Nephrology Flashcards
nephrotic syndrome features
gold standard is 24 hour urine collection: proteinuria >3g/day
Urine dip *** proteinuria
frothy urine
hypoalbuminaemia <30g/L
oedema
hypercholesterolaemia - liver makes more to compensate for low protein
hypercoagulability - loss of protein C,S, antithrombin in urine
nephritic syndrome features
haematuria red clasts mild/moderate proteinuria -- oedema oliguria hypertension
nephrotic syndrome (oedema, frothy urine) in a child most likely to be... Mx.
minimal change diseaseM
Mx. steroids + cyclophosphamide
nephrotic syndrome in an adult most likely to be…
Mx
focal segmental glomerulonephritis
causes: HTN, obesity, HIV, drugs
biopsy shows thickening of segments
Mx. steroids, immunosuppressants
complications of nephrotic syndrome
renal failure
infection risk (loss of immunoglobulin proteins!)
thromboembolism
+ consequences of steroids
general management of nephrotic syndrome
oedema - diuretics proteinuria - ACEi, ARBS (cause afferent renal arteriole vasoconstriction so less glomerular perfusion) hyperlipidemia - statins VTE prophylaxis antibiotic prophylaxis + flu vaccine immunosuppressants/ Steroids treat cause
types of urinary casts and their causes
hyaline - normal/ decreased urine flow (dehydration, exercise, diuretics)
granular - acute tubular necrosis
renal tubular epithelial cell - acute tubular necrosis
RBC - nephritic syndrome (glomerulonephritis)
WBC - pyelonephritis
haematuria in a child + coryzal symptoms: cause and management
post-streptococcal GN
2 weeks after group A, beta-haemolytic strep (pyogenes) infections
immune complexes deposit
raised ASOT (antistreptococcal antibiody titres)
treatment: antibiotics
what are the types of glomeulnephrotides with nephritic syndrome that is associated with respiratory infections
and how can we distinguish them?
post-strep GN: children, 2 weeks after URTI
IgA nephropathy: everyone else, 2 days after URTI
Organisms causing epididymo orchitis
STI likely -chlamydia trachomitis, neisseria gonorrhoea
STI unlikely - ecoli
Signs to distinguish epididymis orchitis and torsion
Cremesteric reflex absent in torsion
Negative Prehn’s sign = pain NOT relieved on testes elevation —- torsion
Positive prehn’s sign is epidiymo orchitis
criteria for diagnosing AKI
rise in creatinine of 25 micromol/L or more in 48 hours
rise in creatinine of more than 50% in 7 days
fall in urine output to less than 0.5ml/kg/hour for more than 6 hours
fall in eGFR by more than 25% in 7 days
nephrotoxic drugs
NSAIDs ACEi angiotensin II receptor antagonists diuretics aminoglycosides
NB. stop in AKI
investigations patient with increased urinary frequency
patient completes urinary-frequency volume chart: distinguish urinary frequency, polyuria, nocturia
patient completes International Prostate Symptom Score - impact on patient’s life as they classify their symptoms into mild, moderate, severe
urinalysis: infection, haematuria
PSA, digital rectal exam: size and consistency of prostate
urodynamic studies: bladder voiding
medical management of BPH
alpha blockers eg. tamsulosin, alfuzosin relax smooth muscle or internal urinary sphincter so easier to flow *SE of postural hypotension, dry mouth, dizziness, depression
5a reductase inhibitors eg. finasteride inhibits conversion of testosterone into dihydrotestosterone (more potent) thus dramatic decrease in prostate size over 6 months *SE: erectile dysfunction, reduced libido, ejaculation problems, gynaecomastia
renal cell carcinoma signs
triad: haematuria, loin pain, abdominal mass FLAWS left varicoele (occlusion of left testicular vein)
endocrine effects - the Ca may secrete EPO (polycythemia), PTH (hypercalcaemia), renin, ACTH
25% have mets – canon ball lung mets
