Renal Flashcards
Nephrotic syndrome
Proteinuria, hypoalbuminaemia, oedema
Nephritic syndrome sx
Haematuria
Hypertension
RBC casts
Function of juxtaglomerular cells
Detects changes in pressure
Function of macula densa
Detects changes in concentration
Cause of nephrotic syndrome
Podocyte damage and glomerulonephritis
Tx nephrotic syndrome
Furosemide and monitor salt/fluid intake
What is rhabdomyolysis?
Breaking down muscle tissue
Cause of rhabdomyolysis
Trauma
Sx rhabdomyolysis
Hyperkalaemia and red/brown urine
Treatment for rhabdomyolysis
Treat hyperkalaemia (insulin)
IV calcium gluconate
Osmotic diuretics
E.g.
Location
MOA
Mannitol
Glomerulus
Decrease H2O reabsorption
CA inhibitor diuretics
E.g.
Location
MOa
Acetazolamide
PCT
No breakdown of carbonic acid means no H+ to be exchanged for Na+ so no H2O reabsorbed
Loop diuretics
E.g.
Location
MOA
Furosemide
LOH
Inhibits Na+/K+/Cl- transporter
Thiazide diuretics
E.g.
Location
MOA
Hydrochlorothiazide
DCT
Block Na+/Cl- co-transporter
K+ sparing diuretics
E.g.
Location
MOA
Triamterene
CD
Aldosterone antagonist
Calcium gluconate MOA
Stabilises myocardium
How does insulin act on potassium?
Shifts from ECF to ICF
How does calcium resonium act on potassium
Removes potassium from body
At which level do the kidneys lie?
T12 to l3 (right is lower due to liver)
Are kidneys retroperitoneal or intraperitoneal
Retroperitoneal
Kidney layers deep to superficial
Renal capsule
Perirenal fat
Renal fascia
Pararenal fat
Posterior relations to kidneys (3 muscle)
Psoas major, quadrates lumborum and transverus abdominis
Blood supply to kidneys
Renal arteries (from abdominal aorta)
How does the renal artery divide once it reaches the kidney?
Renal artery - segmental artery - interlobular artery - arcuate arteries - afferent arterioles
Where do kidneys drain?
para-aortic
Pelvic kidney
In utero, kidneys ascend from pelvis - this may not happen and one may remain at the level of the common iliac artery
Horseshoe kidney
Two developing kidneys fuse together and become stuck under the inferior mesenteric artery
Which rib is the upper pole of both kidneys?
11th rib
Hilum of left kidney
L1
Hilum of right kidney
L1-2
Lower border of kidneys
L3
Level of adrenals
t12
What is an ectopic kidney?
Located below, above or on the opposite side of normal
E.g. osmotic diuretics
Mannitol
How do osmotic diuretics work?
They are not reabsorbed along the nephron - less water is reabsorbed and more is excreted
S/e osmotic diuretics
hyponatraemia and hypokalaemia
How do potassium sparing diuretics work?
Inhibit sodium reabsorption from DCT by antagonising aldosterone
e.g. potassium sparing diuretic
spironolactone
diuretic for heart failure
spironolactone
e.g. thiazide diuretics
hydrochlorothiazide
thiazide diuretics moa
act on DCT and CD and inhibit sodium/chloride co-transporter
loop diuretics e.g.
furosemide
loop diuretics moa
act on sodium/potassium/chloride channel on ascending LOH so no chloride reabsorbed
Most common type of renal stone
Calcium oxalate
Cystine renal stones
Inherited recessive disorder = abnormal reabsorption of cystine from intestine and renal tubes
Where is majority of glucose reabsorbed in nephron
PCT
What is Goodpasture’s disease?
Vasculitis associated with glomerulonephritis
Antibodies present in good pasture’s syndrome
Anti-GBM
HLA association good pasture’s
HLA DR2
Sx Goodpasture’s syndrome
Progressive glomerulonephritis - AKI
Nephritis ->proteinuria and haematuria
Type fo hypersensitivity goodpastures
II
Where does left testicular/gonadal vein drain?
Left renal vein
Where does right testicular/gonadal vein drain to
IVC
Most common cause of acute prostatitis
e coli
Sx prostatitis
Referred pain, fever, tender, enlarged prostate
Tx prostatitis
quinolone
What is rhabdomyolysis?
Breakdown of muscle
Causes of rhabdomyolysis
Trauma, EBV, alcohol, drugs
How to treat rhabdomyolysis
Fluids
Sx rhabdomyolysis
Red-brown urine, hyperkalaemia, renal failure
What is IgA nephropathy?
IgA immune complexes deposited in mesangium causes glomerular injury
Is IgA neuropathy nephritic or nephrotic
Nephritic
What kind of hypersensitivity is IgA nephropathy
3
Pathophys IgA nephropathy
Abnormal glycosylation of IgA means the compound is galactose deficient
Therefore not identified and broken down by body
Abnormal IgA accumulates
Body releases IgG to target
Immune complex forms in mesangium
Glomerular injury
sx iga nephropathy
Haematuria shortly after URTI in young male
Sx post-streptococcal glomerulonephritis
headache
haematuria and proteinuria
hypertension
What is post-streptococcal glomerulonephritis
1-2 weeks after strep progenies infection, infection spreads to glomerulus where it is deposited
Tx post-streptococcal glomerulonephritis
Self-limiting
Describe post-streptococcal gloemrulonephritis immunofluorescence appearance
Granular/starry sky
Which chemicals are deposited in the glomerulus in post-streptococcal glomerulonephritis?
