Renal Flashcards
Types of glomerulonephritis
Minimal change disease Focal segmental glomerulosclerosis Membranous GN IgA Nephropathy Goodpasture's syndrome Etc
What is nephritic syndrome?
Inflammation in the kidneys, causing haematuria, oliguria, proteinuria, fluid retention
Criteria for Nephrotic syndrome
- Peripheral oedema
- Proteinuria
- Low serum albumin
- Hypercholesterolaemia
What is the most common cause of Primary Glomerulonephritis?
IgA Nephropathy
What is the most common cause of Glomerulonephritis overall?
Membranous glomerulonephritis
At what age does Membranous glomerulonephritis peak?
Bimodal peak- 20s + 60s
What is found on histology in Membranous glomerulonephritis?
IgG and complement deposits in basement membrane
What is Polycystic Kidney Disease?
Genetic condition where kidneys develop multiple fluid-filled cysts
What is the inheritance pattern of Polycystic Kidney Disease?
There is an autosomal dominant and an autosomal recessive type
- AD more common
How is Polycystic Kidney Disease diagnosed?
Kidney USS
Genetics
Which chromosome is affected in Autosomal recessive Polycystic Kidney Disease?
Chromosome 6
Features of Autosomal recessive Polycystic Kidney Disease
Oligohydramnios in pregnancy –> underdevelopment of lungs –> respiratory depression shortly after birth
Dysmorphic features- low set ears, flat nasal bridge
End-stage renal failure before adulthood
Complications of Autosomal dominant Polycystic Kidney Disease
Chronic loin pain, hypertension, cardiovascular disease, gross haematuria, renal stones, end-stage renal failure
Features of Autosomal dominant Polycystic Kidney Disease
Extra-renal manifestations- cerebral aneurysms, prostatic/ovarian/splenic/pancreatic/hepatic cysts, cardiac valve disease (MR), colonic diverticula, aortic root dilatation
What is the mutated gene in Autosomal dominant Polycystic Kidney Disease?
PKD1/2
Management of Polycystic Kidney Disease
Tolvaptan- slow progression of cysts and disease
Genetic counselling
Avoid anti-inflammatories + anticoagulation, contact sports
Analgesia for renal colic
Antihypertensives
Dialysis/transplant
What regular monitoring is needed in Polycystic Kidney Disease?
USS, renal function, hypertension monitoring
MR angiogram- for intracranial aneurysms
General management of Glomerulonephritis
Immunosuppression
BP control- ACEi + ARB
Presentation of nephrotic syndrome
Oedema Frothy urine (proteinuria)
Complications of nephrotic syndrome
Thrombosis
Hypertension
Hyperlipidaemia
What is the most common cause of nephrotic syndrome in i) children and ii) adults?
Children- Minimal change disease
Adults- Focal segmental glomerulonephritis
What is the peak age for IgA nephropathy (Berger’s disease)?
20s
Histology findings in IgA nephropathy (Berger’s disease)
IgA deposits and glomerular mesangial proliferation
Causes of Membranous glomerulonephritis
Mostly idiopathic
Secondary to malignancy, rheumatoid disorders and drugs (NSAIDs)
What is post-streptococcal glomerulonephritis?
Presents 1-3 weeks after strep infection eg tonsilitis/impetigo
Nephritic syndrome
Aetiology of Goodpasture syndrome
Anti-glomerular basement membrane antibodies attack glomerular and pulmonary basement membrane
Features of Goodpasture syndrome
- Glomerulonephritis
2. Pulmonary haemorrhage (haemoptysis)
Causes of Chronic Kidney Disease
Diabetes, hypertension, age, glomerulonephritis, polycystic kidney disease, meds eg NSAIDs, PPIs, lithium
Risk factors for Chronic Kidney Disease
Diabetes, hypertension, age, glomerulonephritis, polycystic kidney disease, meds eg NSAIDs, PPIs, lithium
Smoking
Presentation of Chronic Kidney Disease
Usually asymptomatic
Pruritus, loss of appetite, nausea, oedema, muscle cramps, peripheral neuropathy, pallor, hypertension
How is Chronic Kidney Disease diagnosed?
eGFR- 2 tests 3 months apart
Investigations of Chronic Kidney Disease
Urinalysis- proteinuria (urine albumin:creatinine ratio >=3), haematuria
eGFR
Renal USS
Classification of Chronic Kidney Disease
By eGFR: 1) >90 2) 60-89 3) 30-59- mild-moderate 4) 15-29- severe 5) <15- kidney failure By albuminuria: 1) Albumin < 30 - A:Cr <3 2) Albumin 30-300 - A:Cr 3-30 3) Albumin < 300 - A:Cr >30
Management of Chronic Kidney Disease
Slow progression: - Control diabetes + HTN - Treat glomerulonephritis Reduce risk of complications: - Exercise, healthy diet, stop smoking - Reduce water intake - Atorvastatin Treat complications: - Metabolic acidosis- sodium bicarbonate - Anaemia- iron supplement + erythropoeitin - Renal bone disease- vitamin D - Dialysis in end-stage - Renal transplant
Indications for acute renal dialysis
AEIOU:
- Acidosis
- Electrolyte abnormality
- Intoxication
- Oedema
- Uraemia
What is Acute Kidney Injury?
Acute drop in kidney function
- Cr rise >= 25mmol/L in 48hrs
- Cr rise >50% in 7 days
- Urine output < 0.5ml/hr/kg for 6 hours
Risk factors for Acute Kidney Injury
CKD, heart failure, diabetes, liver disease, age > 65, cognitive impairment, nephrotoxic meds (NSAIDs, ACEi), contrast
Causes of Acute Kidney Injury
Pre-renal: dehydration, hypotension, heart failure
Renal: glomerulonephritis, interstitial nephritis, Acute tubular necrosis
Post-renal: kidney stones, masses in abdomen/pelvis, ureter/urethral strictures, enlarged prostate/prostate cancer
Investigations of Acute Kidney Injury
Urinalysis, USSKUB
Management of Acute Kidney Injury
IV Fluid rehydration
Stop nephrotoxic meds
Relieve obstruction eg catheter
Severe- dialysis
Complications of Acute Kidney Injury
Hyperkalaemia, fluid overload, metabolic acidosis
Uraemia –> encephalopathy/pericarditis
