REnal Flashcards
What is Alport syndrome
A genetic defect in type IV collagen
synthesis. Mixed nephrotic and nephritic syndroms
what are the triad of synptoms in Alport syndrome?
Hereditary nephritis
Sensorineural hearing loss
Ocular abnormalities (cataracts, macular retinal flecks)
What is the renal abnormalities in Alport patients?
Proteinuria, haematuria, renal failure
What is thin basement membrname nephropathy?
a common cause of haematuria (asymptomatic)
good prognosis
what is IgA nephropathy?
the most common cause of glomerulonaphritis. and a cause of asymptomatic haematuria.
What is Wolfram syndrome?
a rare genetic disease that causes diabetes insipidus, diabetes
mellitus, optic atrophy and deafness
Do those with Downs have renal abnormalities?
The kidney tends to be spared in such patients
what type of cell lines the kidney to the urethra?
transitional cell epithelium
What are the risk facors of bladder cancer?
smoking
chemical dyes
aromatic amines
What is acute tubulointerstitial nephritis?
a drug hypersensitivity reaction most commonly to penicillin or NSAIDs
Fever, rash and painful joints.
Blood will have eosinophils (which in allergic responses such as asthma and drugs, and parastic infections)
What are the clinical features of Schistosomiasis?
can cause bladder cancer through chronic inflammation,
other symptoms include a local dermatitis at the area of penetration
while more systemic features include fevers, muscle pain and allergic rashes
What is acute tubular necrosis?
Commonly due to renal ischaemia
pharmacological toxicity (diuretics (volume depletion), redio-contrast dye)
What are the signs of acute tubular necrosis?
early oliguria followed by recovery of renal function with an increase in renal
output. GFR, however, may remain low due to tubular damage. Full renal
capacity is usually regained within 6 weeks of the initial stressor.
What is Haemolytic uraemic syndrome (HUS)?
AKI from RBC fragmentation due to thrombosis in the kidneys.
What are the triad of HUS?
heamolytic anaemia
thrombocytopeania
AKI
What is the cause of HUS?
E. coli bacterium, or shigalla.
The shiga toxin
Does SIADH cause hypokalaemia?
Nope
What does wegener’s granulomatosis do to the kidenys?
Antineutrophil cytoplasmic antibodies
(ANCAs) attack small to medium-sized blood vessels resulting in necrotizing
granulomatous inflammation.
REnal failure, patients can be asymptomatic to presenting with
renal failure on presentation
What is the histological finding of Wegener’s granulomatosis?
crescentic
necrotizing glomerulonephritis with the presence of RBC casts
What are the systemic features of minimal change nephropathy?
There is a high association with asthma and eczema
What is rapidly progressice glomerulonephritis?
Patients rapidly develop renal failure over
weeks and may have glomerular crescents on histology.
What are they types of rapidly progressive GN?
ANCA-associated glomerulonephritis, including Wegener’s granulomatosis,
Anti GBM antibody, Goodpasture’s disease
What is Goodpasture’s disease?
Goodpasture’s
disease (B) is due to a type 2 autoimmune reaction with antibodies attacking
the glomerular basement membrane and lung membrane. Patients often
present with upper respiratory tract complaints such as haemoptysis with renal
manifestations, such as anaemia and glomerulonephritis, occuring later.
Whats is posr streptococcal GN?
usually associated with haematuria and hypertension
following a streptococcal infection which leads to an acute nephritis due to
deposition of immune complex
what is the investigation for detecting diabetic nephropathy?
microalbumin in the urine
Is serum creatinine an early or late marker of renal function?
Elevation in serum creatinine (C), which is usually excreted by the kidney, is a late marker of function renal impairment and not appropriate for early risk identification
What do you find on electron microscopy in minimal change disease?
fusion of the podocyte foot process.
Pododcyte effacement
Other than nephrotic syndrome what can minimal change disease present with?
eczema and asthema
What can sustained hyperphosphataemia cause in the vascular structure?
