Renal Medicine Flashcards
AKI pre renal causes
hypovolaemia
decreased effective circulating volume
decreased CO
impaired renal auto-regulation - NSAIDS, cyclosporine, ACEis
AKI intrinsic causes
glomerular: acute glomerular nephritis
vascular: vasculitis, malignant hypertension
tubular: sepsis, ischemia, nephrotoxins (aminoglycosides, cisplatin, contrast, rhabdomyolysis)
AKI post renal causes
bladder outlet obstruction
if + blood and protein on urine dip, what tests next?
c-ANCA (PR3) p-ANCA (MPO) ? vasculitis, anti-GBM ANA C3 / C4 ? SLE serum immunoglobulins electrophoresis ? myeloma
Test for ? post-streptococcal GN
anti-streptolysin O titres
indications for renal replacement therapy
refractory to medical management - hyperkalaemia, metabolic acidosis, anuria (diuretics > fluid overload)
uraemic pericardiditis
uraemic encephalopathy
intoxications
S/Sx of uraemic encephalopathy
vomiting
confusion
drowsiness
altered consciousness
nephrotic syndrome features
oedema
albumin < 30
urine PCR > 350
- hypercholesterolaemia
(foamy urine, weight gain / fluid retention, fatigue)
nephrotic syndrome causes
Minimal change FSGN Amyloidosis / DM / myeloma membranous nephropathy membranoproliferative GN
nephrotic syndrome complications
infection VTE worsening CKD HTN Hyperlipidaemia
nephritic syndrome presentation
AKI \+/- blood and protein on urine dip mild oedema visible haematuria HTN
post infectious GN features
Post group A Beta-haemolytic strep infection
(1-2 weeks post tonsillitis / pharyngitis OR 3-4 weeks post impetigo / cellulitis)
typically in children 3-12 years
post infectious GN investigations
+ anti-streoptolysin O titres
immune complex deposition (IgG, IgM, C3) in sub epithelium on biopsy
post infectious GN treatment
supportive = ACEi / ARB, v Na diet
RRT (if ESRF)
IgA nephropathy features
post URTI / GITI / strenuous exercise
> gross haematuria
M > F
20-30% progresses to ESRF
IgA nephropathy investigations
asymptomatic haematuriaa / microhaemiaturia
^ serum IgA
mesangial immune complex deposits on glomerular biopsy
IgA nephropathy treatment
supportive = ACEi / ARB + v Na diet
small vessel GN features
pulmonary / nasopharyngeal involvement eg. ulcers / polyps / asthma / allergic rhinitis
small vessel GN investigations
c-ANCA (PR3)
p-ANCA (MRO)
segmental necrotising GN
small vessel GN treatment
immunosuppression
Anti-GBM disease alternative name
Goodpasture’s disease
Anti-GBM disease features
Ab against type IV collagen => pulmonary haemorrhage+ haemoptysis
> RPGN
Anti-GMN disease investigations
Anti-GBM Abs
pulmonary infiltrates
IgG deposits on BM
Anti-GBM treatment
plasma exchange
immunosuppression
Thin BM disease features
hereditary
Type IV collagen abnormalities
Thin BM disease investigations
microscopic haematuria (persistent) diffuse BM thinning on biopsy
thin BM disease treatment
monitor renal function
supportive = ACEi / ARB + v Na diet
Alport syndrome features
X linked
Type V collagen gene mutation
> hearing loss + eye abnormalities
> ESRF
Alport syndrome investigations
microcytic haematuria / visible haematuria
SN hearing loss
GBM splitting / thinning + thickening
Fx of disease
Alport Syndrome treatment
supportive
RRT
renal transplant (alport can > anti-GBM)
LN features
compilation of SLE
nephritic / nephrotic
LN investigations
ANA +
ds-DNA +
biopsy
LN treatment
supportive
immunosuppressive therapy
management of GN
supportive = ACEi/ARB (proteinuria), salt / fluid restrictive + diuretics (fluid overload), control BP, statins (hypercholesterolaemia), LMWH (hypoalbuminaemia - VTE risk) immunosuppressive = oral corticosteroids, IV methylprednisolone, rituximab, azathioprine etc. invasive = RRT / haemodialysis (sev AKI / ESRF), plasma exchange (Anti-GBM)
nephrotoxic drugs
aminoglycosides
NSAIDs
ACEi/ARB
diuretics
renally excreted drugs
metformin
opioids
lithium
digoxin
RBC change associated with CKD
anaemia of chronic disease
Burr cells
What is the most common cause of idiopathic nephrotic syndrome in adults?
1 - FSGS
2 - membranous glomerular disease
what is the long term management for CKD
underlying cause: DM, HTN
CVD risk: weight loss, exercise, statin, smoking cessation
Complications of CKD: EPO, vit B12, iron, folate / diuretics (furosemide) / phosphate binders, v phosphate diet / v potassium diet
Definitive: RRT
