Renal and urology Flashcards
Indications for acute renal failure
Severe ECF volume overload - severe HTN, pulmonary oedema
Severe hyperkaelmia
Severeve symptoms uremia - urea >40, hypothermia, seizures
Hypo and hyper natraemia
what is the eGFR for dialysis (and in diabetics)
<10
<15 if diabetic
Haemodialysis
Synthetic material to surround blood with an eelctroylte solution
Differing concentrations of solutes across the membrane facilitate movement from a high concentration (Blood) to a lower
Blood taken from fistula or central venous line
Peritoneal dialysis
Peritoneal vessels are source of blood and dialyste
ultrafiltration regualted by osmolality
can be done during day or over night
Complications of heamodialysis
Thrombus
air thrombus
hypotension
anaphylaxis
Complications of PD
infection
blockage of catheter
hyperglycaemia and weight gain
hernias
Pathology of HSP
Small vascular disease
Immunoglobulin A immune complex deposits in the mesangium
What infection is HSP most commonly preceded by
Haemolytic streptococci
Others - mycoplasma, EBV
Presentation of HSP
Kidneys - nephritis, microscopic haematuria
Skin - erythematous rash on back on legs, buttocks changes to purpuric lesions
Arthritis - transient, affects more joints
GI - abdominal pain
Management of HSP
Self-limiting
Refer to renal specialist for biopsy
Can use steroids +/- azathioprine or MMF
F/U with HSP
Dependent on abnormalities In urinanalysis
Absence of proteinuria - BP and urinanalysis at 7 days, 14 days and one three six and twelve months
Presence of proteinuria - 7 and 14 days, every month until 6 months and 12 months
what type of antibodies are in Goodpasture syndrome
antiglomerular basement membrane antibodies
screening for undescended testes
72 hours
6-8 weeks
4-5 months age
treatment of undescended testes
delay until at least 6 months
treatment should be performed max. 18 months
complications of undescended testes
bilateral more common of infertility problems
trauma
tumour
torsion
Atypical UTI
Not responded to ABX in 48 hours
Raised Cr
Sepsis
Non-ecoli
abdomen mass
Investigation if uti <6 months
Non-complicated - USS in 6 weeks
Atypical or recurrent - USS during infection, DMSA, MSUG
Investigations in UTI in 6months to 3 years
non-complicated - nil
atypical - USS during infection, DMSA 4-6 months after
recurrent - USS in 6 weeks, DMSA 4-6 months after
Investigations in UTI in 3 years <
Non-complicated - none
Atypical - USS during infection
Goodpastures syndrome triad
Glomerulonephritis
Pulmonary haemorrhage
Anti-GBM antibodies
What is SLE associated with
prolific formation of auto antibodies from immune complexes deposited within mesangium and sub endothelial
Most common cause of glomerulonephritis
Post-streptococcal
Acute nephritic syndrome
presents with haematuria
reduced renal function
oliguria
HTN
Nephrotic syndrome triad
Proteinuria
Oedema
Hypoalbumenia
Pathophysiology of nephrotic syndrome
Large molecules leaking across the glomerulus
What is the most commonest cause of nephrotic syndrome in children
Primary idiopathic ns
Minimal change disease - most likely steroid responsive
focal-segmental glomerulosclerosis - likely to be resistant to steroids
membranoproliferazive glomerulonephritis
What causes secondary NS
systemic disease - e.g. lupus
HSP
Signs and symptoms of secondary NS / atypical
> 10 years
Hypertensive
Family Hx
systemic features - rash
abnormal renal function
abnormal complement C3 or autoantibody
What is NS’s affect on thrombosis
Increases risk
Loss of antithrombin III
Treatment of nephrotic syndrome
Prednisolone 16 weeks
PPI
Penicillin proph.
fluid monitoring
pneumococcal vaccination
Where does Fanconi syndrome affect?
Proximal tubular defect
Medullary sponge kidney
Cysts 1-5mm in collecting system
Bilateral in 75% cases
often presents in adulthood
Not considered inherited disorder
Hypercalcemai MSK leads to stones
post-infection GN affect on complements
Low C3 and CH 50
Normal C4
Drop within 2 weeks
What is a DMSA scan best for?
it is a static radio-isotope taken up by proximal tubules
good for assessing scars
What is MCUG use for?
Assessing for reflux
What happens in proximal tubule
Glucose transport
Phosphate transport
Amino acid transport
What happens in ascending limb of Henley
Sodium, potassium and chloride transport
What happens in distal tubule?
Protein section, sodium chloride transport
What happens in collecting duct
Water transport
Sodium and potassium transport
What happens in primary vesicoureteric reflux
Short ureter to bladder
Fails to contract when bladder restricts
What happens in secondary VUR
Abnormally high intravescile pressure
Posterior urethral valves, neurogenic bladder (spina bifida), uterecele
What is the grading for VUR
I = urine tracts into non-dilated ureter
II = urine tracts into renal pelvis without any dilatation
III = mild to moderate dilatation to ureter only
IV = urethral touristy with pelvic dilatation
V = gross dilatation and urethral torisity with blunted fornices
When do you give prophylactic ABX?
I - I I = if recurrent UTIs or not toilet trained
III - V = all
What features might you see in antenatal scans for concerns regarding VUR
Hydronephrosis
Oligohydramnios
What symptoms seen in duplex kidney?
Continuous dribbling
What is affected in Bartter Syndrome
Disturbance in thick ascending limb of loop of Henle
What blood results do you see in Bartter syndrome?
Hypokalaemia, hypochloreamic, metabolic alkalosis with salt wasting
Hyperreineami aan hypaldosteronism
Hypercalcemia
Where is the defect in Gitelman Syndrome
Abnormality in distal consulted tubule
How is gitelman syndrome inherited
Autosomal recessive
What blood results in Gitelman syndrome
Hypokalaemia hypochloreamic metabolic alkalosis with salt wasting
Na not include - can be reabsorbed by paracellular route
How does furosemide work?
Prevents reabsorption of sodium potassium and chloride
How does bendroflumethazide work?
Affects sodium-chloride transporter in distal convuluted tubule
What is idiopathic hyper calciuria
high calcium in urine
normal calcium levels in blood
What is treatment of idiopathic hypercalciuria
thiazide diuretics - promotes calcium reabsorption
How is idiopathic hypercalciuria inherited
autosomal disorder
What would be the histological findings of minimal change disease
Loss/ fusion of podocyte foot processes and growth of vili on the visceral epithelial cells = allowing proteins to be loss = ON ELECTRON MICROSCOPY
NOTE IT IS NORMAL IN LIGHT MICROSCOPY
When would you do a kidney biopsy in nephrotic syndrome
Not responded to steroids in 6 weeks
Most common cause of nephrotic syndroome
minimal change disease
What is the histological finding of membranoproliferazive disease type 1
splitting of capillary basement membrane with deposits in intra-glomerular mesangium
What is the histological finding of membranous glomerulonephritis
deposition of electron-dense material on the capillary basement membrane
What are the two stages of descent of the testes
trans-abdominal phase
inguinoscrotal phase
What hormones are involved in trans-abdominal phase
insulin-like 3 protein and mulliarn inhibiting hormone
Thickening of gumernaculum (attached to caudal end of testis) - this is controlled by insulin-like 3 protein and considered most important stage
When would you transfer albumin in nephrotic syndrome
If symptomatic hypovolemaia or severe diuretic resistant oedema
e.g. CRT >2 secs
Signs of nephritic syndrome
HTN
Heamaturia
red cell casts in urine
proteinuria
Most common cause of nephritic syndrome
post-streptoccocol glomerulonephritis
