Nephrology Flashcards
Reasons for Dialysis
A - acidosis E - electrolyte imbalance I - intoxication O - overload U - uraemia
Top causes of CKD
Diabetes, unknown, glomerulonephritis, HTn, pyelonephritis
Causes of glomerulonephritis
IgA, HSP, SLE, anti GBM, Post strep, rapidly progressive GN,
Trio glomerulonephritis
HTN, haematuria, low eGFR
Causes Pre renal AKI
Hypoperfusion, RAS
Causes Renal AKI
Tubular - ATN, drugs, contrast, myoglobinuria
Glomerular - autoimmunie (SLE),HSP, drugs, infections
Interstitial - drugs, infiltration (myeloma)
Vascular - vasculitis, malignant BP, thrombus
IgA nephropathy
Nephritic - micro/ macro haematuria Most common young man, episodic Increased IgA > complexes > deposit mesangial cells renal biopsy as above Control BP, immunosuppression 20% ESRF 20yrs
HSP
small vessel vasculitis purpura extensor surfaces flitting polyarthritis, abdo pain clinical diagnosis normally or as iga biopsy showed, tx as iga if nephritis + nephrotic syndrome 50% > ESRF
Anti GBM
autoantibodies type 4 collagen
lung > haemorrhage
nephritic syndrome
plasma exchange, steroids +- cytotoxics
Post strep
nephritic syndrome
antigens deposit in glomerulus > host reaction > immune complexes
serology high ASOT
most recover
rapidly progressive GN
ESRF days
biopsy - crescents glomeruli- immune complexes
aggressive immunosuppression
Nephrotic syndrome
Proteinuria >3.5, oedema, hypoalbuminaemia, hypercholesterolaemia.
Minimal change, membranous nephropathy
Secondary - hep, SLE
children - MCGN - steroids
adults - biopsy
Tx - furosemide, ace I - reduce proteinuria, anticoagulate, statin, vaccines,
Minimal change
Most common kids
Membranous nephropathy
Most adults
diffuse thickening gbm
Causes gout
Primary, relatives, thiazide, small dose aspirin, renal failure, myeloproliferative disorders, psorasis
A blockers
Urinary retention
Doxa
Smooth muscle relaxation urethra
Hypotension
Anti androgen
5 a reductase inhibitors
Finasteride
Antimuscurinic
Oxybutynin
Detrusor muscle
Incontinence
ED
Phosphodiesterase I type 5 > increase cGMP > relax smooth penile muscles
Sildenafil
CKD classes
1 - >90 2 - 60-90 3a 45-60 3b 30-45 4 - 15-30 5 <15
CKD - when to refer to nephrology
ACR >70
ACR > 30 + haematuria (or lower if other factors)
ACR cateogories
A1 - <3
A2 - 3-30
A3 - >30
UTI < 3 months
Refer paeds urgent
UTI in children investigations
< 6 months - US
> 6 months - recurrent or atypical
Haematuria 2WW
> 45 visible
>60 non visiblie + raised WCC/ dysuria
Abx for UTI in pregnancy
Tx any bacturia for 7/7
Nitro (not close to end)
Amox
Not trimeth
LUTs in men - voiding issues
IPSS moderate - a blocker
BPH - finasteride
Mixed storage/ voiding - persist after a blocker - try antimuscurinic
OAB treatment
Urine containment products Supervised bladder training Antimuscurinic Oxybutynin (IR) - not if frail Tolterodine (IR) Darifenacin (OD) Mirabegron
Nocturnal Polyuria
Lifestyle
Furosemide 40mg afternoon
Urology
Tumour markers in testicular cancer
LDH, AFP, sometimes HCG
Epidydimal cyst
Separate from testicle, posterior
Common
US if unsure
Hydrocoele
accumulation of fluid in the tunica vaginalis anterior below attached to testes Infantile - repair if > 1year Adult - US exclude tumour
Epididymo orchitis
Norm STIs,
> 35 coliforms
Painful - r/o torsion
Cef + doxy
Varicocele
Bag of worms Infertility Dull ache USS doppler Think RCC
Oxalate stones
cholestyramine and pyridoxine reduce urinary oxalate secretion
Uric acid stones
Allopurinol/ bicarb
Medical indications for circumcision
phimosis
recurrent balanitis
balanitis xerotica obliterans
paraphimosis
