Renal Flashcards
WHAT IS NEPHROTIC SYNDROME
PROTEINUREA
WHAT DOES THE PROTEINUREA CAUSE
LOW PLASMA ALBUMIN AND OEDEMA
WHAT ARE CAUSES OF NEPHROTIC SYNDROME
MINIMAL CHANGE DISEASE
POST STREP GLOMERULONEPHRITIS
SLE
HENLOCH SCHONLEN PURPURA
ALLERGENS IE BEE STINGS
WHAT IS THE PRESENTATION OF NEPHROTIC SYNDROME
OEDEMA (GENITAL, ANKLE AND PERIORBITAL)
ASCITES AND PLEURAL EFFUSION (CAUSING SOB)
HOW DO YOU DIAGNOSE NEPHROTIC SYNDROME
SCREEN FOR POSSIBLE CAUSES :
- THROAT SWAB
- BLOODS: ESR, FBC, U+E (LOW CREATININE AND ALBUMIN)
- HEPATITIS AND MALARIA SCREEN
URINE DIPSTICK
- PROETINUREA
WHAT IS THE MANAGEMENT OF NEPHROTIC SYNDROME
CORTICOSTEROIDS
- PREDNISOLONE, AND TITRATE DOWN
WHAT ARE COMPLICATIONS ASSOCIATED WITH NEPHROTIC SYNDROME
HYPOVOLUMEA CAUSING
- FAINTING
- ABDOMINAL PAIN
- HYPERCOAGUABLE STATE (THROMBOSIS)
LOW ALBUMIN CAUSING
- HYPERCHOLESTEROLAEMIA
INFECTIONS
- ESPECIALLY PNEUMOCOCCUS
HOW DO YOU MANAGE STEROID RESISTENT NEPHROTIC SYNDROME
REFER TO NEPHROLOGIST!!
MANAGEMENT IS WITH:
DIURETICS
SALT RESTRICTION
ACEi
NSAIDS
WHAT IS CONGENITAL NEPHROTIC SYNDROME
NEPHROTIC SYNDROME (PROETINUREA) CAUSED BY
- INHERITED CAUSE
- EN-UTERO INFECTION
IS A MORE SEVERE TYPE OF NEPHROTIC SYNDROME AND TENDS TO BE STEROID RESISTENT
AT WHAT AGE ARE PATIENTS USUALLY DIAGNOSED WITH CONGENITAL NEPHROTIC SYNDROME
2-5 MONTHS
HOW DOES CONGENITAL NEPHROTIC SYNDROME PRESENT (NOT AT BIRTH)
****THINK VERY YOUND SO PRESENTATION DIFFERES TO STANDARD NEPHROTIC SYNDROME BUT MECHANISM IS THE SAME ****
GENERALISED OEDEMA CAUSING
- WIDENED FONTANELLES AND SUTURES
WHAT ARE THE SIGNS AT BIRTH THAT THE CHILD MAY HAVE CONGENITAL NEPHROTIC SYNDROME
PREMATURE
LOW BIRTH WEIGHT
MECONIUM STAINED AMNIOTIC FLUID
LARGE PLACENTA
WHAT ARE COMPLICATIONS OF CONGENITAL NEPHROTIC SYNDROME
FREQUENT AND SEVERE INFECTIONS
- (DUE TO LOSS OF IG’S)
MALNUTRITION
FAILURE TO THRIVE
BLOOD CLOTS
HYPOTHYROIDISM
- (DUE TO LOSS OF THYROID BINDING PROTEINS)
LOW VIT D
CHRONIC KIDNEY INJURY AND FAILURE
HOW DO YOU MANAGE CONGENITAL NEPHROTIC SYNDROME
TRY STEROIDS –> USUALLY RESISTANT
****AIM TO MANAGE PROTEIN LOSS AND SWELLING****
ALBUMIN TRANSFUSIONS
DIURETICS
ACEi
NSAIDs (indomethacin)
VITAMINS
ANTICIAGULATNS
KIDNEY REMOVAL
IMMUNOSUPPRESSION PRIOR TO OPERATION AND ABX
WHAT IS MINIMAL CHANGE DISEASE
A CAUSE OF PROTEINUREA, WITH LITTLE TO NO CHANGES ON HISTOLOGY
WHAT IS THE PRESENTATION OF MINIMAL CHANGE DISEASE
CAUSES NEPHROTIC SYNDROME SO…
- OEDEMA + ASSOCIATED SYMPTOMS (IE SOB)
- WEIGHT GAIN (DUE TO INCREASE IN FLUIDS)
WHAT TESTS ARE REQUIRED IN ORDER TO DIAGNOSE MINIMAL CHANGE DISEASE
