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Z Year3 Conditions > RENAL 2 > Flashcards

RENAL 2 Flashcards

1
Q

Can IgA nephropathy cause proteinuria?

A

Sometimes can cause more proteinuria than haematuria but most likely more haematuria

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2
Q

What conditions cause a lot of haematuria and less proteinuria?

A
  1. Post-strep glomerularnephritis
  2. Small vessel vasculitis
  3. Anti-GBM disease
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3
Q

What are the symptoms of nephrotic syndrome?

A
  1. Proteinuria -PCR>300mg/L
  2. Hypoalbuminaemia (<30g/L)
  3. Oedema
  4. Intravascular volume depletion
  5. Hypercholesterolaemia
    (hyperlipidaemia)
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4
Q

What conditions have high proteinuria and no haematuria?

A
  1. Minimal change nephropathy
  2. FSGS
  3. Membranous nephropathy
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5
Q

What conditions have high proteinuria and low haematuria?

A
  1. amyloid

2. diabetic nephropathy

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6
Q

What condition has some haematuria and some proteinuria?

A

MCGN

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7
Q

What condition can cause a spectrum of low/high proteinuria and haematuria?

A

SLE

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8
Q

What are the urine casts like in nephrotic and nephritic syndrome?

A
  • Nephrotic: fatty casts

- Nephritic: RBC casts (cola/smoky urine)

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9
Q

What are the proteinuria like in nephrotic and nephritic syndrome?

A
  • Nephrotic: >3.5g/day

- Nephritic: <3.5g/day

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10
Q

What are the hematuria like in nephrotic and nephritic syndrome?

A
  • Nephrotic: +/-

- Nephritic: ++

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11
Q

What are the clinical features like in nephrotic and nephritic syndrome?

A
  • Nephrotic: generalised edema, periorbital edema HTN

- Nephritic: HTN

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12
Q

What does the glomerular damage in nephritic syndrome lead to?

A
  1. Haematuria
  2. HTN
  3. RBC casts in urine
  4. Proteinuria
  5. Oliguria
  6. Ureamia
  7. Oedema
  8. Sterile pyuria
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13
Q

What conditions can cause nephritic syndrome?

A
  1. post-strep glomerulophritis
  2. IgA nephropathy (Berger’s disease)
  3. Rapidly progressive glomerulonephritis
  4. Alport syndrome
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14
Q

What are the associations and findings of post-strep glomerulonephritis?

A
  1. Following group A β-haemolytic streptococci infections. WEEKS
  2. Children
    - POSITIVE ASO and ADB
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15
Q

What are the associations and findings of IgA nephropathy?

A
  1. 1-2 days post URTI. DAYS
  2. Henoch-Purpura
    - High IgA
    - Macroscopic haematuria
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16
Q

What are the associations and findings of rapidly progressive glomerulonephritis?

A
  1. Vasculitis (pNCA/cNCA)
  2. Lupus nephritis (dsDNA)
  3. Anti-GBM disease (Goodpastures) (Anti-GBM antibodies)
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17
Q

What is good pastures?

A
  • anti-glomerular basement membrane antibodies
  • attack type IV collagen
  • pulmonary haemorrhage in lung
  • genetic
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18
Q

What is Henich-purpa?

A

to affect older children and presents with abdo pain, arthritis and purpuric rash (non-blanching)

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19
Q

What are the 5 causes of nephrotic syndrome?

A
  1. Focal segmental glomerulosclerosis
  2. Minimal change disease
  3. Membranous nephropathy
  4. Amyloidosis
  5. Diabetic glomerulo-nephropathy
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20
Q

What is minimal change disease?

A

T cell / cytokine mediated damage to GBM + glomerular more permeable to albumin

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21
Q

Who is affected by minimal change disease?

A

child-progresses over a long time

2 weeks

22
Q

How is minimal change disease treated?

A

steroid responsive

23
Q

What is Focal segmental glomerulosclerosis?

A

HIV +ve associated / idiopathic

24
Q

What is membranous nephropathy?

