Renal Diseases & Edema Flashcards by Tadah M

State 5 contents of the glomerular cell free ultrafiltrate

Glucose, phosphate, creatinine, urea, peptides and LMW proteins

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Factors affecting glomerular filtration x2

Size selective barrier of the GBM
Strong negative ionic charges

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Factors that modify filtration x3

Rate of flow of glomerular plasma volume
Hydrostatic pressure within Bowman’s space
Permeability of the glomerular capillary wall

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Define nephrotic syndrome x3

Proteinuria >3,5 g/24hrs
Hypoalbuminemia
Edema and hyperlipidemia

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Primary causes of nephrotic syndrome x5

C3 glomerulopathy
Membranous nephropathy
Minimal change disease
Focal segmental glomerulosclerosis
Membranoproliferative glomerulonephritis

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Secondary causes of nephrotic syndrome x5

Vasculitides - SLE
Malignancy
Infections- HIV, hepatitis
Heart failure
NSAIDs

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State 2 causes of hyperlipidemia in nephrotic syndrome

Hypoalbuminemia results in synthesis of proteins and lipoproteins
Decreases lipid catabolism due to reduced lipoprotein lipase

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Complications of nephrotic syndrome x6

Increase risk of infection
Hypercoagulable state
Vitamin D deficiency
Anemia
Chronic kidney disease
Protein malnutrition

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Differential diagnosis of edema x5

Protein loosing enteropathy
Hepatic failure
Heart failure
Protein malnutrition
Acute or chronic glomerulonephritis

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Clinical features of minimal change nephrotic syndrome MCNS x5

Periorbital edema that reduces throughout the day
Generalized edema
Anorexia, irritability, abdominal pain
Absence of hypertension and gross hematuria

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Features that make MCNS less likely x5

Gross hematuria
Hypertension
Renal sufficiency
Hypocomplementemia
Age <1 or >8

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Diagnosis of nephrotic syndrome x4

Proteinuria
Microscopic hematuria
Serum albumin < 2.5g/dL
Elevated levels of cholesterol and triglycerides

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Management of severe symptomatic edema x4

Sodium restriction
Fluid restriction if hyponatremic
Elevate swollen scrotum with pillows
Increase diuresis with loop diuretics

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Clinical manifestations of acute post-streptococcal glomerulonephritis x5

Proteinuria dark urine > edema and oliguria
Hypertension >encephalopathy or heart failure

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Complications of glomerulonephritis x5

Acute renal failure
Hypertension
Heart failure
Uremia
Hyperkalemia and hyperphosphatemia

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State the filtration apparatus of the kidney x3

Endothelium of glomerular capillaries
Glomerular basement membrane
Visceral layer of Bowmans capsule- contains podocytes

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Pathophysiology of minimal change disease

Infection or vaccination > T cell activation > release of glomerular permeability factor > damage of foot processes of podocytes > selective proteinuria

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Pathophysiology of focal segmental glomerulosclerosis x5

Injury to podocytes > effacement or thinning > collapsing of glomerular capillaries > deposition of lipids and proteins ie hyalinosis > scarring ie glomerulosclerosis

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Pathophysiology of membranous nephropathy

It is primary or secondary to SLE, drugs and hepatitis
There is activation of the complement system > immune complexes that build up in the subepithelium

Describe pathophysiology of edema in nephrotic syndrome in terms of RAAS

Decreased intravascular volume > reduced renal perfusion > activation of the RAA > increased secretion of vasopressin > stimulation of tubular reabsorption of sodium > edema

How to grade edema x4

Grade:
1. Depression of 2mm and rebounding immediately
2. 3-4mm and rebounding within 15 seconds
3. 5-6mm and rebounding within 60 seconds
4. 8mm and rebounding within 2-3 minutes

State 6 characteristics of nephritic syndrome

Hematuria
Oliguria
RBC casts in urine
Proteinuria < 3,5g/24 hours
Hypertension
Azotemia- urea and creatinine

