Nephrotic And Nephritic and infection Flashcards
Define nephritic syndrome
Inflammation of the glomerular capillaries Haematuria Plus minus proteinuria Oligouria Hypertension
Define nephrotic syndrome
Proteinuria more than 3.5g Hyperlipidemia Hypoalbuminemia Peripheral oedema Injured podocytes
Give causes of nephritic syndrome
bIg Al Good ANd CAring
Iga nephropathy
Alport syndrome (also hearing loss and eye problems)
Goodpasture syndrome
Vasculitis eg wegeners, (ANCA)
Which syndrome has hyperlipidemia and which has oligouria
Hyperlipidemia is nephrotic
Oligouria is nephritic
When you have an infection you don’t want to wee
Name three hypertensive causes of renal damage
Chronic hypertension (eyes and LV hypertrophy first), involving intimal thickening and glomerulosclerosis
Renal artery stenosis- acute, evidence of atherosclerosis elsewhere,ischaemic so RAAS activation, worse with ACEi
Acute hypertension- sudden rise, hemolytic anemia, fibrinoid necrosis, ischaemic so RAAS activation, AKI, rapid renal failure, an emergency
Name a structural defect in boys that could cause UTIs
Posterior urethral valve
Name infectious causes of bladder damage and what they do
Schistosomiasis- flukes live in bladder and can lie dormant, cause calcification, bladder cancer, stenosis of VUJ, chronic cystitis. Note haematobium does this, mansonii and japonicum only do GN not cancer
TB- sterile Pyuria because can’t culture it, calcification, ESRD, abscess, stricures
GN can be caused by hiv, hep b/c, staph endocarditis, strep, malaria
Causes of UTIs
Structural problem eg posterior urethral valve in boys
Relaxed vesicoureteric junction so ureteric reflux
Fs have shorter urethras
Obstruction from enlarged prostate, pregnancy
Neurological incomplete emptying
Personal hygiene eg gut flora
In ten women with UTI like symptoms, what will their diagnoses be?
Five will have cystitis ie significant bacteruria
Five will have urethral syndrome which is low bacteria, gonorrhea, mechanical or physical causes
Symptoms of lower and upper UTIs
Lower is cystitis presenting with frequency, urgency, dysuria
Upper is pyelonephritis presenting with fever, loin pain
What is a complicated UTI
UTI associated with abnormalities eg structural problems, abnormal infectious cause like klebsiella, or a reason why they have it like diabetes, or complication like sepsis or fever
How do you treat different UTIs
Uncomplicated three day trimethoprim
Complicated seven days trimethoprim
Pyelonephritis IV co-amoxiclav plus two weeks trimethoprim
Which organism causes UTIs in females 17-27 and which if surgery/IV drug user/catheter
Staph saprophyticus causes 10% if F 17-27
Staph epidermidis if invasive things
In what cases could you prescribe UTI prophylaxis
3 or more UTIs a year trimethoprim nightly 7
Causes of haematuria
Cancer IgA nephropathy UTI nephritis BPH Renal calculi Patients on warfarin, LMWH
Causes of acute urinary retention
Infection, BPH, prolapses, general anaesthetic, spinal cord injury
When should you catheterise
Acute urinary retention
Acute on chronic ie they can’t wee
If you need to monitor fluid balance eg sepsis, trauma
High pressure chronic retention
What is chronic Urinary retention
More than 800ml full, painless
What are most stones made of
Calcium oxalate
What inhibitor in urine prevents stone formation
Citrate
Describe stone treatments
Shock treatment, ureteroscopy (flexible tube inserted to remove small medium stones), nephrostomy (tube through skin for pyelonephritis and infected obstruction)
Define AKI
Abrupt decline in actual GFR
Less than 0.5ml/kg/hr
Raised serum creatinine and urea
May cause acidosis from reduced acid excretion and reduce reabsorption of HCO3. This can cause hyperkalemia
Causes of AKI
Pre renal- hypovolemia, systemic vasodilation eg sepsis, double whammy of nsaids constricting afferent and ACEi dilating efferent. Basically reduced renal blood flow
Intrinsic- ATN eg caused by nephrotoxins, ischaemia, sepsis. Cells are damaged not dead. Also thrombotic microangiopathy from malignant hypertension. Or acute interstitial nephritis with eosinophil invasion
Post renal- obstructive blocking both kidneys or last functioning one. Get dilation of renal pelvis called hydronephrosis. Eg from stones, cancer, prostate
What can you Agive to protect the heart in AKIs and why
Can cause acidosis which causes hyperkalemia which can cause arrhythmias so give calcium gluconate
What investigations should you do in akis
All should have urinalysis
USS within twenty four hours unless pre renal cause
Biopsy if pre and post ruled out
Microscopy if infection
Why does pregnancy increase risk of UTI
Baby presses on bladder so more reflux potential
Also hormones mean more relaxed vesicoureteric junction.
What is the anion gap and what would a high anion gap indicate
Cations minus the anions
High anion gap indicates metabolic acidosis
How does serum urea Change in volume depletion, upper GI bleeds and malnutrition?
Volume depletion increases because GFR reduced
Upper GI bleed increased because blood broken down
Malnutrition decreased because less to metabolise
Define oligouria
Less than 500ml day
Less than 20ml hour
Happens in nephritis
When are red cell casts found?
Glomerulonephritis
Describe stages of diabetic nephropathy (and state of nephrotic or nephritic)
Obvz nephrotic
Stage 1 increased GFR, hyperfiltration, hypertrophy
Stage 2 latent:, mesangial expansion caused by hyperglycaemia, GBM thickening
Stage 3 microalbuminemia- protein starts to appear in urine, injured podocytes, GFR falls to normal
Stage 4 overt proteinuria- low GFR, systemic hypertension, can see protein on normal dipstick, hyalinosis of arterioles
Stage 5 ESRD
What’s the management for diabetic nephropathy at different stages
If at stage two latent or stage three microalbuminemia May be reversible so do primary prevention: tight BP and glucose control can reverse hyperfiltration and microalbuminemia
If already at overt proteinuria can’t prevent, but can manage hypertension with statins, exercise, RAAS inhibition, stop smoking, don’t have huge protein intake
