Nephrology Pathologies

Question 1

ADPKD (Pathophysiology, signs and symptoms, treatment)

Answer 1

Pathophysiology: cystic dilation of renal tubular epithelium. Cysts filled with fluids on the renal cortex and medulla. Bilateral enlargement of the kidneys and destruction of parenchyma.

Signs and symptoms: flank pain, haematuria, renal dysfunction, hypertension, mitral valve prolapse, extra-renal cysts

Treatment: treat problems associated with it, drugs to decrease growth of cysts

Question 2

AKI (Definition, risk factors, tests, causes and treatment)

Answer 2

Definition: within 7 days, decrease in renal function resulting in oliguria and increased serum creatinine and urea. Usually reversible.

Risk factors: chronic kidney disease, HF, hypovolaemia

Tests: FBC, Us and Es, ECG (hyperkalaemia) and CXR (pulmonary oedema)

Causes: shock, renovascular disease, glomerulonephritis, tubular necrosis, obstruction of urine outflow

Treatment: ABCDE, evaluate if fluid needed, exclude nephrotoxic drugs, dialysis if indicated (eg. acidosis, electrolyte imbalance, poisoning, oedema)

Question 3

Chronic kidney disease (definition, causes, treatment)

Answer 3

Definition: gradual, irreversible decline in kidney function, decreased GFR/markers of renal damage >3 months

Causes: vasculitis, renal artery stenosis, amyloidosis, myeloma, PKD, diabetes, hypertension, glomerulonephritis

Treatment: treatment of causes and symptoms, dialysis and transplant in advanced disease, avoid nephrotoxic drugs

Question 4

Glomerulonephritis (Causes, signs and symptoms, tests and treatment)

Answer 4

Causes: infection (eg. Strep A, systemic inflammatory condition (eg. RA/lupus), drugs (eg. NSAIDs), metabolic disorders (eg. diabetes, thyroid disease), malignancy

Signs and symptoms: asymptomatic, haematuria, proteinuria, hypertension, rash, fever

Tests: urinalysis, Us and Es, FBC and CRP

Treatment: antibiotics in infection, ACEi (to decrease proteinuria), corticosteroids, immunosuppressants

Question 5

Nephrotic syndrome (definition, symptoms and signs)

Answer 5

Definition: massive proteinuria and hypoalbuminaemia which causes oedema, hyperlipidaemia and hypercoagulability

Symptoms and signs: oedema, fatigue, frothy urine, SOB

Question 6

Nephritic syndrome (definition, symptoms and signs)

Answer 6

Definition: condition involving haematuria, mild proteinuria, hypertension, oliguria, red cells in urine

Signs and symptoms: increases in JVP and BP

Question 7

Classifications of nephrotic and nephritic disease

Answer 7

Pure nephrotic = minimal change disease
Nephrotic + haematuria = membranous glomerulonephritis
Nephritic + large proteinuria = membrano-proliferative glomerulonephritis
Pure nephritic = post-strep, infective endocarditis, Goodpasture’s, vasculitis

Question 8

UTI (signs and symptoms, tests and treatment)

Answer 8

Signs and symptoms: urinary frequency, urgency, dysuria, suprapubic pain (CYSTITIS). if + fever, vomiting and loin pain (PYELONEPHRITIS)

Tests: urine dipstick (+ leucocytes and nitrites), culture in men, children and pregnant women

Treatment: nitrofurantoin/trimethoprim (cystitis), IV antibiotics (pyelonephritis)