Renal Failure Causes + Nephritic/Nephrotic Syndrome Flashcards
Triad for nephritic syndrome?
Haematuria (micro or macroscopic)
Hypertension
Reduced glomerular filtration rate (e.g. reduced urine output)
Investigations for cause of nephritic syndrome?
Bloods (FBC/CRP/ESR) Electrophoresis (serum/urine) Renal screen including complement Antibody tests (ANA, ANCA, AGBMA) Anti-streptolysin-O titre Hepatitis serology Urine tests - 24 hr protein quantification (check for nephrotic syndrome) + microscopy (check for casts)
Why do bloods for CRP/ESR in nephritic syndrome?
To check for inflammatory cause
Why do electrophoresis on serum/urine in NS?
To check for MYELOMA:
- monoclonal Ig in the serum
- Ig light chains in the urine
Why are complement levels relevant in NS?
Reduced C3/C4 indicates active SLE, particularly in the presence of kidney disease
What are ANA, ANCA, Anti-glomerular basement membrane antibodies and why test for them in NS?
ANA = anti-nuclear antibody, present in SLE which could be causing renal failure ANCA = anti-neutrophil cytoplasm antibodies, present in IBD, PSC, RA, particularly associated with systemic vasculitis which could be causing renal failure AGBMA = anti-glomerular basement membrane antibodies - tests for Goodpasture syndrome which causes bleeding from lungs/kidneys
Why do an anti-streptolysin-O titre in NS?
Check for post-streptococcal glomerulonephritis
Most common glomerulonephritis? (in western world at least)
Berger disease - IgA nephropathy
Who does Berger disease most commonly affect, what is its pathophysiology, and how is it diagnosed?
Usually affects young men after upper respiratory tract infection
- IgA builds up and clumps in glomeruli
- Causes local inflammation which impairs kidneys’ ability to filter the blood
- Causes haematuria, sometimes proteinuria
- Check with a kidney biopsy to diagnose
How is Berger disease (IgA nephropathy) treated?
ACEi or ARB
If that fails, immunosuppression should be started
What is nephrotic syndrome triad?
Proteinuria
Hypoalbuminaemia
Oedema (peripheral/pulmonary)
How do you test for nephrotic syndrome?
24 hr urine protein quantification
Urine protein:creatinine ratio (I believe this is done first, in case they come up together in a question)
Renal calculi presentation?
Haematuria
Severe pain on one side of back/abdomen
Test + treatment for renal calculi?
Abdo x-ray/CT
Treat cause of stone/give analgesia, or surgery to remove
What is acute tubular necrosis?
A form of acute renal injury usually following renal ischaemia due to dehydration, sepsis, hypotension, or renal vascular disease
