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
