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Urinary > Nephrotic And Nephritic and infection > Flashcards

Nephrotic And Nephritic and infection Flashcards

1
Q

Define nephritic syndrome

A 
Inflammation of the glomerular capillaries 
Haematuria 
Plus minus proteinuria 
Oligouria
Hypertension
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2
Q

Define nephrotic syndrome

A 
Proteinuria more than 3.5g
Hyperlipidemia 
Hypoalbuminemia
Peripheral oedema 
Injured podocytes
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3
Q

Give causes of nephritic syndrome

A

bIg Al Good ANd CAring

Iga nephropathy
Alport syndrome (also hearing loss and eye problems)
Goodpasture syndrome
Vasculitis eg wegeners, (ANCA)

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4
Q

Which syndrome has hyperlipidemia and which has oligouria

A

Hyperlipidemia is nephrotic
Oligouria is nephritic

When you have an infection you don’t want to wee

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5
Q

Name three hypertensive causes of renal damage

A

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

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6
Q

Name a structural defect in boys that could cause UTIs

A

Posterior urethral valve

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7
Q

Name infectious causes of bladder damage and what they do

A

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

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8
Q

Causes of UTIs

A

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

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9
Q

In ten women with UTI like symptoms, what will their diagnoses be?

A

Five will have cystitis ie significant bacteruria

Five will have urethral syndrome which is low bacteria, gonorrhea, mechanical or physical causes

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10
Q

Symptoms of lower and upper UTIs

A

Lower is cystitis presenting with frequency, urgency, dysuria

Upper is pyelonephritis presenting with fever, loin pain

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11
Q

What is a complicated UTI

A

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

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12
Q

How do you treat different UTIs

A

Uncomplicated three day trimethoprim
Complicated seven days trimethoprim
Pyelonephritis IV co-amoxiclav plus two weeks trimethoprim

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13
Q

Which organism causes UTIs in females 17-27 and which if surgery/IV drug user/catheter

A

Staph saprophyticus causes 10% if F 17-27

Staph epidermidis if invasive things

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14
Q

In what cases could you prescribe UTI prophylaxis

A

3 or more UTIs a year trimethoprim nightly 7

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15
Q

Causes of haematuria

A 
Cancer
IgA nephropathy
UTI
nephritis 
BPH 
Renal calculi 
Patients on warfarin, LMWH
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16
Q

Causes of acute urinary retention

A

Infection, BPH, prolapses, general anaesthetic, spinal cord injury

17
Q

When should you catheterise

A

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

18
Q

What is chronic Urinary retention

A

More than 800ml full, painless

19
Q

What are most stones made of

A

Calcium oxalate

20
Q

What inhibitor in urine prevents stone formation

A

Citrate

21
Q

Describe stone treatments

A

Shock treatment, ureteroscopy (flexible tube inserted to remove small medium stones), nephrostomy (tube through skin for pyelonephritis and infected obstruction)

22
Q

Define AKI

A

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

23
Q

Causes of AKI

A

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

24
Q

What can you Agive to protect the heart in AKIs and why

A

Can cause acidosis which causes hyperkalemia which can cause arrhythmias so give calcium gluconate

25
Q

What investigations should you do in akis

A

All should have urinalysis
USS within twenty four hours unless pre renal cause
Biopsy if pre and post ruled out
Microscopy if infection

26
Q

Why does pregnancy increase risk of UTI

A

Baby presses on bladder so more reflux potential

Also hormones mean more relaxed vesicoureteric junction.

27
Q

What is the anion gap and what would a high anion gap indicate

A

Cations minus the anions

High anion gap indicates metabolic acidosis

28
Q

How does serum urea Change in volume depletion, upper GI bleeds and malnutrition?

A

Volume depletion increases because GFR reduced
Upper GI bleed increased because blood broken down
Malnutrition decreased because less to metabolise

29
Q

Define oligouria

A

Less than 500ml day
Less than 20ml hour

Happens in nephritis

30
Q

When are red cell casts found?

A

Glomerulonephritis

31
Q

Describe stages of diabetic nephropathy (and state of nephrotic or nephritic)

A

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

32
Q

What’s the management for diabetic nephropathy at different stages

A

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

Urinary (11 decks)

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