Renal disease Flashcards
What cells within the kidney are usually affected in haematuria vs proteinuria
Haematuria - endothelial cells
Proteinuria - podocytes
Go through the 7 questions you should ask a patient with haematuria, and what diagnoses a positive answer points you towards (from RCH clinical guidelines)
Fever - UTI/other infection (can get transient haematuria from increased cardiac output in infection)
Recent trauma? - injury
Rash/bruising? - HSP, ITP, coagulopathy
Oedema/HT? - glomerulonephritis
Loin pain/abdominal mass? - malignancy (Wilms’ tumor), calculi, hydronephrosis, polycystic kidneys
Bloody diarrhoea? - HUS
Macro or microscopic haematuria? - if micro, usually doesn’t need to be investigated (idiopathic)
What types of disease cause pain and haematuria?
Urological, not intrarenal disease.
In conditions causing proteinuria, what is the degree of proteinuria usually proportional to and why? What medications are most effective at treating this?
Degree of proteinuria proportional to degree of renal damage, because of the feedback cycle that occurs in these conditions. Proteinuria generally represents podocyte loss from diseased glomeruli. Fewer glomeruli = increased blood flow through remaining glomeruli = further strain on podocytes = more apoptosis = more proteinuria
ACEI/ARBs effective - they prevent the increased blood flow through remaining glomeruli = reduced podocyte apoptosis
Name 4 components of nephrotic syndrome. Name 4 complications of nephrotic syndrome
Oedema
Hypoalbuminaemia
Proteinuria
Hyperlipidaemia
Cx - infection (lose Abs especially to encapsulated organisms), thrombosis (intravascularly deplete), dehydration, effusions
What is the most common cause of nephrotic syndrome in kids? Treatment?
Minimal change disease - treat with steroids
Name 5 components of nephritic syndrome (not all have to be present though)
Haematuria Proteinuria Renal impairment Oliguria HT
What is the most common cause of nephritic syndrome in kids? How do you diagnose and treat? Name 3 Ddx
PSGN - usually 2-4 weeks after Strep throat/skin infection. Look for +ve Strep serology, low C3/C4 (uses up complement factors). Treat with frusemide
Ddx - SLE nephritis, IgA nephropathy, UTI
What causes haemolytic-uraemic syndrome? How does it present?
Caused by Shiga toxin (usually from E. coli in uncooked meat), causes blood clots, leading to anaemia and thrombocytopaenia (hence haemolytic). Blood clots prevent glomerular filtration = become oliguric, AKI
Name 3 most common reasons for CKD in a child
Glomerulonephritis
Kidney hypoplasia/dysplasia
Reflux nephropathy
Does urine output always correlate with GFR? Why/why not?
No - if the pathology is primarily tubular, then won’t be able to resorb any fluid, so even if GFR is low you can still be producing more fluid
Name 3 symptoms of malignant hypertension. Name 3 organs that can be damaged in HT. How should you treat?
Encephalopathic (confusion, headache, decreased GCS, vomiting, blurred vision)
CCF (SOB, palpitations, swelling)
Check eyes (retinopathy), kidneys (urinanalysis), heart (LVH) - think of DM
Treat by slow reduction in BP