Clinical presentation of hemolytic uremic syndrome HUS x6

Abdominal pain
Decreased urine output
Hematuria
Bruising
Lethargy confusion
Hypertension

Supportive management of HUS x3

Antihypertensive meds
Blood transfusion
Hemodialysis

Indications of dialysis x5

Acidosis, electrolyte imbalance, intoxication, oedema, uremia

State 2 types of peritoneal dialysis

Automated peritoneal dialysis Continuous ambulatory peritoneal dialysis

Complications of peritoneal dialysis x5

Abdominal pain Nausea and vomiting Peritonitis Fever Hernia

State 3 complications of hemodialysis

Infection Poor blood flow Blood clot formation

State 4 factors affecting development of edema

Hydrostatic pressure Oncotic pressure Lymphatic system Vascular permeability

State 3 ways of classifying edema

Pathophysiological mechanism- transudate and exudate Clinical findings- pitting and non pitting Location- generalized or localized

State 4 types of edema

Lymphadema - build up of lymphatic fluid Lipedema - accumulation of fat under the skin Angioedema - swelling under the skin caused by an allergic reaction Myxedema - sever hypothyroidism presenting with pretibial and periorbital swelling

4 disorders with increased lymphatic pressure/obstruction

Inflammation Neoplasms Congenital absence of lymphatic system Post surgical removal of LN

State 3 causes of increased hydrostatic pressure

Sodium retention due to venous insufficiency Increased venous pressure due to DVT or obstruction Arteriolar dilation > increased blood flow

Pathophysiology of hemolytic uremic syndrome x5

Infection > toxins damaging endothelial cells > secretion of cytokines > vasoconstriction and intravascular coagulopathy > thrombocytopenia

Describe how hemolysis occurs in HUS x3

Platelet microthrombi occludes small blood vessels > RBC hemolysis as they pass through > end organ ischemia

Describe pathophysiology of acute renal failure x8

Decreased blood supply to kidneys Decreased GFR Activation of RAAS Increased aldosterone release Increased reabsorption of Na and H2O Increased urine osmolarity Secretion of antidiuretic hormone Increased reabsorption of water and urea

State 5 effects of RAAS activation

Vasoconstriction Na reabsorption Aldosterone release Sympathetic outflow of CNS Vasopressin release by hypothalamus

Pathophysiology of immune hydrops x4

Fetal erythrocytes express protein not present on maternal erythrocytes Maternal immune system is sensitized and produce IgG antibodies Destruction of fetal erythrocytes > anemia >cardiac failure > edema

Pathophysiology of diabetic nephropathy

Hyperglycemia induces mesangial expansion - hypertrophy and proliferation Thickening of the GBM Intraglomerular HTN causes glomerular sclerosis

Define edema

Abnormal fluid accumulation in the interstitium due to an imbalance in fluid homeostasis

Disorders with normal serum albumin that cause edema x4

Increased capillary permeability Increased hydrostatic pressure Increased lymphatic pressure Increased venous pressure

Disorders with decreased serum albumin that cause edema x4

Nephrotic syndrome Glomerulonephritis Renal failure HUS

Pathophysiology of glomerulonephritis x4

Immunologic mechanism triggers inflammation and proliferation of glomerular tissue Damage to basement membrane, mesangium, capillary endothelium Loss of renally excreted RBCs and Glomerular filtrate Hematuria, oliguria, increased renin Edema and hypertension

Disorders that cause edema with decreased serum albumin but no proteinuria x3

Food protein allergies - celiac disease Protein losing enteropathy Liver disease

Non immune causes of hydrops fetalis x3 and pathophysiology

Maternal infection Fetal abnormalities Massive fetal maternal hemorrhage Severe fetal anemia > hypoxia > fetal edema

Describe how B12 deficiency causes megaloblastic anemia

There is no DNA synthesis hence cells divide but their nuclei remain immature