Nephrology Flashcards
What does proteinuria mean in glomerular disease?
Glomerular injury
Nephrotic syndrome
What causes haemolytic uraemic syndrome?
Acute kidney injury
What are 5 functions of the kidneys?
Waste handling Water handling Salt balance Acid/base control Endocrine
What are some endocrine functions of the kidneys?
Red cells
Blood pressure
Bone health
What are podocytes?
Specialized epithelial cells that cover the outer surfaces of glomerular capillaries
What do podocytes produce?
Podocin
Nephrin
What is the GBM?
Glomerular basement membrane (GBM) is the extracellular matrix component of the selectively permeable glomerular filtration barrier
Made of type IV collagen and laminin
What does the GBM do?
Separates vasculature from urinary space
Synthesis of podocytes and endothelial cells
What do mesangial cells do?
Glomerular structural support
Embedded in GBM
Regulates blood flow of the glomerular capillaries
What are some signs of nephritic syndrome?
Increasing haematuria
Intravascular overload
What are some signs of nephrotic syndrome?
Increasing proteinuria
Intravascular depletion
Which component is affected in minimal change disease?
Epithelial cell
Podocyte
Which component is affected in post infectious glomerulonephritis (PIGN)?
Basement membrane
Endothelial cell
Which component is affected in haemolytic uraemic syndrome (HUS)?
Endothelial cell
Which component is affected in HSP or IgA nephropathy?
Mesangial cells
What is a drawback of dipstix for measuring proteinuria concentration?
False positives and negatives
What is the gold standard for measuring proteinuria concentration?
24hr urine collection
What is the nephrotic range in protein creatinine ratio testing?
> 250mg/mmol
How does nephrotic range proteinuria affect fluid?
Hypoalbuminaemia
Results in oedema and increasing 3rd space fluid volume
How might nephrotic range proteinuria present?
Pale Inflated weight Periorbital oedema Pitting oedema Ascites Pleural effusion Low BP Frothy urine
How would bloods be affected in nephrotic syndrome?
Normal creatinine
Low albumin
How do we manage nephrotic syndrome?
Prednisolone 8 weeks
What are some possible causes of haematuria?
Clotting disorders Glomerulonephritis Wilm's tumour Cyst Sarcoma Stones UTI Trauma Urethritis
What are some consequences/features of nephritic syndrome?
Haematuria Proteinuria Reduced GFR Oliguria Fluid overload HT
What are the usual causes of acute post-infectious glomerulonephritis?
Usually group A strep
Beta hemolytic
What is the go-to imaging technique for glomerulonephropathy?
Renal USS
How is Acute Post-Infectious Glomerulonphritis diagnosed?
Bacterial culture
Positive ASOT
Low C3 normalises
How is Acute Post-Infectious Glomerulonphritis managed?
Self-limiting
Antibiotic
Electrolytes to support renal function
Diuretics to help fluid overload
What is the most common glomerulonephritis?
IgA nephropathy
How do we diagnose IgA nephropathy?
Negative autoimmune workup
Confirmation biopsy
How do we treat proteinuria in IgA nephropathy?
ACEi
What is KDIGO?
KDIGO defines AKI as any of the following:
Increase in serum creatinine by 0.3mg/dL or more within 48 hours or
Increase in serum creatinine to 1.5 times baseline or more within the last 7 days or
Urine output less than 0.5 mL/kg/h for 6 hours
What is Henoch Schonlein purpura?
IgA related vasculitis
How does Henloch Schonlein purpura present?
Abdominal pain
Renal involvement
Arthritis/arthralgia
4-6 weeks duration
How does AKI present?
Anuria/oliguria
HT with fluid overload
Rapid rise in plasma creatinine
What are some features of HUS?
Haemolysis
Thrombocytopenia
AKI
What are 5 things to monitor in HUS?
Fluid balance Electrolytes Acidosis Waste Hormones
Which factor may cause presentation of CKD to vary?
Kidney functions affected
How might a uraemic cause of CKD present?
Weight loss
Loss of appetite
Itch
How might a water handling problem causing CKD present?
Polyuria
Which functions may be affected when CKD presents with lethargy?
Salt balance
Acid/base
How might an endocrine caused CKD present?
Lethargy
Reduced effort tolerance
Why is papilla shape significant in UTI?
Concave associated with intra renal reflux and found in the renal poles
The most common place for renal scaring
What are some useful antibiotics if UTI causing HUS?
Trimethoprim
Co-amoxiclav
Cephalosporin
What are some bloods in metabolic bone disease?
High phosphate
Increase PTH
High PTH causes metabolic bone disease and CV disease
What are some treatment principles of metabolic bone disease?
Low phosphate diet
Phosphate binders
Active Vitamin D
