Renal Flashcards
Kidney Stone results from infection
Struvite
Nephrotic Syndrome Proteinuria requirement
over 3.5 grams in 24hrs
This creates the hypoalbumeia, hyperlipidemai
Diabetes
Minimal Change is little kids
HUS- what’s going on?
What to do?
Hemolytic Uremic Syndrome
Triad:
Hemolytic Anemia (RBC damage)
Acute Kidney Failure and
Low Platelets (thrombocytopenia)
Mostly children w/infectious diarrhea
EColi 0157:H7
Shigella
Campylobacter jejuni
Bacterial toxin binds glomerular epithelium, COMPLEMENT gets initiated and inflammation leads to epithelial cell damage and
ADAMTS13 being inhibited which causes TTP (Thrombotic Thrombocytopenic Purpura - VonWillibrand Factor goes nuts, platelets get clumpy and micro clots form everywhere). Circulating platelets drop to 60K as most of them get stuck in clots.
Clots get stuck in capillaries, damage RBCs as they pass causing hemolysis (look for schistocytes - RBC fragments)
Clots cause vital organ ischemia and the kidneys are first to suffer in HUS (since they were the site of first damage…)
Acute Renal Failure follows
10% chance of death but even survivors suffer
increased risk of CKD.
New drug for EColi Shiga-toxin caused HUS is a MAB (ECULIZAMAB) that attacks
the final protein released in complement. It shuts down the part of the cascade that actually pokes holes in the membranes of bacteria/invaders but in the case of HUS also pokes holes in the glomerular epithelium allowing blood and protein to pass through.
CIPRO may or may not work on the infectious organism but ECULIZAMAB should be started earlier rather than later, to preserve the glomerular endothelium- as soon as HUS is diagnosed.
The MAB is uber-expenisve and until 2014 was indicated for life, not sure how often the maintenance dose is but one dose costs over 6K. Patent was 3/2007 expires +/- 3/2017
But it may turn out you can discontinue the MAB once kidney function returns. Pts on the MAB early recover kidney function much better than those who take it late or not at all.
Painless Hematuria, Smoker
Bladder Cancer
Involves primarily the kidneys and the lungs.
Renal signs include hematuria, red blood cells casts, and proteinuria, acute renal failure
Coin lesions in the lungs and hemoptysis
Saddle Nose, Strawberry Gingivitis
ANCA Antibodies
Wegener’s Granulomatosis aka
Granulomatosis with polyangitis
THIS IS PAINFUL URINATION
Systemic Vasculitis caused by ANCA Antibodies attacking endothelium
Fatal sites are Glomerulus and Lung tissue
Saddle Nose d/t perforation of septum and nose collapse
Cola Colored Urine, Swollen Face & Hands, Oliguria and Hematuria…
Glomerulonephritis
There should be a history of strep somewhere in the last couple of weeks as this is most likely rheumatic fever.
Acute Tubular Necrosis caused by
Kidney Trauma
Nephrotoxins (gentamycin, chemo drugs)
“MUDDY BROWN CASTS” OF Acute Tubular Necrosis
Uremic Symptoms
N/V Malaise and Altered Mental Status
too many toxins in the blood!
Fatty Casts
Yellow
Maltese Cross sign under polarized light
Neprhotic Syndrome
Holes in the glomerular capsule so large that fats are getting through
Waxy Casts
The big ones, indicating enlarged collecting ducts
Caused by urine stasis of chronic kidney disease
Hyaline Casts
Most Common kind
Normal in dehydration and exercise
These are essential the BASE cast, from which all other kinds are made but alone, they are not a particularly bad sign.
RBC Casts
Glomerulonephritis
Something is poking holes in the glomerular capsule, Something BAD
Strep
Wegeners/ Poly Angitis
Goodpasture
Lupus
Goodpasture
Coughing up Blood first then Blood in the urine, swollen face/limbs, high BUN…
Anti-Glomerular Basement Antibodies (anti-GBM Ab) or ANTI-Neutrophilic Antibodies are attacking the Alveoli and the basement membrane in the glomerulus.
Differers from Wegeners in that Wegeners/Polyangitis is ANCA proteins attacking and has that saddle nose thing.
Plasmapheresis is the Rx
Strain out those antibodies and then suppress the immune system with chemo (Rituximab, Cyclophosphadine and Prednisone) and start over
Pre-Renal Azotemia cause
Intra-Renal
Post-Renal
Pre = Volume depletion, bleed/dehydrate
Intra= DAMAGE to nephrons or parenchyma
Aminoglycosides or CT Contrast Dye
Post= Blockage in ureter, bladder or urethra
causing backup
