RENAL 2 Flashcards
Can IgA nephropathy cause proteinuria?
Sometimes can cause more proteinuria than haematuria but most likely more haematuria
What conditions cause a lot of haematuria and less proteinuria?
- Post-strep glomerularnephritis
- Small vessel vasculitis
- Anti-GBM disease
What are the symptoms of nephrotic syndrome?
- Proteinuria -PCR>300mg/L
- Hypoalbuminaemia (<30g/L)
- Oedema
- Intravascular volume depletion
- Hypercholesterolaemia
(hyperlipidaemia)
What conditions have high proteinuria and no haematuria?
- Minimal change nephropathy
- FSGS
- Membranous nephropathy
What conditions have high proteinuria and low haematuria?
- amyloid
2. diabetic nephropathy
What condition has some haematuria and some proteinuria?
MCGN
What condition can cause a spectrum of low/high proteinuria and haematuria?
SLE
What are the urine casts like in nephrotic and nephritic syndrome?
- Nephrotic: fatty casts
- Nephritic: RBC casts (cola/smoky urine)
What are the proteinuria like in nephrotic and nephritic syndrome?
- Nephrotic: >3.5g/day
- Nephritic: <3.5g/day
What are the hematuria like in nephrotic and nephritic syndrome?
- Nephrotic: +/-
- Nephritic: ++
What are the clinical features like in nephrotic and nephritic syndrome?
- Nephrotic: generalised edema, periorbital edema HTN
- Nephritic: HTN
What does the glomerular damage in nephritic syndrome lead to?
- Haematuria
- HTN
- RBC casts in urine
- Proteinuria
- Oliguria
- Ureamia
- Oedema
- Sterile pyuria
What conditions can cause nephritic syndrome?
- post-strep glomerulophritis
- IgA nephropathy (Berger’s disease)
- Rapidly progressive glomerulonephritis
- Alport syndrome
What are the associations and findings of post-strep glomerulonephritis?
- Following group A β-haemolytic streptococci infections. WEEKS
- Children
- POSITIVE ASO and ADB
What are the associations and findings of IgA nephropathy?
- 1-2 days post URTI. DAYS
- Henoch-Purpura
- High IgA
- Macroscopic haematuria
What are the associations and findings of rapidly progressive glomerulonephritis?
- Vasculitis (pNCA/cNCA)
- Lupus nephritis (dsDNA)
- Anti-GBM disease (Goodpastures) (Anti-GBM antibodies)
What is good pastures?
- anti-glomerular basement membrane antibodies
- attack type IV collagen
- pulmonary haemorrhage in lung
- genetic
What is Henich-purpa?
to affect older children and presents with abdo pain, arthritis and purpuric rash (non-blanching)
What are the 5 causes of nephrotic syndrome?
- Focal segmental glomerulosclerosis
- Minimal change disease
- Membranous nephropathy
- Amyloidosis
- Diabetic glomerulo-nephropathy
What is minimal change disease?
T cell / cytokine mediated damage to GBM + glomerular more permeable to albumin
Who is affected by minimal change disease?
child-progresses over a long time
2 weeks
How is minimal change disease treated?
steroid responsive
What is Focal segmental glomerulosclerosis?
HIV +ve associated / idiopathic
What is membranous nephropathy?
- Commonest in adults
- Associated with malignancy
- PLAR2 antigen
How do you diagnosis amyloidosis?
Rectal biopsy = congo staining = apple-green birefrigence
What is diabetic nephropathy?
US KUD = large kidneys
How do you treat diabetic nephropathy?
ACEi
What is alport syndrome?
- genetic condition characterized by kidney disease
- sensorineural hearing loss and eye abnormalities
- Caused by an inherited defect in type IV collagen
What sort of disease is polycystic kidney disease?
Autosomal recessive – PKD1 gene on chromosome 16
Where are the cysts in PCKD?
Multiple cysts within the renal parenchyma
What are the symptoms of PCKD?
- Abdominal or loin pain due to kidney hypertrophy
- Symptoms of chronic renal failure (fatigue, nausea/vomiting, oedema, pruritis) as kidney function fails overtime
- Heart murmur (mid systolic click = mitral prolapse)
Whats important in FHx in PCKD?
Family member who has died from subarachnoid haemorrhage (caused by berry aneurysm)
What are the investigations of PCKD?
- Blood pressure
- Urine dip
- U+Es: ↑creatinine, ↑ urea
- Abdo US – least invasive, can give good picture
- MRI – can use but more expensive and less readily available
- Biopsy
- ECG (mitral valve)
- CT Head (berry aneurysm)
What is renal artery stenosis?
renal hypoperfusion
What does renal hypoperfusion stimulate?
- The renin-angiotensin system
- Increase angiotensin II prod so increased aldosterone so increase BP
What can the high BP cause?
renal failure
What is the most common cause of renal artery stenosis?
- atherosclerotic disease (makes up most cases and tends to occur in men over 50)
- fibromuscular dysplasia (this mainly occurs in women with hypertension <45 years old)
What is the presentation of renal artery stenosis?
often asymptomatic
-May have symptoms of renal disease eg proteinauria, pulmonary oedema, abdominal bruits
What are some tell-tale signs of renal artery stenosis?
- Hx of HTN
- Difficulty in controlling HTN
- Renal deterioration after starting ACEi / angiotensin II receptor antagonist
What does vasoconstriction in the afferent and efferent arteriole usually do in the kidney?
- Afferent: decreases GFR
2. Efferent: increases GFR
What does angtiontensin II do?
causes vasconstriction in efferent arteriole, increasing GFR
What would ACEi do?
stop the vasoconstriction in the efferent arteriole, decreasing GFR
What happens to the afferent arteriole in renal artery stenosis?
afferent pressure is reduced due to narrowed vessel (therefore decreased GFR)
Why is the efferent arteriole important in renal artery stenosis?
- patients rely on efferent artery constriction to maintain normal glomerular pressures as afferent arteriole is narrowed vessel and so GFR is reduced
- all regulation for GFR is dependent on the efferent arteriole
So why is ACEi bad for people with renal artery stenosis?
ACEi interfere with autoregulation and cause a fall in glomerular perfusion leading to renal ischaemic nephropathy
What are the investigations for renal artery stenosis?
- Bloods
- Duplex US
- Conventional angiography (Digital subtraction angiography gold-standard – most sensitive )
What is measured in the bloods?
serum creatinine, potassium, urinalysis, aldosterone-to-renin ratio
What does the duplex US measure?
- measures flow velocity through renal arteries to assess severity of stenosis 2. However not v sensitive only for lesions >50% reduction in vessel diameter
Why is Gadolinium-enhanced MR Angiography not great?
not available to patients with pacemakers, metal implants + risk of contrast nephrotoxicity
What is CT angiography not great?
intravenous contrast and so challenging in using in patients with high stage CKD as risk of contrast-induced nephropathy
