Nephrology Flashcards
what is the GFR of a neonate and at what age does it mature to its full function?
20-30
reaches adult function of >90 by 2 years old
what are the 5 main kidney functions?
waste handling water handling salt balance acid base control endocrine - red cells, blood pressure, bone health
how does glomerulopathy present?
proteinuria
haematuria
does nephrotic or nephritic syndrome cause intravascular overload?
nephritic = intravascular overload nephrotic = intravascular depletion
what component of the glomerular filtration barrier is affected in minimal change disease?
epithelial cell (podocyte)
what component of the glomerular filtration barrier is affected in post-infective glomerulonephritis
basement membrane & endothelial cell
what component of the glomerular filtration barrier is affected in haemolytic uraemia syndrome?
endothelial cell
what component of the glomerular filtration barrier is affected in IgA nephropathy?
mesangial cell
how would you test for proteinuria?
dipsix
protein creatinine ratio
24 hour urine collection
what is the normal protein creatinine ratio and what is the nephrotic range?
< 20mg/mmol
>250mg/mmol
what is the typical presentation of a child with nephrotic syndrome?
swollen face in the mornings periorbital and eyelid swelling in the morning pitting oedema ascites pale, dehydrated, low BP
what are the clinical signs of nephrotic syndrome in a child?
frothy urine
ascites, small pleural effusion, pitting oedema
a patient presents with signs of nephrotic syndrome. what investigations would you carry out?
urine dipstick
protein creatinine ration
urine Na (low)
blood;
- Albumin (low)
- Creatinine (normal)
when would you consider a renal biopsy in a child who presented with nephrotic or nephritic syndrome?
steroid resistant
what is the treatment for nephrotic syndrome in a child?
prednisolone for 8 weeks
what are the side effects from high dose steroids?
behaviour change sleep disturbance increased infection risk hypertension cushings
after how long of no response are they considered steroid resistant?
> 4 weeks
what is responsible for steroid resistance in nephrotic syndrome?
interaction between lymphocytes and podocytes
what is the 1st and 2nd line treatment for nephrotic syndrome in children?
1st line - prednisolone
2nd line - immunosuppression
when would you change treat with immunosuuppresion in nephritic syndrome?
steroid dependant and frequent relapses (>4/year)
name an acquired cause of steroid resistant nephrotic syndrome?
focl segmental glomerulosclerosis (FSGS)
what is the treatment for focal segmental glomerulonephritis (FSGF)?
immunosuppression i.e. cyclophosphamide
how would you differentiate haemaglobinuria from microscopic haematuria?
haemaglobinuria is dipstick positive but microscopy negative
what are causes of haematuria?
systemic - clotting factors renal - glomerulonephritis tumour - wilm's nephroblastoma kidney cysts malignancies i.e. bladder cancer bladder/kidney stones UTI trauma urethritis
what are the features of nephritic syndrome?
haematuria and proteinuria hypertension reduced GFR - oliguria - fluid overload (raised JVP, oedema) - hypertension - AKI
what are the features of nephrotic syndrome?
hypoalbuminaemia
hypoproteinuria
oedema
is intravascular overload associated with nephrotic or nephritic syndrome?
nephritic syndrome
a patient presents with haematuria. he was found to have nephritic syndrome.
what immunological tests will you carry out to approach a diagnosis?
renal USS
throat swab and ASOT (anti-streptolysin O test)
ANA, ANCA
complement C3 and C4
a patient presents with haematuria. he was found to have nephritic syndrome.
what tests would you carry out to approach a diagnosis?
FBC U&E creatinine albumin urine culture (exclude UTI) protein creatinine ratio (exclude nephrotic syndrome)
what immunological test is diagnostic for post-streptococcal glomerulonephritis?
ASOT
anti-streptolysin O test
what change in complement C3 and C4 is found in post-streptococcal glomerulonephritis ?
low C3
normal C4
what is the treatment for post- infectious glomerulonephritis?
antibiotics
support electrolyte and/or acid base imbalance
correct overload/hypertension with diuretics
what is the cause of IgA related vasculitis?
non-streptococcal post infectious glomerulonephritis
- any virus can cause this
what are the diagnostic features of IgA related vasculitis?
palpable purpura \+ 1 of the following - abdominal pain - renal involvement - arthritis or arthralgia - biopsy (IgA deposition)
is IgA vasculitis granulomatous or non-granulomatous inflammation?
non-granulomatous
what is the treatment for IgA vasculitis?
treat symptomatically for mild disease
severe disease - immunosuppression with prednisolone or cyclophosphamide
what are the clinical features of IgA nephropathy?
recurrent macroscopic haematuria
+/- chronic microscopic haematuria
varying degree of proteinuria
negative autoimmune workup
normal compliment levels
confirmation biopsy if unsure
what is the treatment for mild and severe IgA nephropathy?
mild - ACE inhibitors (for proteinuria)
moderate/severe - immunosuppression
mutations in which genes are responsible for acquired FSGS?
NPHS1 - nephrin
NPHS2 - podocin