INVESTIGATE ALL POSSIBLE CAUSES OF NEPHROTIC SYNDROME
- THROAT SWAB
- BLOODS: ESR, FBC, U+E (LOW CREATININE AND ALBUMIN)
- HEPATITIS AND MALARIA SCREEN
- URINE DIPSTICK
- PROETINUREA
TRY CORTICOSTEROID TEST IF RESISTANT LOOK AT PERFORMING A RENAL BIOPSY
HOW WOULD YOU MANAGE MINIMAL CHANGE DISEASE
CORTICOSTEROIDS
IF UNDRESPONSIVE:
CYCLOSPORINS (these are immunosuppressants)
RUTIXIMAB (biologic)
WHAT IS HENLOCH SCHONLEN PURPURA
A VASCULITIS WITH A CHARACTERISTIC TRIAD OF
- MACULOPAPULAR PURPURIC RASH
- ARTHRALGIA
- ABDO PAIN
WHAT IS THE DRIVING PATHOLOGY OF HENLOCH SCHLONLEIN PURPURA
IGA VASCULITIS
WHAT IS THE PRESENTATION OF HENLOCH SCHLONLEIN PURPURA
CLASSIC TRIAD:
- MACULOPAPULAR PURPURIC RASH
- ARTHRALGIA
- knees, ankles and periarticular
1. ABDO PAIN
WHAT ARE RISK FACTORS OF HENLOCH SCHOLNEIN PURPURA
URTI
WINTER
MALE - 3 TO 10 YEARS OLD
WHAT IS THE APPEARENCE OF THE RASH IN HENLOCH SCHONLEIN PURPURA
SYMMETRICAL
ON EXTENSOR SURFACES
URTACARIAL
MACULOPAPULAR
PURPURIC
BLANCHING
WHAT ARE COMPLICATIONS OF HENLOCH SCHOLEIN PURPURA
INTRACUSSEPTION
CKD
HOW DO YOU MANAGE HENLOCH SCHONLEN PURPURA
CORTICOSTEROIDS
FOLLOW UP AFTER 1 YEAR TO CHECK RENAL FUNCTION
WHAT IS POST STREP GLOMERULONEPHRITIS?
AN INFLAMMATION OF THE GLOMERULUS AND NEPHRON AFTER A STREP INFECTION EITHER OF THROAT OR SKIN
WHAT CAN POST STREP GLOMEULONEPHRITIS LEAD TO (RENAL)
NEPHROTIC / NEPHRITIC SYNDROME AND ASSOCIATED SYMPTOMS
HOW DO YOU MANAGE POST - STREP GLOMERULONEPHRITIS
FLUID BALANCE AND ELECTROLYTE BALANCE
(POTENTIAL NEED FOR DIURETICS)
CORTICOSTEROIDS
WHAT IS THE DEFINITION IF NEPHRiTIC SYNDROME
PROTEINUREA AND HAEMATURIA
HOW DOES NEPHRiTIC SYNDROME PRESENT
BLURRED VISION
ANURIA/OLIGOUREA
DARK BLOODY URINE
OEDEMA
POTENTIAL HYPERTENSION
WHAT ARE THE CAUSES OF NEPHRITIC SYNDROME (MORE COMMON IN CHILDREN)
IGA NEUROPATHY
POST STREP GLOMERULONEPHRITIS
HAEMOLYTIC URAEMIC SYNDROME
HENLOCH SCHLONLEIN PURPURA
WHAT ARE THE CAUSES OF NEPHRITIC SYNDROME (MORE COMMON IN ADULTS)
GOODPASTEURES SYNDROME
SLE
INFECTIVE ENDOCARDITIS
HOW WOULD YOU DIAGNOSE NEPHRITIC SYNDROME
****CHECK FOR UNDERLYING CAUSES****
BLOODS: ESR, UREA(RAISED), CREATININE(RAISED), POTASSIUM(RAISED)
TRAOT SWAB
URINALYSIS: PROETINUREA AND HAEMATURA
HYPERTENSION
KIDNEY BIOSPY
HOW WOULD YOU MANAGE NEPHRITIC SYNDROME
UNDERLYING CAUSE
ANTIHYPERTENSIVES:
- ACEi (RAMAPRIL)
- CCB (AMILODAPINE)
- DIURETICS (INDAPEMIDE OR FRUSEMIDE)
NSAID
WHAT ARE CHILDHOOD CAUSES OF CKD
CONGENITAL AND HEREDITARY ARE THE MOST COMMON
- STRUCTURAL MALFORMATIONS
- GLOMERULONEPHROPATHIES
- HEREDITARY NEPHROPATHIES
WHEN IS CKD DETECTED?
