Renal Flashcards
Nephritic syndrome: Symptoms
Haematuria ⬇️UO Facial swelling/edema Milder proteinuria Mild HTN
Nephritic syndrome: Causes
Group A strep Bacterial (MRSA, pneumonia, IE) Viral (measles, mumps, hep) Toxo, malaria Good pasture, wegeners, SLE, HSP
Nephrotic vs Nephritic syndrome
Main difference is haematuria –> nephritic Proteinuria is milder in nephritic Albumin and lipid changes and nephrosis
Nephrotic syndrome: Symptoms/features
Proteinuria >3.5g/day Serum album
Nephrotic syndrome: Management
Low salt high protein Diuretics, ACE inhibitors Steroids Immunosuppressants if steroids don’t work
IgA nephropathy (Bergers disease): Symptoms
Gross haematuria +URTI/gastroenteritis
IgA nephropathy: Ix
Renal biopsy is gold standard Measure protein excretion, if too high ?myeloma Urine microscopy Renal function
Good pastures: Presentation
Massive pulmonary haemorrhage + acute glomerulnephritis
Investigation for renal colic
Non-contrast CT
Haemolytic Uraemic Syndrome: Typical/features
Acute renal failure+microangiopathic haemolytic anaemia + thrombocytopenia Usually post dysentery (typically E. coli) , if not cicoosporin, tumor, preg Needs FBC, U+E, stool culture Supportive management only
Alports syndrome
Haematuria + progressive CKD + sensorineural hearing loss + ocular abnormalities X links dominant HTN and supportive tx
Autosomal recessive poly cystic kidney disease
Rare Chr6 Pre/perinatal Bilateral masses, generally fibrosis
Renal cancer: Endocrine complications
Erythropoietin- polycythaemia Parathyroid - high Ca
PKD: Symptoms
Frequency Loin pain HTN Bilateral kidney enlargement UTI/pyelonephritis Gross haematuria following trauma Stones
PKD: Extra renal manifestations
Liver cysts Pancreatic cysts Aneurysms: cardiac, berry Cardiac eg mitral valve prolapse
PKD: Ix and target BP
USS is definitive scan Higher number of cysts needed for diagnosis as you get older due to naturally occurring cysts
Muddy brown casts on microscopy
Acute tubular necrosis
Post-streptococcal glomerulonephritis: Signs and symptoms
Post strep - sore throat, impetigo Haematuria, Oliguria, edema, HTN (ie Nephritic syndrome) + general malaise
Most common viral infection in organ transplant
CMV
Renal artery stenosis: Signs
HTN resistant to tx Worsening renal function in response to ACE Flash pulmonary edema Carotid/femoral bruit
Renal Artery Stenosis: Ix
USS - smaller kidney Doppler - poor blood flow CT/MRI Renal angio - gold standard but invasive
Renal tubular acidosis: Metabolic effect
Hyperchloraemic acidosis with normal anion gap
Diabetic nephropathy stages
1) GFR elevated 2) glomerular hyperfiltration 3) microalbuminaemia 4) nephropathy
Myeloma kidney
Antibodies and light chains accumulate and block tubules Causes acute tubular necrosis Tx - fluids and dialysis
AKI: Risk factors
Diabetes Sepsis CKD Heart failure PVD Drugs Dehydration
AKI: Pre renal causes
Renal hypoperfusion e,g from hypovolaemia, hypotension, sepsis, RAS
AKI: Intrinsic causes
Acute tubular necrosis Autoimmune e.g SLE, HSP Drugs Vasculitis
AKI: Post renal
Urinary tract obstruction
AKI: Management/Investigations
ABCDEU
ABG - degree of acidosis, K+
Bloods - FBC, U+Es, cultures
Catheter to assess fluid balance
Dietary protein restriction and Drug r/v
Electrolytes and ECG - hyperkalaemia
Ultrasound - obstruction, renal size
AKI: Referral criterial
Hyperkalaemia and oligoanuric/unresponsive to Tx Urea>40 or Uraemic Glomerulonephritis Systemic disease
AKI: Dialysis criteria
Persistent hyperkalaemia Refractory pulmonary edema Severe acidosis Drug OD Uraemic complications
eGFR >90%
Stage 1 CKD - eGFR fine but other abnormalities
eGFR 60-89
Stage 2 CKD: mild
eGFR 30-59
Stage 3 CKD: moderate
eGFR 15-29
Stage 4 CKD: severe
eGFR <15
Stage 5: end stage