IgM, IgG and C3
What is Henoch-Schonlein purport?
Small cell IgA mediated vasculitis
Tx Henoch-Schonlein purpura
Self limiting
Sx hence-schonlein purpura
Purpuric rash + oedema
Rash on buttocks and extensor surfaces
Abdo pain
Inheritance of Alport’s
X-linked dominant
What is Alpert’s syndrome
Defect in type 4 collagen forms abnormal GBM -> Goodpasture’s
Mx Alport’s
ACEi/ARB
Dx Alport’s
Splitting of lamina densa = basket weave appearance
Why do renal transplants fail?
Anti-GBM antibodies -> Goodpasture’s
Sx Alport’s syndrome
Haematuria
Renal failure
Sensorineural deafness
What is Goodpasture’ syndrome
Anti-GBM ABs against type 4 collagen
IgG in basement membrane
Hypersensitivity type Goodpasture’s
2
HLA-DR2 association
Tx Goodpasture’s
Steroids and cyclophosphamide
Sx Goodpasture’s syndrome
Glomerulonephritis and pulmonary haemorrhage
Where does adrenal artery come from
aorta
Contents of hilum from anterior to posterior
Renal vein
Renal artery
Ureter
When demyelinated, which nerves cause urinary retention?
Pelvic splanchnic
Parasympathetic innervation to bladder
pelvic splanchnic
risk factors for bladder cancer
smoking and 2-naphthylamine
most common type of bladder cancer
transitional cell carcinoma
sx bladder cancer
painless macroscopic haematuria
staging and diagnosing bladder cancer
TURBT and pelvic MRI
How does alcohol act as a diuretic?
Suppreses ADH from post pituitary
Sx hypocalcaemia
tetany (muscle spasm), paraesthesia, long QT, cataracts
trousseau’s sign: wrist flexion
Chvostek’s sign: tapping parotid makes face twitch
Hyperkalaemia causes
metabolic acidosis, AKI, K+ sparing diuretics, ACEi, heparin, Addison’s, rhabdomyolysis
causes of hypocalcaemia
vit D deficiency, CKD, hypoparathyroidism, rhabdomyolysis
management of hypocalcaemia
calcium gluconate
Mx hypocalcaemia
calcium gluconate
Eosinophilis granulomatosis with polyangiitis
Churg-Strauss
pANCA +ve
Severe asthma, eosinophilia
Tx = steroids
Granulomatosis with polyangiitis
Wegener’s disease
cANCA +ve
Saddle nose deformity
Tx = steroids
first line treatment for CKD
ACEi/ARB
Acute tubular necrosis
Necrosis of epithelial cells in tubules caused by toxins (ahminoglycosides, methotrexate etc)
Necrotic cells obstruct lumen
MUDDY BROWN CASTS
mussy brown casts
acute tubular necrosis
acute interstitial nephritis
inflammation of extra-glomerular tissue
causes of intra-renal AKI
acute tubular necrosis and acute interstitial nephritis
What is minimal change disease?
Most common cause of nephrotic syndrome in children, normally idiopathic
Pathophysiology minimal change disease
Podocytes lose negative charge
- Unable to repel ions
- Ions cross into urine = proteinuria
Sx minimal change disease
- Nephrotic syndrome
- Normotension
- Proteinuria
- Hypoalbuminaemia
- Oedema
Diagnosis minimal change
electron microscopy
Tx minimal change
oral corticosteroids
What is rapidly progressive glomerulonephritis/
destruction of glomeruli due to nephritis
tx rapidly progressive GN
steroids and cyclophosphamide
what is CKD?
kidney dysfunction >3 months characterised by abnormal creatinine and electrolyte levels
CKD stages
- CKD 1: eGFR >90
- CKD 2: eGFR 60-89
- CKD 3a: eGFR 45-59
- CKD 3b: eGFR 30-44
- CKD 4: eGFR 15-29
- CKD 5: eGFR <15 (kidney failure)
sx CKD
Normally asymptomatic - characterised by abnormal creatinine and electrolytes
Can have pruritus, lethargy, insomnia, HTN
what is hepatorenal syndrome?
AKI + liver failure
cardiorenal syndrome
congestive HF + renal failure
acute interstitial nephritis
‘allergic reaction’ - inflammation of extra-glomerular tissue
caused by ABx, NSAIDs, diuretics, PPIs, or infections
symptoms acute interstitial nephritis
pyuria (oesinophils), crystals
tx acute interstitial nephritis
discontinue drugs, add fluids
muddy brown casts
acute tubular necrosis
what is acute tubular necrosis
necrosis of epithelial cells in tubules
causes of acute tubular necrosis
ischaemia, toxins, haemoglobin, proteins (rhabdomyolysis)
tx acute tubular necrosis
no treatment - terminal
Nephritis 1-2d post URTI
IgA nephropathy
nephritis 1-2w post URTI
post-strep GN
why do you give steroids in IgA nephropathy?
if renal function starts declining, due to immune reaction - steroids will counteract this
cANCA +ve with saddle-nose deformity
Wegener’s
pANCA +ve granulomatosis
Churg-Strauss (eosinoPhilic)
Severe asthma + severe renal failure + high eosinophil count
churg - strauss (eosinophilic granulomatosis with polyangiitis)
antibodies against t4 collagen, destroys GBM
Goodpasture’s syndrome
mutated gene for t4 collagen
alport
most common cause of nephrotic syndrome in adults
membranous nephropathy
mx membranous nephropathy
ACEi/ARBs
most common cause of SIADH
small cell lung cancer