WHAT ARE INVESTGATIONS USED TO DIAGNOSE CHILDHOOD CKD
USUALLY ON FETAL ULTRASOUND
BLOODS:
- U+E (RAISED CREAT KINASE)
- CALCULATE eGFR
URINALYSIS:
- (RAISED ALBUMIN, RAISED CREATININE, +/- HAEMATURIA)
US/CT/MRI
KIDNEY BIOPSY
WHAT IS THE PRESENTATION OF CKD IN CHILDHOOS
HYPERTENSION
BONY DEFORMITIES - RENAL RICKETS
ANOREXIA + FAILURE OT THRIVE
PROTEINUREA
NORMOCYTIC AND NORMOCHROMIC ANAEMIA
HOW DO YOU MANAGE CKD?
MANAGE HYPERTENSION
- ACEi, ARB, DIURETICS,
- CALCIUM CARBONATE TO REDUCE POTASSIUM
MANAGE GROWTH
- ENTERIC FEEDS/CALORIE SUPPLIEMENTS
- PROTEIN, CONTROL
- SALT SUPPLIMENTS, BICARBONATE SUPPLIMENTS
- FLUID BALANCE
- RECOMBINANAT HUMAN GROWTH HORMONE
WHAT IS THE DEFINITION OF AKI
ACUTE KIDNEY INJURY =
A SUDDEN AND POENTIALLY REVERSIBLE REDUCTION IN RENAL FUNCTION
WHAT IS THE PRESENTATION OF AKI
ANUREA
OLIGOUREA
WHAT SIGNS WOULD YOU FIND ON URINE TESTS IN AKI
RAISED CREATININE KINASE
RCC
HAEMATURIA
WHAT VALUES ARE CLASSED AS OLIGOUREA
<400ML X 24 HRS
WHAT VALUES ARE CLASSED AS ANUREA
<100ML X 24HR
WHERE ARE THE POSSIBLE LOCATIONS FOR CAUSES OF AKI
(WHAT ARE THE TYPES OF AKI)
PRE RENAL
RENAL
POST RENAL
WHAT ARE THE CAUSES OF PRE RENAL AKI
HYPOVOLUMEA (CIRCULATORY FAILURE)
WHAT ARE RENAL CAUSES OF AKI
VASCULAR
- THROMBOSIS
TUBULAR
- NECROSIS, ISCHEMIC EVEN, TOXIC IE DRUGS
GLOMERULONEPHRITESES
WHAT ARE CAUSES OF POST RENAL AKI
OBSTRUCTION
EITHER CONGENITAL OR ACCQUIRED
HOW WOULD YOU MANAGE PRE RENAL AKI?
FLUIDS (+ELECTROLYTES) AND CIRCULATORY SUPPORT
HOW WOULD YOU MANAGE RENAL AKI?
