Presentation of Kidney Disease Overview: Nephrotic Vs Nephritic Syndrome

Question 1

Which common antibiotics can affect the kidneys?

Answer 1

Gentamicin (nephrotoxic)

Trimethoprim (creatinine rise non-damaging)

Penicillins (allergic reactions)

Question 2

Which two investigations are extremely useful in those with kidney presentations?

Answer 2

1. Blood pressure
2. Urinalysis

Question 3

In terms of blood pressure, kidney disease is associated with ____________

Answer 3

In terms of blood pressure, kidney disease is associated with hypertension

Question 4

If a patient is acutely unwell and stop passing urine, their blood pressure is likely ________

Answer 4

If a patient is acutely unwell and stop passing urine, their blood pressure is likely low

Question 5

What can splinter haemorrhages be associated with?

Answer 5

Bacterial endocarditis

Vasculitis

(affects kidneys)

Question 6

How does leukonychia appear?

Answer 6

A white band across the nails created in acute disease

Question 7

What is the gold standard for quantifying urine protein concentration?

Answer 7

24 hour urine collection

(generally ACR is used instead for convenience)

Question 8

What is the normal result for 24 hour urine collection for protein content?

Answer 8

<150mg/25hr

Question 9

Which other test can quantify unrine protein content?

Answer 9

Albumin/creatinine ratio (ACR)

Normal - 50mg/mmol (0.5g/24hours)

Question 10

What are the different classification cut-offs for urine/creatinine ratio?

Answer 10

1. Asymptomatic low grade (< 1g/day)
2. Heavy proteinuria (1-3/day)
3. Nephrotic range (>3g/day)

Question 11

What is acute kidney injury?

Answer 11

Decline in GFR over < 90 days

It may be with or without oliguria (<400ml urine output/day) in a patient with normal or impaired baseline renal function

Question 12

What is nephrotic syndrome?

Answer 12

A triad of symptoms due to glomerular disease

1. Proteinuria > 3g/day
2. Hypoalbuminaemia
3. Oedema

Hypercholesterolaemia (hyperlipidaemia) and lipiduria may also be present

Classically they have normal renal function

Question 13

Nephrotic syndrome involves ________ of tissues

Answer 13

Nephrotic syndrome involves swelling of tissues

Question 14

For which reason does nephrotic syndrome involve swelling of tissues?

Answer 14

Glomeruli are damaged and allow passge of proteins (including albumin) through

This leads to hypoalbuminaemia and proteinuria

In the blood there is a loss of oncotic pressure and blood flows by osmosis into the tissues

Question 15

How does the urine appear visually in nephrotic syndrome?

Answer 15

Frothy

Question 16

Why does periorbital swelling occur in nephrotic syndrome and not heart failure?

Answer 16

Patients with heart failure cannot lie flat (due to breathlessness)

Question 17

What is nephritic syndrome?

Answer 17

Inflammation of the kidneys (nephritis)

Question 18

What are the hallmarks of nephritic syndrome?

Answer 18

Haematuria and red cell casts (shows glomerular damage)

Proteinuria (much less than nephrotic syndrome)

Mild hypertension

Low urine volume (<300ml/day)