Nephrology Flashcards
Intrinsic causes of acute kidney injury?
- Glomerulonephritis
- Acute tubular necrosis
- Acute interstitial nephritis
- Rhabdomyolysis
- Tumour lysis syndrom
The most common type of glomerulonephritis in adults? How do patients usually present?
Membranous glomerulonephritis (due to autoantibodies targeting the basement membrane), patients present with nephrotic syndrome or proteinuria
Quick recap of nephrotic and nephritic syndrome!
Nephrotic:
- insidious onset
- Oedema +++
- Hyperlipidaemia
- Normal BP/JVP
- Proteinuria ++++
- +/- haematuria
Nephritic:
- Abrupt onset
- Raised BP/JVP
- Haemturia
- Proteinuria +
Prognosis rule of membranous gloemrulonephritis?
Rule of thirds!
1/3 spontaneous remission
1/3 remain proteinuric
1/3 develop ESRF
**good factors include female sex, young age and only moderate proteinuria
Managment of membranous glomerulonephritis?
- Immunosuppression: combination of corticosteroids + chlorambucil used
- BP control
If a young child presented with urinary symptoms following a throat/URTU infection, what likely ddx should we be considering?
Post-streptococcal glomerulonephritis
Typically 7-14 days post GAS infection.
What causes the cresent shaped appearance within rapidly progressive glomerulo nephritis and what is the outcome of this?
Inflammation of the glomerulus causes a proliferation of cells.
This can lead to the BM breaking, causing
Haematuria, decreased GFR → rapid kidney failure over weeks/months
What are the features of rapidly-progressive glomerulonephritis?
Nephritic Syndrome: haematuria with red cell casts, proteinuria, hypertension, oliguria
+ features specific to the underlying cause (e.g. haemoptysis with Goodpasture’s, vasculitic rash or sinusitis with Wegener’s)
IgA Nephropathy is also called?
How common is this disease?
Also called Bergers Disease this is the most common cause of glomerulonephritis worldwide
** caused by depositions of IgA immune complexes **
Classical presentation of IgA nephropathy
- Young male, recurrent episodes of macrosomic haematuria
- 1-2 days post URTI
What are the two main steps of Good pastures Syndrome
What anti-body is it caused by???
- Pulmonary haemorrage
- Followed by rapidly progressive glomerulonephritis!
Anti-GBM against type IV collagen
What is Rhabdomyolysis and why should we be worried about it?
serious syndrome due to a direct or indirect muscle injury. It results from the death of muscle fibers and release of their contents into the bloodstream.
- typically feature in the exam as a patient who has had a fall or prolonged epileptic seizure and is found to have an acute kidney injury on admission.
This can lead to serious complications such as renal (kidney) failure.
Features of Rhabdomyolysis
- AKI with disproportionately raised Creatinine
- Elevated CK
- Myoglobinuria
- hypocalcaemia (as myoglobin binds calcium)
- Elevated phosohate
- Hyperkalaemia
- Metabolic acidosis
What is the most common cause of acute kidney injury seen in clinical practise?
What causes this?
Acute Tubular Necrosis
- necrosis of the renal epithelial cells
- Causes: renal ischaemia, toxins