Vascular calcification
how do you treat hyperphosphataemia?
phosphate binders–> sevelamer
it bind to phosphates in the Gut and lowers the serum phosphaste level
it also lowers calcium and cholesterol
Why do we give phosphates bilders before Vitamin D in those with 2nd hyperparathyroidism?
Vitamine D increases calcium and phosphate reabsorption and so can
inadvertently exacerbate the patient’s symptoms.
Can you get parechymal gas accumulation in pyelonephritis?
Parenchymal infection
results in gas accumulation which is identifiable on CT scan
Does renal stone cause renal infections?
they are rarely
coincident with renal infection as suggested by the urine dipstick
But the obstruction can lead to infections
what is Kimmelstiel-Wilson lesion associated ith?
Diabetic nephropathy; glomerulosclerosis
What is a red cell cast
RBC that have gotten into the renal tubules. It is a strong indication of glomerular pathology
Explain the pathophysiology of diabetic nephropathy
an initial increase in glomerular filtration rate and glomerular basement membrane
hypertrophy.
As the disease progresses, glomerulosclerosis occurs as a result of accumulation of extracellular matrix and destroying the filtering ability of the glomerular membrane. This allows protein leakage.
clinial test results of renal failure?
oliguric
raised urea and creatinine
UTI clinical test result?
dysuria
rised WBC
leucocytes and nitrites (bacterias convert nitrates to nitrites)
Triad of nephrotic syndrome?
Proteinuria (>3g/24hrs)
hypoalbuminaemia (<25g/L)
hyperlipidaemia
1st line treatment of nephrotic syndrome?
fluid restrict
sodium restriction
diuretic (furosemide)
How does ACE-I protect against protinuria?
It reduces filtration pressure on the glomerular capillaries.
The disadvantage of US KUB
KUB US scan is poor at differentiating different
stones and can often miss smaller stones.
Symptons of tuberculosis on the kidneys?
Insidious symptoms.
Pain in the back, flank and suprpubic region
Haematuria, frequency and noicturia
Most patients with renal TB have sterile pyuria, which can be accompanied by microscopic hematuria.
What is the classic presentation og bladder cancer?
Painless haematuria
The triad of renal cell carcinoma?
haematuria,
flank pain
flank/abdo mass
weight loss, fever, malaise
Anaemia from impaired erythropoiesis (SOB, pallor)
what is post streptococcal GN
part of the nephritic syndrome
Patients usually suffer from a streptococcal infection 1–3 weeks prior to presenting with the symptoms or signs of the nephritic syndrome. During this time, immune
complexes are formed and deposited in the glomeruli causing damage.
Symptoms of hypercalaemia
abdo pain
depression
constipation
Presentation of polycyctic kidney disease
loin or abdo pain
symptoms of renal failure
What are vascular findings of PKD?
mitral valve prolapse
berry aneurysms
what is a medullary sponge kidney?
a congenital disorder of the kidneys that
is characterized by the formation of cystic sacs within the papillary zone
of the kidney creating a sponge-like appearance.
what does a medullaty sponge kidney predispose you to?
The cysts create an
obstruction that prevents the optimal flow of urine through the renal
tubules, predisposing to UTIs, haematuria and renal calculi.
hemihypertrophy, hypercalciuria and renal tubular acidosis
what do hotse shoes kidney cause?
UTI, renal stones
What is analgesic nephropathy?
From chronic NSAIDs consumption
Papillary necrosis and tubulointerstitial nephritis. Anaemia, UTI and haematuria
Acute hyperuricaemice nephropathy
A result of hyperuricaemia, common in patients with increased cell turnover, such as those with myeloproliferative disorders after chemo.
Uric acid crystallizes within in the renal system causing obstructions–> flank pain, oliguria, hypertension and oedema.
symptoms of hypoglycaemia?
sweating, tachycardia, palpitations and tremor.
Triads of goodpasture’s disease?
glomerulonephritis, pulmonary haemorrhage and anti-GBM
a type 2 autoimmune reaction, attach on type 4 collagen of the lungd and glomerulus.
