Nephrology/GU Flashcards
Define Nephrotic Syndrome
A glomerular disorder when the basement membrane in the glomerulus becomes highly permeable to protein, allowing proteins to leak from the blood into the urine.
Nephrotic syndrome proteinuria criteria
- > 200mg/mmol
Nephrotic syndrome hypoalbuminaemia criteria
- <25g/L
Nephrotic syndrome Epidemiology in the UK
- 2 per 100,000 children per year
- 6-8 times higher in UK Asian populations
- twice as common in boys
- affecting children 2 – 5 years
Ohh
Nephrotic Syndrome classic Triad
- oedema
- heavy proteinuria (>200mg/mmol)
- hypoalbuminaemia (<25g/L)
Nephrotic Syndrome Aetiology
- Minimal Change Disease (90% of the cases)
Secondary to: intrinsic kidney disease - Focal segmental glomerulosclerosis
- Membranoproliferative glomerulonephritis
Secondary to: systemic illness - Henoch schonlein purpura (HSP)
- Diabetes
- Infection, such as HIV, hepatitis and malaria
3 Highs
Nephrotic Syndrome uncommon Triad
- High Lipid profile (chol, TGL, LDL)
- HTN
- Hyper-coagulability
Nephrotic Syndrome complications
- Hypovolaemia
- Thrombosis
- Infection
- Acute or chronic renal failure
- Relapse
How do Nephrotic Syndrome lead to hypovolaemia
occurs as fluid leaks from the intravascular space into the interstitial space causing oedema and low BP
How do Nephrotic Syndrome lead to Thrombosis
can occur because proteins that normally prevent blood clotting are lost in the kidneys, and because the liver responds to the low albumin by producing pro-thrombotic proteins.
immunosuppressant
How do Nephrotic Syndrome lead to infections
occurs as the kidneys leak immunoglobulins, weakening the capacity of the immune system to respond. This is exacerbated by treatment with medications that suppress the immune system, such as steroids.
Nephrotic Syndrome Mx
- High dose steroids (i.e. prednisolone)
- Low salt diet
- Diuretics may be used to treat oedema
- Albumin infusions may be required in severe hypoalbuminaemia
- Antibiotic prophylaxis may be given in severe cases
SEs: steroids on growth
Define Wilms’ Tumour
Nephroblastoma
the most common form of renal malignancy in childhood. It usually occurs in children under 5 years
Wilms’ Tumour Sx
- Abdo pain
- Abdo distention
- HTN
RED FLAGS - unintenional WL
- Fever
- Haematuria
- Lethargy
Wilms’ Tumour clinical presentations
- Unilateral painless, NT, firm, smooth abdo mass
- ballotable and does not move with respirations
Wilms’ Tumour Risk factors
- Age <5 years
- Congenital urogenital anomalies (cryptorchidism etc.)
- L»_space; R kidney (can be bilateral)
Wilms’ Tumour Diagnostic Ix
- Abdo USS w/doppler
- CT CAP or MRI without contrast for staging
- Bloods: U&E, LFTs, FBC, Bone profile
- Bone scan (for bone met)
Wilms’ Tumour definitive Dx Ix
Bx for histology of tumour
Wilms’ Tumour Mx
- Nephrectomy followed by
1. Adjuvant chemotherapy
2. Adjuvant radiotherapy
Define Cryptorchidism
undescended testes
a congenital absence of one or both testes in the scrotum due to a failure of the testes to descend during development
Cryptorchidism Risk Factors
- FMHxof undescended testes
- Low birth weight
- Small for gestational age
- Prematurity
- Maternal smoking during pregnancy
ETA
Types of Cryptorchidism
- Ectopic testis: where the testis is found away from the normal path of decent
- True undescended testis: where testis is absent from the scrotum but lies along the line of testicular descent
- Ascending testis: where a testis previously identified in the scrotum undergoes a secondary ascent out of the scrotum
Cryptorchidism Pathophysiology
Normally, the testis descends from the abdomen to the scrotum, pulled by the gubernaculum, within the processes vaginalis
- True undescended testis: This process is incomplete
- Ectopic testis: Tracks to an abnormal position
- Bilateral cryptorchidism:, hormonal causes such as androgen insensitivity syndrome or disorder of sex development must also be excluded
True undescended testis locations
- Abdo
- Inguinal
- Suprascrotal