Renal Disorders Flashcards
What are the standard definitions of AKI?
AKI Stage 1:
Increase ≥26 µmol/L; or by1.5-1.9x the reference sCr <0.5mL/kg/hr, 6-12hr
o AKI Stage 2:
Increase 2.0-2.9x the reference sCr <0.5mL/kg/hr, ≥12hr
o AKI Stage 3:
Increase ≥354 µmol/L; or by ≥3x the reference sCr <0.3mL/kg/hr, ≥24hr
Anuric for ≥12hr
Investigations for AKI?
Urine dip -> blood, protein, leucocytes, nitrates, glucose
o Renal USS (only if pyelonephritis or if no identifiable cause)
What is nephrotic syndrome?
Common causes?
low albumin, peripheral oedema, proteinuria
minimal change disease
what are some signs and symptoms of nephrotic syndrome?
1st = peri-orbital oedema (often misdiagnosed as allergy)
o 2nd = other delayed features of oedema (i.e. peripheral leg swelling), features of underlying diagnosis
investigations for nephrotic syndrome?
Urine dipstick testing, urea, U&Es, urine MC&S, urinary sodium
o FBC, ESR, creatinine, albumin
o Complement levels (C3, C4)
o Anti-streptolysin O or anti-DNase B titres (recent streptococcal throat infection)
o HBV, HCV, malaria screen
Management of nephrotic syndrome?
- oral prednisolone (4-6 weeks)
if steroid sensitive will return to normal - renal biopsy if steroids don’t work1
complications of nephrotic syndrome?
§ Risk of thrombosis loss of AT-III in the urine à hypercoagulable state
§ Risk of infection loss of immunoglobulin in urine à infection risk (esp. NHS bacteria)
§ Hypercholesterolaemia urinary albumin loss à less oncotic pressure à hepatic cholesterol synthesis
What is the common cause of renal failure?
Acute -
Haemolytic Uraemic Syndrome / HUS – low RBC, low platelets and AKI;
Acute tubular necrosis - usually after organ failure
Signs and symptoms of renal failure?
Oliguria or anuria Discoloured urine – brown
o Oedema – feet, legs, abdo, weight gain
Fatigue, lethargy, N&V
Investigations for renal failure?
Renal Ultrasound
CKD - small kidneys
AKI - large bright kidneys
Management for renal failure?
Pre-renal failure
- Fluid replacement /circulatory support is key
Intrinsic renal failure
- monitoring water and electrolyte balance
Post-renal failure
- Requires assessment of the site of obstruction (i.e. PUV, VUJ obstruction, etc.)
o Relief can be achieved by nephrostomy or bladder catheterisation
What is acute glomerulonephritis?
inflammation in the glomerulus and other kidney compartments, 1st or 2nd:
minimal change
diffuse (all glomeruli)
focal (some glomeruli)
segmental (parts)
Cause of acute glomerulonephritis?
Post-infectious (streptococcus in children) Vasculitis (SLE, ANCA +ve)
o IgA nephropathy (adults, but includes HSP in children) Mesangiocapillary glomerulonephritis
o Goodpasture’s
Signs and symptoms of acute glomerulonephritis?
Nephrotic syndrome – low albumin, oedema, proteinuria
o Nephritic syndrome – haematuria, HTN, proteinuria
o Decreased urine output and volume overload / oedema
o Hypertension and seizures
Management of acute glomberulonephritis?
minimal change - steroids
focal segmental - steroids, diiuretics, ace inhibitors, immunosuppresive drugs
membranous - supportive, acei and arbs.
correct water and electrolyte imbalances
BP management, dietary advice, lipid lowering therapy.
What is IgA vasculitis?
Henoch-Schönlein Purpura - palpable Purpura with joint and abdominal pain, loss of blood and protein in the urine
IgA and IgG complex and deposits in organs activitating complement
Signs and symptoms of IgA Vasculitis?
Purpuric Rash
Arthlagia
Abdominal Pain
Glomerulonephritis
Investigations of IgA Vasculitis?
FBC, clotting screen, urine dipstick, U+Es
Urinalysis: RBC, proteinuria, casts, urea, creatinine
Increased IgA, normal coagulation
Management of IgA vasculitis?
most cases resolve spontaneously within 4 weeks
NSAIDs
Oral prednisolone
IV corticosteroids
Renal transplant - end stage renal disease
What is nephroblastoma (Wilm’s tumour)
Most common intra-abdominal tumour of childhood (2nd most common cancer of childhood after ALL)
o <5yo (80%) – often 3yo
o 95% unilateral
o 1-2% familial /FHx
· Undifferentiated mesodermal tumour of intermediate cell mass
What are signs and symptoms of a Wilm’s tumour?
Asymptomatic abdominal mass (MOST COMMON)
- Painless haematuria
o Less common:
- Abdominal pain Anorexia
- Anaemia (haemorrhage into mass) Hypertension
Investigations of Wilm’s Tumour?
Ultrasound
CT/MRI
Stage 1-5:
1 = limited to kidney, completely excisable
2 = not limited to kidney, completely excisable
3 = not limited to kidney, not completely excisable
4 = spread beyond abdomen, haematogenous metastasis
5 = bilateral (each tumour graded separately)
Management of Wilm’s Tumour?
Nephrectomy + chemotherapy (± radiotherapy prior to surgery if advanced disease)
80% cure rate
