nephrology Flashcards
what are the functions of the kidney ?
waste handling water handling salt balance acid/base control endocrine - RBC, BP, Vit D
what is nephrotic syndrome ?
proteinuria - 3+
hypoalbuminaemia
oedema
what are typical features of nephrotic syndrome ?
age 2-5
normal BP
resolving microscopic haematuria
normal renal function
how do you treat nephrotic syndrome ?
prednisolone 8 weeks
side effects - check varicella status, pneumococcal vaccination
what causes steroid resistant nephrotic syndrome ?
acquired - focal segmental glomerulosclerosis FSGS - podocyte loss, inflammation
congenital - infants
what causes macroscopic haematuria ?
GN, post infective GN
IGA
UTI
trauma
stones
what causes microscopic haematuria ?
GN, post infection GN
IGA
UTI
trauma
stones
what is nephritic syndrome ?
haematuria
proteinuria
reduced GFR - oliguria, fluid overload, hypertension, worsening renal failure
what causes glomerulonephritis ?
post infective HSP/ IgA nephropathy membranoproliferative GN Lupus nephritis ANCA positive vasculitis
what is the usual causative organism of post-infective GN ?
group A strep
beta haemolytic
throat 7-10 days
skin 2-4 weeks
how is post infective strep diagnosed ?
bacterial culture
positive ASOT
low C3 normalises
self-limiting
how do you treat post-infective GN ?
antibiotics
support renal function
diuretics if overload/ hypertension
when is IgA nephropathy seen ?
1-2 days after URTI
usually older children/adults
most common glomerulonephritis
what are clinical signs of IgA nephropathy ?
recurrent macroscopic/ +/- microscopic haematuria
varying degree of proteinuria
how do you treat IgA nephropathy ?
mild - ACEi
moderate to severe - immunosuppression
outcomes variable 25% ESRF by 10 yrs
what are features of Henoch Schonlein purpura IgA related vasculitis ?
mandatory palpable purpura
1 of; abdominal pain renal involvement arthritis or arthralgia biopsy - IgA deposition
how do you treat IgA vasculitis ?
symptomatic
glucocorticoids may help with GI involvement
immunosuppression
long term hypertension and proteinuria screening
how do you manage AKI ?
3Ms
monitor - urine output, PEWs, BP, weight
maintain - good hydration
minimise - drugs
what are different intrinsic renal problems and what causes them ?
glomerular disease - HUS, GN
tubular injury - acute tubular necrosis - hypoperfusion, drugs
interstitial nephritis - NSAIDs, autoimmune
what is haemolytic-uraemic syndrome ?
typical post diarrhoea
E.coli
pneumococcal infection
drugs
what is the triad of haemolytic-uraemic syndrome ?
microangiopathic haemolytic anaemia
thrombocytopenia
AKI
what are the grades of vesico-ureteric reflux ?
1 - ureter only 2 - ureter, pelvis, calyces 3- dilatation ureter 4 - moderate dilatation of ureter 5 - gross dilatation
what factors affect progression of CKD ?
late referral hypertension proteinuria high intake of protein, phosphate, salt bone health acidosis recurrent UTIs
what is Potter’s sequence ?
decreased amniotic fluid pulmonary hypoplasia fetal compression bilateral renal agenesis AR polycycstic kidney disease