A
  1. Commonest in adults
  2. Associated with malignancy
  3. PLAR2 antigen
25
Q

How do you diagnosis amyloidosis?

A

Rectal biopsy = congo staining = apple-green birefrigence

26
Q

What is diabetic nephropathy?

A

US KUD = large kidneys

27
Q

How do you treat diabetic nephropathy?

A

ACEi

28
Q

What is alport syndrome?

A
  1. genetic condition characterized by kidney disease
  2. sensorineural hearing loss and eye abnormalities
  3. Caused by an inherited defect in type IV collagen
29
Q

What sort of disease is polycystic kidney disease?

A

Autosomal recessive – PKD1 gene on chromosome 16

30
Q

Where are the cysts in PCKD?

A

Multiple cysts within the renal parenchyma

31
Q

What are the symptoms of PCKD?

A
  1. Abdominal or loin pain due to kidney hypertrophy
  2. Symptoms of chronic renal failure (fatigue, nausea/vomiting, oedema, pruritis) as kidney function fails overtime
  3. Heart murmur (mid systolic click = mitral prolapse)
32
Q

Whats important in FHx in PCKD?

A

Family member who has died from subarachnoid haemorrhage (caused by berry aneurysm)

33
Q

What are the investigations of PCKD?

A
  1. Blood pressure
  2. Urine dip
  3. U+Es: ↑creatinine, ↑ urea
  4. Abdo US – least invasive, can give good picture
  5. MRI – can use but more expensive and less readily available
  6. Biopsy
  7. ECG (mitral valve)
  8. CT Head (berry aneurysm)
34
Q

What is renal artery stenosis?

A

renal hypoperfusion

35
Q

What does renal hypoperfusion stimulate?

A
  • The renin-angiotensin system

- Increase angiotensin II prod so increased aldosterone so increase BP

36
Q

What can the high BP cause?

A

renal failure

37
Q

What is the most common cause of renal artery stenosis?

A
  1. atherosclerotic disease (makes up most cases and tends to occur in men over 50)
  2. fibromuscular dysplasia (this mainly occurs in women with hypertension <45 years old)
38
Q

What is the presentation of renal artery stenosis?

A

often asymptomatic

-May have symptoms of renal disease eg proteinauria, pulmonary oedema, abdominal bruits

39
Q

What are some tell-tale signs of renal artery stenosis?

A
  1. Hx of HTN
  2. Difficulty in controlling HTN
  3. Renal deterioration after starting ACEi / angiotensin II receptor antagonist
40
Q

What does vasoconstriction in the afferent and efferent arteriole usually do in the kidney?

A
  1. Afferent: decreases GFR

2. Efferent: increases GFR

41
Q

What does angtiontensin II do?

A

causes vasconstriction in efferent arteriole, increasing GFR

42
Q

What would ACEi do?

A

stop the vasoconstriction in the efferent arteriole, decreasing GFR

43
Q

What happens to the afferent arteriole in renal artery stenosis?

A

afferent pressure is reduced due to narrowed vessel (therefore decreased GFR)

44
Q

Why is the efferent arteriole important in renal artery stenosis?

A
  • 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
45
Q

So why is ACEi bad for people with renal artery stenosis?

A

ACEi interfere with autoregulation and cause a fall in glomerular perfusion leading to renal ischaemic nephropathy

46
Q

What are the investigations for renal artery stenosis?

A
  1. Bloods
  2. Duplex US
  3. Conventional angiography (Digital subtraction angiography gold-standard – most sensitive )
47
Q

What is measured in the bloods?

A

serum creatinine, potassium, urinalysis, aldosterone-to-renin ratio

48
Q

What does the duplex US measure?

A
  1. measures flow velocity through renal arteries to assess severity of stenosis 2. However not v sensitive only for lesions >50% reduction in vessel diameter
49
Q

Why is Gadolinium-enhanced MR Angiography not great?

A

not available to patients with pacemakers, metal implants + risk of contrast nephrotoxicity

50
Q

What is CT angiography not great?

A

intravenous contrast and so challenging in using in patients with high stage CKD as risk of contrast-induced nephropathy

Z Year3 Conditions (13 decks)

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