Renal Disease

Question 1

What hormones do the kidney produce?

Answer 1

Erythropoeitin
Renin
Vitamin D

Question 2

What are the autocrine productions of the kidney?

Answer 2

Endothelin
Prostaglandins
RNP - Renal Natriuretic Peptide

Question 3

What is nephrotic syndrome?

Answer 3

Proteinurea ( > 3.5g/24h in adults)
Hypoalbuminaemia ( < 30g/L)
Oedema

+ Hypercholesterolaemia

Question 4

What are the most common types of nephrotic syndrome with ‘bland’ sediments?

Answer 4

Adults - Membranous Nephropathy and Focal Segmental Glomerulosclerosis

Children - Minimal Change Nephropathy

Other causes are drugs such as penicillamine, gold, NSAIDs

Question 5

What can cause secondary nephrotic syndrome with ‘bland’ sediments?

Answer 5

Amyloidosis

Diabetic Neuropathy

Question 6

What are the most common causes of nephrotic syndrome with ‘active’ sediments (mixed nephrotic and nephritic syndromes)?

Answer 6

Mesangiocapillary Golmerulonephritis (occurs with chronic infection)
Mesangial Proliferative Golmerulonephritis

Question 7

What can cause secondary nephrotic syndrome with ‘active’ sediments?

Answer 7

SLE

HSP

Question 8

What are the clinical features of nephrotic syndrome?

Answer 8

Oedema of ankles, genitals and abdominal wall
NORMAL JVP (unlike HF or RF)

Question 9

What is the general management of nephrotic syndrome?

Answer 9

Thiazide diuretic - reduces the oedema
ACE-I - reduces proteinurea
Treat underlying cause / withdraw offending drug
Offer pneumococcal and influenza vaccine

Question 10

What is the specific management of nephrotic syndrome?

Answer 10

Specific management is for those with moderate to severe disease

Cyclophosphamide with Prednisolone
Rituximab if resistant to this

Question 11

What investigations are indicated in glomerular disease?

Answer 11

eGFR, Urinary protein, serum urea, serum albumin, serum electrolytes

Urine microscopy
Culture (swab to check for recent strep infection)

Test for specific antibodies for underlying cause (anti-ANA, ANCA, GBM, Hep B, Hep C)

Question 12

What are some complications of nephrotic syndrome?

Answer 12

Venous thrombosis - due to loss of clotting factors in the urine
Sepsis - due to loss of Ig’s in the urine

Question 13

What is acute glomerulonephritis? (Nephritic Syndrome)

Answer 13

Often caused by an immune response triggered by an infection

Typically Group A beta-haemolytic streptococcus

Question 14

What defines acute glomerulonephritis? (Nephritic Syndrome)

Answer 14

Haematuria - typically seen on urine microscopy
Proteinurea (usually <2g in 24h)
Oedema
HTN, Oliguria

Question 15

What diseases are commonly associated with acute nephritic syndrome?

Answer 15

Post-strep
Infective endocarditis
SLE
HSP

Question 16

What investigations would you order for acute glomerulonephritis?

Answer 16

Same as nephrotic syndrome

Urine microscopy - will show red cell clasts

Question 17

How do you manage acute glomerulonephritis?

Answer 17

Post-strep is usually just supportive

HTN is with salt restriction, loop diuretics, vasodilators