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
DDx bilateral enlarged kidneys
autosomal dominant polycystic kidney disease
diabetic nephropathy
HIV associated nephropathy
amyloidosis
DDx shrunken bilateral kidneys
glomerulonephritis
hypertension induced nephropathy
chronic kidney disease (except autosomal dominant PKD, diabetic and HIV associated nephropathy, amyloidosis )
bilateral renal artery stenosis
DDx testicular swelling
renal cell carcinoma varicocele inguinal hernia epididymo-orchitis hydrocele testicular torsion testicular cancer
removal of renal stones in pregnant women
uteroscope
when do you start treatment for hyperK
> 6.5
or ECG changes
what diseases associated with rapidly progressive glomerulonephritis
Goodpasture’s
Wegener’s granulomatosis
SLE
microscopic polyarteritis
causes of erectile dysfunction
psychogenic
**vascular — CVD, HTN, hyperlipidemia, DM, smoking
neurogenic
structural/anatomical
1st line treatment for erectile dysfunction
phosphodiesterase - 5 inhibitor Sildenafil (viagra)
bought without prescription
lupus nephritis management
- treat HTN
- corticosteroids
- immunosuppressants
glucose requirements daily
50-100g daily regardless of weight
water and K,Na,Cl requirements daily
25-30ml/kg/day of water
1mmol/kg/day of K,Na,Cl
which fluid to avoid in patients with hyperkalaemia
Hartmann’s – contains potassium
most common kidney transplant rejection type
***acute T cell mediated rejection (weeks-months)
recipient develops T cells to attack organ
chronic rejection (months-years) repeated episodes of acute rejection results in fibrosis and atrophy of the transplant
HLA system - where is it coded and what are the antigens and important ones that need to be matched before transplant
Human leucocyte antigen is coded for on chromosome 6
class 1 antigens: A, B, C class 2 antigens: DP, DQ, DR
relative importance DR>B>A
infection causing acute graft failure of kidney
CMV
size of renal stone that will pass spontaneously
<5mm
when do you need to actively treat renal stones
> 5mm stones
<5 mm with signs of:
- ureteric obstruction
- patient has abnormal structure of kidney eg. horseshoe kidney or previous transplant
what is a renal stone emergency state
what do you do
renal stone + ureter obstruction + infection
surgical emergency for decompression: nephrostomy tube placement, insertion of ureteric catheters, ureteric stent placement
aspirin overdose symptoms and signs
mild - N& V
severe - pyrexia, tachypnoea, tachycardia, tinnitis
mixed respiratory alkalosis and metabolic acidosis
raised anion gap due to circulating salicyclics
anion gap calculation
normal range
(Na + K ) - (Cl + HCO3)
normal range is 10-18mmol/L
what is a normal anion gap and some causes
hyperchloraemic metabolic acidosis
(chloride is high so there is normal anion gap)
causes:
GI bicarbonate loss - diarrhoea, fistula, uterosigmoidostomy
renal tubular acidosis
drugs
Addison’s disease
causes of a raised anion gap
lactic acid - sepsis, shock, hypoxia, burns, metformin
ketones - DKA, alcohol
urate - renal failure
acid poisoning - salicylates (aspirin), methanol
best way to differentiate chronic vs acute kidney failure
bilateral USS
NB. there are some chronic kidney causes with enlarged
renal transplant + infection
CMV
link between ckd and Iron deficiency annaemia
Hepcidin is an acute-phase reactant that is often increased in CKD due to inflammation and reduced renal clearance. Hepcidin plays a role in preventing iron absorption by blocking the action of ferroportin, a transmembrane protein that maintains iron homeostasis. Due to increased levels of hepcidin in CKD, iron absorption is pathologically reduced, leading to iron-deficiency anaemia.
