Nephrology Flashcards
What are the three aspects of nephrotic syndrome in terms of presentation?
Proteinuria
Hypoalbuminemia
Oedema
What is minimal change disease?
Minimal change disease (MCD) is the most common form of nephrotic syndrome (a clinical condition characterised by heavy proteinuria, oedema, hypoalbuminaemia, and hyperlipidaemia) affecting children. 90% of children with nephrotic syndrome have minimal histological changes in the kidney. MCD is typically primary (idiopathic) but may also be secondary to another condition.
What is the presentation of minimal change disease?
Facial or generalised oedema
History of viral illness (gastroenteritis)
Can be associated with lymphoma or leukaemia
Dyspnoea from resp complications
Normal blood pressure
No Frank haematuria
Normal renal function
In what circumstances of nephrotic syndrome would you consider a renal biopsy?
Suggestions of autoimmune disease
Abnormal renal function
Steroid resistance
What is the management of nephrotic syndrome?
8 weeks prednisolone
Low salt diet and fluid restriction
Albumin and furosemide
What is the management of steroid resistant nephrotic syndrome?
Secondary immunosuppression
Name a steroid resistant nephrotic syndrome?
Focal Segmental Glomerulosclerosis (FSGS)
What is the presentation of nephritic syndrome?
Haematuria and proteinuria Reduced GFR Oliguria Fluid overload Raised JVP oedema Hypertension Worsening renal failure = Rapidly Progressive GN
What investigations should be done in glomerulonephritis?
Urinalysis-exclude UTI
Comprehensive metabolic profile-may see hyperkalaemia, hyponatraemia
Glomerular filtration rate (GFR)
Full blood count-raised creatinine, anaemia
Lipid profile
Spot urine albumin:creatinine ratio (ACR)
Ultrasound of kidneys
Investigations to consider
Erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP)
Renal biopsy
Complement levels, bacterial culture and ASOT (to look for acute post infectious GN)
What is the management of post infectious GN?
Antibiotic
Support the 5 renal functions
Electrolyte / acid base
Diuretics
What is the presentation of Henoch Schonlein Purpura/IgA related vasculitis?
Mandatory palpable purpura One of 4 1. Abdominal pain 2. Renal involvement 3. Arthritis or arthralgia 4. Biopsy - IgA depostition
What is the management of IgA vasculitis?
Immunosuppression - Prednisolone / cyclophosphamide
Use ACE inhibitors to reduce proteinuria
What is IgA nephropathy?
Most common glomerulonephritis IgA nephropathy (IgAN) is defined by the presence of dominant or co-dominant mesangial IgA immune deposits, often accompanied by C3 and IgG in association with a mesangial proliferative glomerulonephritis of varying severity. 1-2 days after URTI Non streptococcal post infectious GN Usually older children and adults Clinically Recurrent macroscopic haematuria Chronic microscopic haematuria Varying degree of proteinuria Clinical diagnosis and biopsy Treat with Ace inhibitor and immunosuppression
What is an acute kidney injury?
Abrupt loss of kidney function, resulting in the retention of urea and other nitrogenous waste products and in the dysregulation of extracellular volume and electrolytes
Serum creatinine: > 1.5x age specific reference creatinine (or previous baseline if known)
Urine output<0.5 ml/kg for > 8hours
What are the criteria for acute renal failure?
Anuria/oliguria (<0.5ml/kg/hr)
Hypertension with fluid overload
Rapid rise in plasma creatinine
What is the treatment of AKI?
3 Ms Monitor Paediatric Early Warning Scores(BP), Urine Output, weight Maintain good hydration Minimise Drugs
What is haemolytic uraemic syndrome?
Haemolytic uraemic syndrome (HUS) is characterised by microangiopathic haemolytic anaemia, thrombocytopenia, and acute kidney injury. Ninety percent of HUS cases occur in the paediatric population, due to Shiga toxin-producing Escherichia coli. Atypical HUS occurs due to abnormalities in the alternative complement regulatory pathway, resulting in endothelial cell damage and causing microvascular thrombosis.
What is the presentation of HUS?
Bloody diarrhoea
Abdominal pain
Fever
Vomiting
What is the management of HUS?
Monitor 5 kidney functions Fluid balance - hypertension Electrolytes Acidosis Waste Hormones - hypertension Aware of other organs Maintain IV normal saline and fluid Renal replacement therapy Minimise No antibiotics / NSAIDS Red cell transfusion if anaemic
What are the stages of CKD?
Normal function- 90-120 CKD2-60-89 CKD3- 30-59 CKD4- 15-29 CKD5- end stage renal disease
What is the presentation of CKD?
Uraemic – loss of appetite, weight loss, itch
Water – polyuria
Salt / acid base – lethargy
Endocrine – lethargy, reduced effort tolerance
Bladder - UTIs
What is the management of CKD?
Low phosphate diet Oral phosphate binders Calcium containing Active Vitamin D If ongoing poor growth Growth hormone
