Renal Flashcards by Claudia Zizzo

WHAT IS NEPHROTIC SYNDROME

PROTEINUREA

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WHAT DOES THE PROTEINUREA CAUSE

LOW PLASMA ALBUMIN AND OEDEMA

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WHAT ARE CAUSES OF NEPHROTIC SYNDROME

MINIMAL CHANGE DISEASE

POST STREP GLOMERULONEPHRITIS

SLE

HENLOCH SCHONLEN PURPURA

ALLERGENS IE BEE STINGS

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WHAT IS THE PRESENTATION OF NEPHROTIC SYNDROME

OEDEMA (GENITAL, ANKLE AND PERIORBITAL)

ASCITES AND PLEURAL EFFUSION (CAUSING SOB)

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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

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WHAT IS THE MANAGEMENT OF NEPHROTIC SYNDROME

CORTICOSTEROIDS

PREDNISOLONE, AND TITRATE DOWN

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WHAT ARE COMPLICATIONS ASSOCIATED WITH NEPHROTIC SYNDROME

HYPOVOLUMEA CAUSING

FAINTING
ABDOMINAL PAIN
HYPERCOAGUABLE STATE (THROMBOSIS)

LOW ALBUMIN CAUSING

HYPERCHOLESTEROLAEMIA

INFECTIONS

ESPECIALLY PNEUMOCOCCUS

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HOW DO YOU MANAGE STEROID RESISTENT NEPHROTIC SYNDROME

REFER TO NEPHROLOGIST!!

MANAGEMENT IS WITH:

DIURETICS

SALT RESTRICTION

ACEi

NSAIDS

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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

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AT WHAT AGE ARE PATIENTS USUALLY DIAGNOSED WITH CONGENITAL NEPHROTIC SYNDROME

2-5 MONTHS

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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

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WHAT ARE THE SIGNS AT BIRTH THAT THE CHILD MAY HAVE CONGENITAL NEPHROTIC SYNDROME

PREMATURE

LOW BIRTH WEIGHT

MECONIUM STAINED AMNIOTIC FLUID

LARGE PLACENTA

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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

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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

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WHAT IS MINIMAL CHANGE DISEASE

A CAUSE OF PROTEINUREA, WITH LITTLE TO NO CHANGES ON HISTOLOGY

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WHAT IS THE PRESENTATION OF MINIMAL CHANGE DISEASE

CAUSES NEPHROTIC SYNDROME SO…

OEDEMA + ASSOCIATED SYMPTOMS (IE SOB)
WEIGHT GAIN (DUE TO INCREASE IN FLUIDS)

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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

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HOW WOULD YOU MANAGE MINIMAL CHANGE DISEASE

CORTICOSTEROIDS

IF UNDRESPONSIVE:

CYCLOSPORINS (these are immunosuppressants)

RUTIXIMAB (biologic)

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WHAT IS HENLOCH SCHONLEN PURPURA

A VASCULITIS WITH A CHARACTERISTIC TRIAD OF

MACULOPAPULAR PURPURIC RASH
ARTHRALGIA
ABDO PAIN

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WHAT IS THE DRIVING PATHOLOGY OF HENLOCH SCHLONLEIN PURPURA

IGA VASCULITIS

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WHAT IS THE PRESENTATION OF HENLOCH SCHLONLEIN PURPURA

CLASSIC TRIAD:

MACULOPAPULAR PURPURIC RASH
ARTHRALGIA

knees, ankles and periarticular
1. ABDO PAIN

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WHAT ARE RISK FACTORS OF HENLOCH SCHOLNEIN PURPURA

URTI

WINTER

MALE - 3 TO 10 YEARS OLD

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WHAT IS THE APPEARENCE OF THE RASH IN HENLOCH SCHONLEIN PURPURA

SYMMETRICAL

ON EXTENSOR SURFACES

URTACARIAL

MACULOPAPULAR

PURPURIC

BLANCHING

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WHAT ARE COMPLICATIONS OF HENLOCH SCHOLEIN PURPURA

INTRACUSSEPTION

CKD

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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 1. ACUTE RENAL FAILURE 2. THROMBOCYTOPAENIA 3. 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