Nephrotic syndrome, hydronephrosis, nephropathies + HUS Flashcards
Describe IgA nephropathy
Occurs days after URTI or gastroenteritis Gross haematuria + RBC casts in urineNephritic syndrome
Describe post strep glomerulonephritis
Occurs weeks after strep infection (6 weeks after impetigo, 2 weeks after strep throat)
Type 3 hypersensitivity - IgG + IgM deposit in kidneys
Nephritic syndrome
Causes haematuria, HTN, oliguria, oedema
Describe Goodpasture’s syndrome
Anti GBM AbType 2 hypersensitivity reaction IgG ab - damage basement membrane Lung damage = cough, haemoptysisNephritic syndrome - haematuria, HTN, oedema Treat with steroids
Describe haemolytic uraemic syndrome
Blood clots in kidneys cause RBC break down + decrease in kidney function + nephritic syndrome Triggered by bloody diarrhoea Caused by E coli
Describe diabetic nephropathy
Causes damage to kidneys from glucose, microalbuminuria Causes nephrotic syndrome Treat with ACEi
What is nephrotic syndrome?
Disease causing inflammation to kidney that causes protein loss, low albumin in the blood + high cholesterol
Causes oedema, hypovolemia, AKI
Causes of nephrotic syndrome
Minimal change disease, diabetic nephropathy, amyloidosis, SLE
Management of nephrotic syndrome
ACEi or ARBs
Sodium restriction
Loop diuretics
Statins
Presentation of urinary tract obstruction
Pain, change in urine output, haematuria, increased serum creatinine
Distended abdomen, abdo mass
Assessment + management of urinary tract obstruction
US
CT if kidney stones suspected
Complications of urinary tract obstruction
Tubular atrophy
Renal injury
Genetics of polycystic disease
Autosomal dominant, defect on chromosome 16
S+S of polycystic disease
HTN hematuria Proteinuria Decreased kidney function Flank pain due to hemorrhage, calculi or UTIs are common May present with cysts in other organs
Diagnosis of polycystic disease
Usually due to routine bloods in positive family history
US, then MRI if needed for asymptomatic
CT/ MRI for symptomatic pts
Management of polycystic disease
ACEi or ARBs for HTN
Tolvaptan
Dialysis if needed
Causes of urethral strictures in men
Trauma
Infection
Catheterisation
S+S of urethral stricture
Chronic obstructive voiding symptoms: Decreased stream Incomplete bladder emptying Recurrent UTIs Urinary spraying Dysuria Ejaculatory dysfunction
Investigations for ?urethral stricture
Cystourethroscopy, retrograde urethrogram, voiding cystourethrogram or US urethrography
Management of urethral stricture
Abx prophylaxis prior to cystourethroscopy or surgery
What is vesicoureteral reflux?
Retrograde passage of urine from bladder to upper urinary tract
2 types of vesicoureteral reflux
Primary = due to incompetent or inadequate closure of ureterovesical junction Secondary = result of abnormally high voiding pressure in bladder
How does vesicoureteral reflux present?
Prenatally as antenatal hydronephrosis on prenatal US
Postnatally aft§er initial UTI
Imaging to diagnose vesicoureteral reflux
Contrast voiding cystourethrogram (VCUG)
DMSA renal scan
Management of vesicoureteral reflux
Abx prophylaxis
Surgery to correct anatomy
S+S of glomerulonephritis
Haematuria Proteinuria Renal insufficiency HTN Oedema Hypercoagulability
What are the causes/ pathology of proteinuria?
Glomerular disease - this is picked up as protein on a dipstick
Tubular proteinuria
Overflow proteinuria (ie multiple myeloma)
Postrenal (UTI)
What are the causes of proteinuria without nephrotic syndrome?
Orthostatic proteinuria
Transient proteinuria
Reflux nephropathy
Diabetic nephropathy
Evaluation of glomerulonephritis
Kidney biopsy
C3 + C4 complement levels
ANCA, ANA
Hep B + C serology
How can a diagnosis of thrombotic microangiopathy be made?
Microangiopathic hemolytic anemia
Thrombocytopenia
Kidney failure
What is of orthostatic proteinuria?
Elevated protein excretion while in upright position
Management of orthostatic proteinuria
Benign condition, doesn’t affect renal function so no intervention needed
