Nephrology Flashcards
What is the main sign in nephrotic syndrome?
Proteinuria
What is the main sign in nephritic syndrome?
Haematuria
What are some acquired glomerulopathies?
Minimal change disease
Post-infectious glomerulonephritis
Haemolytic uraemia syndrome
IgA nephropathy
What are some congenital glomerulopathies?
Congenital nephrotic syndrome
Alport syndrome
Thin basement membrane disease
Complement regulatory proteins
What is the most common cause of post-streptococcal glomerulonephritis?
Beta-haemolytic streptococcal infection
Eg - strep throat, impetigo
When do symptoms of post-streptococcal glomerulonephritis present?
Throat - 2-7 days
Skin 2-3 weeks
What are the signs of post-streptococcal glomerulonephritis?
Frank haematuria Oedema Hypertension Fever Abdominal pain
How is post-streptococcal glomerulonephritis investigated?
Urine dipstick - proteinuria, RBC casts, oliguria
Bloods - increased urea and creatinine, decreased C3
Anti-streptolysin raised
Bacterial culture
How is post-streptococcal glomerulonephritis treated?
Diuretics
Anti-hypertensive
Penicillin - 10 days
What type of glomerulonephritis is IgA nephropathy?
Nephritis
Most common glomerulonephritis
What is the pathology of IgA nephropathy?
IgA deposits in the nephrons of the kidneys causes inflammation
What are the signs of IgA nephropathy?
Frank haematuria
Abdominal swelling
How is IgA nephropathy investigated?
Urine dipstick
Biopsy
How is IgA nephropathy treated?
Steroids
What is the pathology of Henoch Schonlein purpura IgA related vasculitis?
Inflammation and leaking of blood from small blood vessels
What are the signs of Henoch Schonlein purpura IgA related vasculitis?
Purpura - legs
Joint pain
Abdominal pain
IgA nephritis
How is Henoch Schonlein purpura IgA related vasculitis investigated?
FBC, CRP Blood film Blood culture Urine dipstick BP
How os Henoch Schonlein purpura IgA related vasculitis treated?
Analgesia
Hydration
What type of glomerulonephritis is minimal change disease?
Nephrosis
What is the classic triad of minimal change disease?
Low serum albumin
Proteinuria
Oedema
What are the signs of minimal change disease?
Oedema - peri-orbital Anorexia GI disturbance Irritability Ascites Oliguria
How is minimal change disease investigated?
Urine dipstick - frothy
Blood - decreased albumin
How is minimal change disease treated?
Steroids - prednisolone
If steroid resistant - cyclophosphamide
What is the pathology of haemolytic uraemia syndrome?
Thrombosis in small vessels throughout the body
What is the classic triad of haemolytic uraemia syndrome?
Haemolytic anaemia
Acute kidney injury
Thrombocytopenia
What causes haemolytic uraemia syndrome?
Typical - post-diarrhoea (Shiga toxin from E. Coli)
Pheumococcal infection
Drugs
(risk period - 2 weeks)
What are the signs of haemolytic uraemia syndrome?
Bloody diarrhoea Oliguria Haematuria Hypertension Abdominal pain Lethargy Irritability
How is haemolytic uraemia syndrome treated?
Monitor 5 kidney functions
Maintain IV fluids
What are the causes of acute kidney injury?
Rapid rise in creatinine or development of oliguria/anuria
Causes:
Diarrhoea/dehydration
Glomerulonephritis
Drug induced haemolysis
Secondary to – cardiac surgery, bone marrow transplantation, toxicity (NSAIDs, aminoglycosides, vancomycin etc)
What are the causes of chronic renal failure?
Congenital dysplastic kidneys Pyelonephritis Glomerulonephritis Recurrent infection Reflux nephropathy AKI leading to cortical necrosis
What are the signs of UTI in a baby?
Non-specific Fever Lethargy Irritability Vomiting Poor feeding Frequency Smelly urine
What are the signs of UTI in an infant?
Fever
Abdominal/suprapubic pain
Dysuria
Frequency
How is UTI investigated?
Urine sample (clean catch) - high nitrates and leukocytes Urine culture - mid-stream
How are UTIs treated?
Lower tract - trimethoprim
Upper tract - 3rd generation cephalosporins
When should UTIs be investigated further and what would be done?
If recurrent:
Ultrasound
Dimercapto-succinic acid scan (DMSA)
Micturating cystourethro-gram (for vesico-ureteric reflux)
When do infants have normal kidney function?
By age 2/3 - maturation over time
What are the functions of the kidneys?
Waste handling Water handling Salt balance Acid base control Endocrine - red cells, BP, bone health
What makes up the glomerular filtration barrier?
Endothelial cell
GBM - type IV collagen and laminin
Podocytes
Mesangial cells
What part of the nephron is affected in minimal change disease?
Epithelial cell (podocyte)
What part of the nephron is affected in post-streptococcal glomerulonephritis?
Basement membrane
What part of the nephron is affected in haemolytic uraemia syndrome?
HUS
What part of the nephron is affected in IgA nephropathy?
Mesangial cell
What are the causes of chronic kidney disease?
Congenital anomalies of the kidney and urinary tract (CAKUT) - 55% (reflux nephropathy, dysplasia, obstructive uropathy)
Hereditary - 17%
Glomerulonephritis - 10%