FLUID RESTRICTION
DIURETICS
SODIUM CONTROL
HIGH CALORIE NORMAL PROTEIN FEEDS
HOW WOULD YOU MANAGE POST RENAL AKI?
NEPHROSTOMY / BLADDER CATHETER
SURGERY TO REMOVE OBSTRUCTION
WHAT ARE THE INDECATIONS FOR DIALYSIS?
HYPERKALAEMIA
HYPERNATREMIA OR HYPONATREMIA
PULMONARY OEDEMA
PULMONARY HYPERTENSION
SEVERE ACIDOSIS
MULTISYSTEM FAILURE
WHAT IS THE PRESENTATION OF ACUTE ON CHRONIC AKI
GROETH FAILURE
ANAEMIA (NORMOCYTIC NORMOCHROMIC)
BONEY RICKETS
PLUS THEN
OLIGOURIA, ANURIA
WHAT IS ACUTE ON CHRONIC RENAL FAILURE
WHEN AN EXACCERBATION CAUSES A SUDDEN DECLINE IN eGFR IN A PATIENT WHO ALREADY HAS CHRONIC KIDNEY INJURY
WHAT CAN CAUSE ACUTEON CHRONIC AKI
DEHYDRATION
INFECTION
WHAT IS THE DEFINITION OF SLE
AN AUTOIMMUNE DISEASE AFFECTING MULTISYSTEMS THROUGH THE PRESENCE OF SERUM ANTIBODIES
WHAT ARE THE POTENTIAL CAUSES OF SLE
HLA B8 (HEREDITARY/GENETICS)
UV FLARES
EBV EXPOSURE (MOLECULAR MIMICARY)
WHO IS THE TYPICAL PATIENT WHO DEVELOPS SLE
FEMALE
20-40YEARS
WHAT IS THE PRESENTATION OF SLE
BUTTERFLY RASH
SMALL JOINT ARTHRALGIA
PHOTOSENSITIVITY
ALOPECIA
GLOMERULONEPHROPATHIES
RAYNAUDS SYNDROME
HOW DO YOU DIAGNOSE SLE
4/11 SYMPTOMS
NORMOCYTIC NORMOCHROMIC ANAEMIA
NORMAL CRP BUT HIGH ESR
HOW DO YOU MANAGE SLE
MILD
- NSAIDS
MODERATE
- CHLORIQUININE (ANTIMALARIA)
- CORTICOSTERIODS
SEVERE
- RUTXIMAB (IMMUNOSUPPRESSANT)
MAJOR ORGAN INVOLVEMENT
- TRANSPLANT
WHAT IS THE DEFINITION OF HAEMOLYTIC URAEMIC SYNDROME
A TRIAD OF SIGNS
- ACUTE RENAL FAILURE
- THROMBOCYTOPAENIA
- MICROANGIOPATHIC HAEMOLYTIC ANAEMIA
WHAT IS THE PRESENTATION OF HAEMOLYTIC URAEMIC SYNDROME
LOODY DIAHRROEA
PALE
FATIGUE
WHAT IS THE PATHOPHYSIOLOGY OF HAEMOLYTIC URAEMIC SYNDROME
POST INFECTIVE
TOXIN ENTERS GASTRIC MUCOSA: E COLI/SHIGELLA
TOXINS SETTLE IN RENAL EPITHELIAL CELLS
CAUSING INTRAVASCULAR THROMBOGENESIS
THIS USES UP PLATELETS CAUSING THROMBOCYTOPENIA
WHAT CAUSES HAEMOLYTIC URAEMIC SYNDROME
E COLI
SHIGELLA
TOSINS ENTER VIA GI TRACT
HOW DO YOU MANAGE HAEMOLYTIS URAEMIC SYNDROME
IV FLUIDS
ENTERIC FEEDING
DIALYSIS NEEDED IN 50%
WHAT IS PROGNOSIS OF HAEMOLYTIC URAEMIC SYNDROME
GOOD IF CAUGHT EARLY
NEPHROTIC SNDROME WITH HTN AND DECREASING RENAL FUNCTION MAY OCCUS IN FOLLOWING YEARS SO FOLLOW UP IS IMPORTANT
