Renal Medicine Flashcards
3 stages of a kidney biopsy
- Hematoxylin- eosin stain for messangial expansion
2- fluorescinn stain for igA deposition
3- electron microscopy
IgA nephropathy
What type of disease is it, and what is its clinical presentation
Also known as bergers or synonaryngitic glomerulonephritis
Type of proliferative glomerulonephritis
Occurs 1-2 days after URTI
Presents with nephritic syndrome with mild proteinuria
Post streptococcal glomerulonephritis clinical presentation
Nephritic syndrome 1-3 weeks after streptococcal infection
Goodpastures disease aetiology and presentation
Anti glomerular basement membrane antibodies attack kidney and lungs
Causes glomerular nephritis ( nephritic syndrome haematuria) and haemoptysis
Most common cause of glomerulonephritis overall
Presentation
Membranous glomerulonephritis
Bimodal district in 20s and 60s
Presents with nephrotic syndrome
Spike and dome appearance on biopsy
Minimal change disease
Presentation
Aetiology
Most common cause of nephrotic syndrome in kids
Lack of histological change with pods yet effacement
Thin basement disease presentation and aetiology
Microscopic haematuria with no other loss of kidney function
Caused by thinning of basement membrane
Alports syndrome presentation
Glomerulonephritis causing haematuria
Sensorineural hearing loss
Eye disease
Most common cause of adult nephrotic syndrome
Focal segmental glomeruloscleoris
Criteria of nephrotic syndrome
24 hour urinary protein >3G
Serum albumin <25g/L
Hypercholestriaemia
Peripheral oedema
Most common cause of AKI
Acute tubular necrosis
What casts are seen in acute tubular necrosis
Muddy brown casts
Causes of acute tubular necrosis
Ischaemia - shock, sepsis and dehydration
Nephrotoxicity- gentamicin, radiology contrast, and NSAIDS
Presentation of acute intistitial nephritis
AKI and hypertension
Classic triad of rash, fever and arthralgia
Causes of acute interstitial nephritis
Hypersensitivity reaction to infection or drugs
NSAIDS, abx and rifampicin
Presentation of nephritic syndrome
Haematuria, hypertension, oliguria
Treatment of nephrotic syndrome
Treat underlying cause
ACE I
LMWH
Pneumococcal vaccines and infection surveillance
Statins
High dose corticosteroids
What is released in rhabdomyolysis
Myoglobin
Phosphate
Potassium
CK
Causes of rhabdomyolsis
Prolonged immobility
Seizures
Crush injury
Vigorous excessive
AKI stages
1- creatinine rise 1.5 -1.9 x, creatinine rise by 26.5 or oliguria of <0.5ml/kg/hr for 6 hours
2- rise in creatinine 2-3 times and oliguria 0.5 ml/kg/hr for 12 hours
3- 3x increase in creatinine or oliguria <0.3ml/kg/hr
What drugs must be stopped in AKI
DAMN + opioids, lithium and LMWH
Diuretics
AceI/ARB/Aminoglycosides (gentamicin)
Metformin
NSAIDS
Which drugs don’t worsen renal impairment but have increased risk of toxicity in AKI
Metformin
Lithium
Digoxin
What cell casts are seen in AIN
White cell casts
What renal tests should all diabetics have annually
Annual urinary albumin creatinine ratio
Should not be more than 2.5
Manage with dietary protein control, tight glycemic control and BP mx with potential ACEI
Indication for acute dialysis (AEIOU)
Acidosis
Electrolyte annormality
Intoxication
Oedema
Uraemia
which type of PKD is more common
What are some complications
How is it managed
Autosomal dominant is far more common and presents earlier
Associated with sub arrack bleeds, chronic loin pain, stones and haematuria
HTN and cvd
Can use tolvaptan, which is a a vasopresser receptor 2 antagonist
