renal

Question 1

Glomerulonephritis- causes

Answer 1

hematuria, proteinuria, and azotemia.

many are progressive

can be primary or 2’ to infection

acute post-streptococcal glomerulonephritis (PSGN)- is quite common

can be both nephritic and nephrotic

nephritic examples- IgA(most common), henoch schonlein purpure, strep, rapidly progressive, antiGBM, polyarteritis nodosa.

Nephrotic examples- minimal change disease, focal segmental glomerulosclerosis, diabetic nephropathy,

Question 2

kidney transplantation

Answer 2

done in stage 5 ckd where egfr is lower than 15.

must match blood group

then must match 6 different antigens

listed as 0-0-0

up to 2-2-2

000 the best- means there is no mismatch on any of the 6.

still need immunosupression after operation
steroids

of steroid sparing regemes

which include tac, cyclosporine, mycophenolate, axathioprine etc.

highest at the start then can reduce.

Question 3

polycystic kidney disease

Answer 3

an genetic renal cystic disease- autosomal polycystic kidney disease is most common form

recessive is the less common other form.

presence of renal, extrarenal cysts, intracranial aneurysms, aortic root dilatation and aneurisms + mitral valve and abdo wall hernias

S+S: HTN, flank/abdo pain. renal colic, abdo mass + gross haematuria.

Ix: ask about fam history
Uss- under 40- 3 cysts. 40-60- 2 cysts, over 60-4 cysts.
contrast enhanced CT.

Rx: lifestyle
tolvaptan- disease modifying agent.

rigorous bp control.- ACEi or ANG-antag.

if end game- get a new kidney.

Question 4

discuss reflux nephropathy

Answer 4

otherwise termed chronic pyelonephritis.

often presents in early adulthood.

characterised by retrograde flow of urine from bladder into ureters- incompetent or mislocated ureterovesical valves.

the reflux can stunt the growth of kidneys,- leads to chronic nephritis, tubular atrophy, and renal scarring.

S+S: often picked up incidentally, e.g on preg screening. recurrent UTI, proteinurea, HTN.

Ix: metabolic panel, urine analysis, CBC, urine protein: creatinine ratio.

USS can be used, some nuclear scanning thing is gold standard- DMSA

Rx: may resolve over time, but need to maintain sterility of urine.

in chronic/ severe- surgical re-implantation of ureters into bladder.

aggressively manage hypertension.