapse
immunosuppression
steroid resistant nephrotic syndrome
acquired = FSGS
congenital
persistent haematuria and proteinuria =
glomerular disease
Nephritic syndrome presentation
haematuria and proteinuria reduced GFR - oliguria fluid overload - high JVP, oedema hypertension AKI
Causes of nephritic syndrome
post infectious
IgA nephropathy
lupus nephritis
membranoproliferative
diagnosing nephritic syndrome
Renal USS
ASOT, throat swab, low complement
immune disease - ANCA -ve
Usual cause of PIGN
beta haemolytic group A strep
throat or skin infection
Treating PIGN
antibiotic
diuretics
IgA nephropathy presentation
1-2 days after URTI older children and adults recurrent macroscopic haematuria chronic microscopic haematuria varying proteinuria
