Renal Flashcards
oedema, proteinuria, hypoalbuminaemia
nephrotic syndrome
haematuria, HTN, RBC casts, oliguria
nephritic syndrome
nephrotic and nephritic syndrome are both types of
glomerulonephritis
3 types of nephrotic syndrome
Minimal change disease (children)
Membranous glom
Focal segmental glom
Subtypes of nephritic syndrome
Post-strep (1-4 weeks post infection)
IgA nephropathy (1-2 days post infection)
Alport syndrome
Goodpastures (autoimmune)
ANCA +ve vasculitis (GPA/Wegner’s, MPA, EGPA/Churg strauss)
Features of Alport syndrome
Nephritic syndrome plus sensorineural hearing loss and ocular disturbances
What do ‘muddy casts’ suggest
acute tubular necrosis
Nephrotic syndrome is at risk of what
VTE
AKI diagnostic criteria
↑ creatinine > 26µmol/L in 48 hours
↑ creatinine > 50% in 7 days
↓ urine output < 0.5ml/kg/hr for more than 6 hours
When is asymptomatic bacteruria treated
pregnant
prior to urological procedures
infant
Canon ball mets suggests
Renal cell carcinoma
Urine ACR for CKD diagnosis- what levels = what action
<3- no action
3-70 repeat in 3m
>70 no need to repeat- refer to renal
CKD can be ruled out in bloods and urine ACR if
if the eGFR is persistently greater than 60 mL/min/1.73 m2,
and/or the urinary ACR is persistently less than 3 mg/mmol, and there are no other markers of kidney damage.
Diagnosis of CKD?
eGFR is less than 60 and/or proteinuria (urinary ACR is greater than 3 mg/mmol) lasting for at least three months.
All CKD patients should be offered
statin (20mg atorva)
aspirin
polycystic kidney disease inheritance
autosomal dominant
abrupt onset of haemoptysis, cough, shortness of breath, peripheral oedema, dark urine and oliguria
Goodpastures
antibodies in Goodpastures
Anti-GBM antibody
ANCA in 30%
What does renal biopsy show in goodpastures
Crescentic glomerulonephritis
Linear IgG staining on immunofluorescence
How to differentiate goodpastures vs wegners (GPA)
renal biopsy shows no immune complex deposition in wegners
Wegners ANCA positive
GPA (Wegners) investigations
ANCA positive
epithelial crescents in Bowman’s capsule on biopsy
May have cavitating lesions on CXR
Vasculitis with a prodromal asthma/allergic phase
Eosinophilic granulomatosis with polyangiitis (Churg Strauss)
‘spike and dome’ on renal biopsy
Membranous glomerulonephritis
All patients with membranous glomerulonephritis should recieve
ACE inhibitor or an angiotensin II receptor blocker
Membranous glomerulonpehritis prognosis
one-third: spontaneous remission
one-third: remain proteinuric
one-third: develop ESRF
ANCA positive vasculitis affecting many different systems eg cutaneous and neuro manifestations
Microscopic polyangiitis
present with oedema, proteinuria, hypoalbuminemia, and hyperlipidemia.
Minimal change
Mx post-streptococcal glomerulonephritis
generally supportive initially
visible haematuria following a recent URTI
IgA nephrop
HSP overlaps with what renal disease
IgA nephrop
Renal diet involves
Low protein
Low phosphate
Low sodium
Low potassium
First line mx of htn in renal disease
ACEi
you start an acei to treat hypertension in ckd, however the egfr drops, what is the action
a decrease in eGFR of up to 25% or a rise in creatinine of up to 30% is acceptable`
hyperacute rejection in renal transplant mx
no treatment available- remove graft
rising creatinine, pyuria and proteinuria a few months post renal transplant
acute graft failure, may be reversible with steroids and immune suppressants
CKD on haemodialysis most likely cause of death
IHD
haematuria, loin pain, abdominal mass
pyrexia of unknown origin
left varicocele
renal cell carcinoma
Most common cause of intrarenal aki
acute tubular necrosis
acute tubular necrosis what happens to urinary sodium
high as can’t conc the urine
