Renal Flashcards
Most common type of glomerulonephritis
Usually 20+60s peak
IgG + complement deposits on basement membrane
Membranous gN
diffuse proliferative GN
<30 usually
1-3 weeks after strep infection
Nephritic syndrome develops
Usually fully recover
which one
Post streptococcal GN
Most common cause of primary glomerulonephritis
GN following sore throat (1-2days following)
Peak 20
IgA deposits + glomerular mesangial proliferation
dx?
IgA nephropathy:
(Berger’s disease)
GN + Pulmonary haemorrhage
(Acute kidney failure + haemoptysis + proteinuria)
dx
Goodpastures
Anti-GBM antibodies attack glomerulus + pulmonary basement membranes
Nephrotic syndrome - most common in children vs adults
Most common cause is minimal change disease in children = steorids
Most common cause is focal segmental glomerulosclerosis in adults
Acute = Presents AKI + HTN
Hypersensitivity reaction to drugs (NSAID/ABx)/ infection usually
Might also have rash/ fever/ eosinophilia
Eosinophilic casts can be seen
diagnosis
interstitial nephritis
Most common cause of AKI
7-21 days recovery
Due to ischaemia/toxins
Muddy brown casts
Acute tubular necrosis
Screening for PCKD
US
Pt presents with anaemia, low platelet count, AKI 5 days after diarrhoea - dx and mx
Haemolytic Uraemic syndrome
Thrombosis in small blood vessels from shiga toxin (e.coli 0157 or shigella - Abx or anti-motility can increase risk HUS with these)
Medical emergency -Anti-HTN, blood transfusions, dialysis
Nephrotoxic drugs
NSAIDs, Anti-HTN (ACEi)
Treating complications in CKD
Sodium bicarb - met acidosis
Iron + erythropoietin
Vit D - bone disease
Transplant
Acute dialysis indications
AEIOU
Acidosis, Electrolyte abnormalities ( ↑K), Intoxication, Oedema (pulm), Uraemia symptoms (seizures)
Hyperacute rejection vs acute graft failure vs chronic graft failure
Hyperacute rejection (mins- hours) = due to pre-existing Abs against ABO or HLA antigens. T2 Hs. no tx possible - remove the graft
Acute graft failure <6m = usually asmyp with rising creatinine, pyuria and protienuria
Chronic graft failure >6m
Crush injury then…
Myoglobinuria - red-brown urine
U&Es = ↑ K (as phosphate released), AKI
↑ CK
SUspect in crush injury etc
dx, mx
rhabdomyolysis - skeletal muscle breakdown
IV Fluids, Na bicarb, poss mannitol…
Treat high potassium
Medications that can cause hyperkalaemia
Aldosterone antag, ACEi, ARBs, NSAIDs, K+ supp
Hyperkalaemia ECG signs
Tall tented T waves, flattening/absence P waves, Broad QRS Complexes
Tx hyperkalaemia
k</6 = diet + stop meds
K>/6 + ECG changes = urgent Tx
K>6.5 regardless ECG changes = urgent Tx
Insulin + dextrosie = drive carbs to cells to take K+ too
Calcium gluconate = stabilise cardiac membrane and ↓ arrhythmia risk
Also:
Neb salbutamol (temp drive K to cells)
IV F to increase urine output
PO Calcium resonium which works slow to drive K to stools
Sodium bicarb
Dialysis
Overdose - what type… and mx
Raised anion gap metabolic acidosis
N&V, tinnitus, headache. In more severe - hyperventilation and 2ry resp alkalosis which over 24hrs can progress to met acidosis and hypokalaemia.
Salicylate poisoning
IV sodium bicarb
Primary vs secondary aldosteronism
Primary and secondary aldosteronism can be differentiated by looking at renin levels. If renin is high then a secondary cause is more likely like renal artery stenosis.
Intermittent hypertensive episodes with paroxysmal palpitations, sweating, tremors or anxiety
likely diagnosis
Pheochromocytoma
