renal investigations + findings Flashcards
Nodular glomerulosclerosis (Kimmelstein- Wilson lesions)
Diabetic nephropathy
management of diabetic nephropathy?
- tight glycemic control
- ACEI/ ARB (aim for BP <130/80)
- statins
investigations chronic pyelonephritis?
- micturating cystography
- renal USS
- CT urogram
may all be useful
most common cause of chronic pyelonephritis?
- reflux nephropathy
- vesico ureteric reflex (genetic disposition) usually presenting in childhood with recurrent infection but often asymptomatic
investigations renal artery stenosis?
1st= MR angiography or CT angiography
Duplex USS (difficult in obese patients)
-renin: aldosterone (both high)
renal artery stenosis treatment
- ACEI (contraindicated in bilateral disease)
- statin
- antiplatelets
surgical angioplasty +/- stent in severe cases
string bean appearance on angiography
fibromuscular dysplasia
string bean appearance on angiography
-what treatment?
-this is fibromuscular dysplasia (rare cause of renal artery stenosis)
treatment= surgical stenting
diabetic nephropathy on USS
bilaterally enlarged kidneys
what type of glomerulonephritis causes haematuria
nephritic syndrome
-mesangial cell damage/ endothelial (vasculitis) is proliferative leading to haematuria
what type of glomerulonephritis causes proteinuria?
- nephrotic syndrome
- prodocyte damage (non priliferative atrophy) causes proteinuria
nephrotic syndrome presentation?
- proteinuria (>3g/day)
- hypo albuminaemia (<30g/l)
- eodema
nephritic syndrome presentation?
- oliguria
- haematura (red cell casts in urine)
- hypertension
- some proteinuria/ fluid retention
light microscopy shows mesengial cell proliferation + immunofluorescence shows IgA and C3 deposits
IgA nephropathy
podocyte fusion and foot process effacement?
minimal change
minimal change treatment
1st- steroids
cyclophophamide= if steroid resistant
IgA nephropathy treatment?
ACEI/ ARB
minimal change- nephritic or nephrotic?
nephrotic
FSGS- nephritic or nephrotic
nephrotic
light microscopy= focal/ segmental sclerosis + hyalinosis
electron microscopy= effacement of foot processes
immunofluorescence= minimal Ig/ complement deposition
focal segmental glomerulosclerosis
focal segmental glomerulosclerosis treatment
steroids +/- immunosuppression
membranous nephropathy- nephritic or nephrotic
nephrotic
electron microscopy= thick BM with sub epithelial electron complex depositions (spike and dome appearance)
-membranous nephropathy
treatment- membranous nephropathy
- ACEI/ ARBs
- immunosuppression (steroids + cyclophosphamide +/- B cell monoclonal antibodies)
1/3rd spontaneously resolve, 1/3rd respond to immunosuppression, 1/3 rd end stage renal failure
patient just started amoxicillin, presents with fever, rash, arthralgia, elevated creatinine
urine test:
- raised eosinophils
- white cell casts
- sterile pyuria
acute interstitial nephritis
urinary ACR >30mg/mmol + hypertension
treatment?
ACIE (ramipril)
what formula is used to help estimate GFR?
Modification of Diet in Renal Disease Equation (MDRD):
- serum creatinine
- age
- gender
- ethnicity
used as serum creatinine may not provide an accurate estimate of renal function due to differences in muscle mass
- nephritic
- rapid decline in renal function + glomerular epitherlial crescent formation on biopsy
-rapidly progressive glomerulonephritis
treatment- radpidly progressive glomerulonephritis
-immunosuppression (steroids + cyclophosphamide + azathioprine) +/- plasma + temporary RRT
congo red staining
-apple green birefringence under polarised light
amyloidosis
longitudinal splitting of lamina densa seen on electron microscopy (characterised by basket weave appearance)
- microscopic haematuria
- progressive renal failure
- bilateral sensorineural deafness
- ocular manifestations
- proteinuria
Alport’s syndrome (X linked dominant defect in type IV collagen)
indications for dyalisis?
AEIOU
- Acidosis (PH <7.15)
- Electrolyte abnormalities (K > 7 or resistant to treatment)
- Intoxication (overdose of certain meds)
- Oedema (severe and unresponsive pulmonary oedema)
- Uraemia > 40 (seizures, loss of conscioussness)
causes of interstitial nephritis?
Drugs: (Not All Pills Fuck Renals) NSAIDS Allopurinol Penicillin Furesomide Rifampicin
Infection:
-TB
Systemic:
-sarcoidosis
causes of tubular injury?
- iscaemia (prolonged renal hypoperfusion)
- drugs (gentamycin)
- contrast
- rhabdomyolysis
treatment- hyperkalaemia?
- ECG + IV access
- 10 ml 10% calcium gluconate (protect myocardium)
- insulin actrapid 10 units + 50ml 50% dextrose or nebuliser salbutamol (short term shift)
hyperkalaemia- ECG findings
- tall tented T waves
- small p waves
- wide QRS
hypokalaemia- ECG findings
- U waves
- small or absent T waves
- prolonged PR interval
- ST depression
findings of acute tubular necrosis
- AKI
- muddy brown casts in urine
- high urine sodium + low urine sodium (with poor response to fluid challenge)
findings in rhabdomyolysis?
- AKI
- disproportionall raised creatinine
- raised CK
- metabolic acidosis
- hyperkalaemia
- high phosphate
- low calcium
- myoglobinuria
Patient often has had a fall or been immobile for hours + is associated with statins
rhabdomyolysis treatment?
IV fluids +/- urinary alkalinisation
Drugs that should be stopped/avoided in AKI
- ARB
- Diuretics
- Trimethoprin (co trimoxazole)
- Contrast
- Gentamycin
- NSAIDs
- ACEI
Avoid Drugs That Can Give Nasty AKIs
ascites treatment
spironolactone
