renal Flashcards
nephrotic syndrome presentation
protienuria - urinary protein creatinine ratio >200mg/mmol
hypoalbuminaemia - <25g/L
oedema (pitting) - periorbital, scrotal/vulua, legs and ankles
+/- hypercholesterolaemia
nephrotic syndrome 3 types
congential
steroid sensitive
steroid resistant
steroid sensitive nephrotic syndrome features
Normal BP No macroscopic haematuria Normal renal function No features to suggest nephritis Respond to steroids Histology – “minimal change” usually
steroid resistant nephrotic syndrome features
Elevated BP Haematuria May be impaired renal function Features may suggest nephritis Failure to respond to steroids Histology – various, underlying glomerulopathy, basement membrane abnormality
steroid sensitive nephrotic syndrome management
prednisolone
steroid resistant nephrotic syndrome management
ACE-i
diuretics for odema
congenital nephrotic syndrome managment
rare. hypoalbuminaemia causes mortality, need a nephrectomy
nephrotic syndrome remission criteria
3 days -ve dip stick test
acute kidney injury presentation
rise in creatinine >26umol/L within 48hrs or
rise in creatinine >1.5 x baseline with 7 days or
urine output <0.5ml/kg/h for >6 consecutive hrs
acute kidney injury causes
pre-renal (most common in children) - hypovalaemia e.g. haemorrhage, low CO e.g. MI, sepsis, D+V
renal - haemolytic uraemic syndrome, vasculitis, glomerulonephritis
post-renal - stones, malignancy
acute kidney injury investigations
raised - k, creatinine, urea
low - ca, na, cl
acute glomerulonephritis presentation
macroscopic haematuria
Proteinuria
Impaired GFR – rising creatinine, variable degree
Salt and water retention – hypertension, oedema
oliguria
acute glomerulonephritis cause
group a b haemolytic strep (strep.pyogenes)
acute glomerulonephritis investigations
FBC – mild normochromic, normocytic anaemia
U&Es – increased urea and creatinine, (hyperkalaemia, acidosis)
urinalysis - Haematuria (macroscopic), Proteinuria protein:creatinine
acute glomerulonephritis management
fluid balance - salt restriction, diuretics
penicilin 10 days
henoch-schonlein purpura cause
IgA mediated autoimmune hypersensitivity vasculitis
henoch-schonlein purpura presentation
purpura (purple spots dont disappear on palpation) arthritis (knees and ankle) abdominal pain renal involvement Follows URTI – Step Pyogenes
henoch-schonlein purpura investigations
raised IgA and ESR
proteinuria / haematuria
bacteriuria definition
bacteria in urine uncontaminated by urethral flora
UTI definition
upper
lower
symptomatic bacteriuria
pyelonephritis
cystitis
upper UTI symptoms - pyelonephritis
Fever, septicaemic illness (with meningitis in infancy)
General malaise, vomiting
Loin/abdominal pain – older child
Failure to thrive, jaundice - infancy
lower UTI symtoms - cystitis
Dysuria Urinary frequency/urgency Incontinence Lower abdominal pain Haematuria
UTI cause
e.coli
also klebsiella
atypical UTI definition
infection not by e.coli
UTI investigations (5)
urine clean catch dipstick - nitrates, WCC, leucocyte esterase
mc+s
micturating cystourethrogram scan - for vesicouteric reflux
dimercaptosuccinc acid scan - for renal scaring
US
UTI management
<3 months - IV amoxicillin and gentamicin
>3 months - trimethroprim / nitrofurantoin
haemolytic uraemic syndrome presentation
acute microangipathic haemolytic anaemia
thrombocytopenia
renal failure
typical (95%) - associated with diarrhoea (shiga toxin from e.coli)
atypical is not
chronic renal failure presentation
weakness
vomiting
headache
anaemia
chronic renal failure managment
calcium carbonate and activated vit D supplements - prevents renal osteodystrophy
recombinant EPO - for anaemia
adequate proteins and nutrition (NG tube)
