Nephrotic and nephritic syndromes Flashcards
Describe the aetiology of nephrotic syndrome
Children:
-Minimal change disease (95%)
Adults:
Primary causes:
-FSGS
-Membranous nephropathy (most common)
Secondary causes:
- Diabetic nephropathy (common)
- Infectious diseases: HBV, HCV, HIV
- Inflammatory conditions eg vasculitis
- Multiple myeloma
- Amyloidosis
Define nephrotic syndrome
Characterised by:
1) Proteinuria (>3.5g/day)
2) Hypoalbuminaemia (<30g/L)
3) Oedema
Describe the presentation of nephrotic syndrome
May be non-specific
- Swelling: peripheral oedema, ascites
- Foamy urine
- Fatigue and malaise
Describe the investigations for nephrotic syndrome
- History and examination
- Urine: dip, ACR (^^), 24 hour collection (rarely done)
- Bloods: FBC, U+Es (^^), LFTs (albumin low), clotting, lipids (^^cholesterol), HbA1c, serology, antibodies, free light chains
- USS/other imaging
- Biopsy/ further ix
Describe the management of nephrotic syndrome
- Treat cause!! e.g steroids/immunosuppressants (almost always need steroids)
- ACEis/ARBs
- Sodium +fluid restriction, diuretics (may need IV)
- Statins
Describe the signs of nephrotic syndrome on examination
Peripheral oedema
Muehrcke’s lines (nail hypoalbuminaemia)
Xanthomas and xanthelasmata
Define nephritic syndrome
Characterised by:
1) Haematuria + mild/mod proteinuria
2) Hypertension
Describe the types of nephritic GN
Rapidly progressive GN:
1) anti-GBM disease (linear deposits)
2) Immune complex GN (granular deposits)
- Post-infectious GN
- IgA nephropathy
3) Pauci-immune- ANCA+ eg. GPA, MPA
Describe the presentation of IgA nephropathy
Presents during/shortly after acute illness eg. Strep tonsillitis
Haematuria- tea coloured urine
May have rash eg. petechiae
Describe the presentation of post-infectious GN
Presents weeks after acute illness eg strep tonsillitis
Haematuria
Fatigue
Describe the presentation of rapidly progressive GN
Haematuria
Proteinuria
Hypertension: headaches
AKI: decreased output, malaise, palpitations, swelling
Describe the investigations for nephritic syndrome
- History and examination
- Urine: dip, ACR/PCR, 24 hour collection (rare)
- Bloods: FBC, CRP/ESR, U+Es, LFTs, lipids, antibodies, serology
- USS
- CXR in RPGN (pulmonary haemorrhage), CTCAP for malignancy
- Renal biopsy
Describe the management of nephritic syndrome
Depends on cause
- Mild (IgA nephropathy, post-infectious): conservative
- Mod/severe: ACEis, steroids/immunosuppressants
- RPGN: admit, AKI management, steroids/immunosuppressants, consider plasmapharesis
What are the hallmarks of glomerular damage?
Proteinuria (specifically podocyte damage)
Haematuria w/ red cell casts
Describe the aetiology of PKD
Mostly autosomal dominant inherited condition
Describe the presentation of PKD
May be detected incidentally eg. USS in pregnancy Abdominal/flank pain Haematuria Abdo mass; early satiety etc Headaches Recurrent UTIs: common
Describe the investigations for PKD
- History and examination
- BP measurement
- Urinalysis, 24 hour biochemistry (if stones)
- Bloods: FBC, U+Es, lipids, HbA1c (RF management)
- USS!! -> CT/MRI
Extrarenal manifestations:
- ECG and echo
- CTH (aneurysms)
Describe the pathophysiology of PKD
Cysts forming in kidneys -> compression of normal tissues, fibrosis -> progressive renal impairment
+ cysts in liver, berry aneurysms
Describe the signs of PKD on examination
HTN
Hernias
Palpable abdominal mass/ballot-able kidneys
Hepatomegaly
Describe the management of PKD
Conservative:
- Lifestyle: renoprotective diet
- Avoid oestrogens (liver cysts)
Medical:
- Tolvaptan (slows cyst development)
- Hypertension Mx: ACEi/ARB 1st line
- Reduce CV RFs: statin, glycaemic control
- RRT
Surgical:
-Transplant
Describe the pathophysiology of renal artery stenosis
Narrowing of the renal arteries -> reduced renal blood flow
-> activation of the renin-angiotensin system
-> increase sodium + water resorption -> increase BP
+ remodelling of nephron
Describe the aetiology of renal artery stenosis
Atherosclerosis (90%): M >F, vasculopaths Fibromuscular dysplasia (10%): young F
Describe the presentation of renal artery stenosis
- Refractory hypertension
- Accelerated/malignant HTN
- Acute deterioration in renal function
- Flash pulmonary oedema
Describe the investigations for renal artery stenosis
- History and examination
- BP
- Urinalysis
- Bloods: FBC, U+Es, lipids, HbA1c (RF screen), aldosterone:renin ratio (normal/low)
- Duplex USS -> CTA/MRA
Screen for end-organ damage:
- ECG
- Fundoscopy
