Renal Flashcards
What do patients present with in nephritic syndrome?
Haematuria with RBC casts Proteinuria Increased BP Oliguria Renal impairment
What is the commonest cause of glomerulonephritis?
IgA nephropathy
What is the typical presentation of someone with IgA nephropathy?
Young male present with haematuria with an or just following an URTI
- Increased IgA in infection causes IgA deposition in mesangial cells
Give some other causes of nephritis
SLE Anti-GBM disease/ Goodpastures Hennoch sconlein purpura Rapidly progressive GN Proliferative GN
What is the treatment for IgA nephropathy?
Steroids
ACEi - proteinuria
Can use cyclophosphamide in patients with rapidly deteriorating renal function
What symptoms do you get in nephritic syndrome?
P - proteinuria H - haematuria A - azotemia R - red cell casts O - Oliguria A - anti-streptolysin-O titres H - hypertension
What happens in post-streptococcal glomerulonephritis?
Gives an acute response of: - Haematuria - Oedema - Proteinuria - Hypertension Following pharyngitis or impetigo due to Group A Beta-haemolytic streptococci
What is the treatment for post-streptococcal glomerulonephritis?
Most episodes are subclinical and resolve on their own.
- Supportive treatment
- Control BP of admission is needed
- > 95% regain their renal function
What are the variables which are needed to calculate eGFR?
C - creatinine levels
A - age
G - gender
E - ethnicity
What are the points needed to diagnose AKI?
- loss of 25% of eGFR in 7 days
- increase in creatinine to 26mmol/L in 24 hrs
- urine output of less than 0.4ml/kg over 6 hours (8 hours in child)
What are the causes of AKI?
Pre-renal (40-70%) - renal hypoperfusion - renal artery stenosis - cirrhosis - nephrotoxic drugs Renal (10-50%) - ATN due to ischaemia or nephrotoxins - contrast materials Post-renal (10%) - obstruction
What is the management for AKI?
Stop nephrotoxic drugs Fluids Treat electrolyte imbalances RRT if needed - HDU or ITU If volume overloaded then give diuretics (loop diuretic)
What changes in nephrotic syndrome predispose to venous thromboembolism formation?
Loss of antithrombin III, protein C and protein S in the urine as well as a rise in fibrinogen levels
How is Alports syndrome inherited?
X-linked dominant
What does Alport’s syndrome cause?
Type IV collagen defect
What is the most common viral infection in a solid organ transplant?
Cytomegalovirus
What organism is the most likely cause of haemolytic uraemic syndrome?
E.coli
What is haemolytic uraemic syndrome?
Characterised by: - Haemolytic anaemia - AKI - Thrombocytopaenia Generally affects children and is preceded by bloody diarrhoea.
How do you treat haemolytic uraemic syndrome?
Supportive treatment
- Fluids
- Blood transfusions if needed
- Dialysis if needed
What are the features of Hennoch-Schonlein Purpura?
- palpable purpuric rash (with localized oedema) over buttocks and extensor surfaces of arms and legs
- abdominal pain
- polyarthritis
- features of IgA nephropathy may occur e.g. haematuria, renal failure
What are the features of Alport’s syndrome?
- microscopic haematuria
- progressive renal failure
- bilateral sensorineural deafness
- lenticonus: protrusion of the lens surface into the anterior chamber
- retinitis pigmentosa
- renal biopsy: splitting of lamina densa seen on electron microscopy
Why do you give calcium gluconate in hyperkalaemia?
Protects the myocardium
What do you give in hyperkalaemia in order to reduce potassium levels?
IV insulin and dextrose
When starting an ACEi, what level of a drop in eGFR and rise in serum creatinine is acceptable?
25% drop in eGFR
30% rise in creatinine
