Renal medicine Flashcards
State FIVE diagnostic criteria for NEPHROTIC syndrome
‘O’ for PROtein
PROteinuria (3.5g/day) [frothy urine +++]
Oedema (dependent, periorbital, lungs)
HYPOalbuminaemia
HYPERalbuminuria
HYPERlipidaemia (b/c liver is non-selectively increasing synthesis)
HYPERcoagulation (b/c AT-III PRO is also lost - antithrombin III) - increases risk of RVT (renal vein thrombosis) and increases risk of DVT & PE
State SIX diagnostic criteria for NEPHRITIC syndrome
'I' for INCLUDE both PRO & RBC 'I' for IMMUNE & INFLAMMATION PROteinuria HAEMaturia sediment in urine PYURIA (WBCs in the urine) OLIguria - LOW UO b/c of poor filtration b/c of filtrate deposition = LOW GFR HTN - b/c of the lack of blood flow Granular casts
What is the mechanism for NEPHROTIC syndrome
Podoctyes or BM are unable to keep PRO in the blood.
What is the mechanism for NEPHRITIC syndrome
I for Immune & inflammation;
immune complexes lodge in the capillaries;
The inflammation allows for RBC & WBC to exit the glomerulus;
Plus PRO also exits the glomerulus (may be up to nephrotic range too)
State the eGFR (in ml/min) for the FIVE stages of kidney disease: [note that stage 3 has two subcategories A & B]
- > 90 ml/min
- 60-89
- A. 45-59
- B. 30-44
- 15-29
- <15
Name the TWO types of albuminuria.
Which is detected with a urine dipstick?
microalbuminuria ¯oalbuminuria.
Dipstick detects MACROalbuninuria.
If you suspect someone has albuminuria but it is NOT detected by a urine dipstick [ie, microalbuminuria], what test is done?
What population of patients should have this test done annually?
Why?
ACR - albumin creatinine ratio
DM (diabetic patients)
Microalbuminuria is considered reversible - so detection is important. Macroalbuminuria is considered to be established nephropathy.
What is a legacy effect in the context of glycaemic control and renal function?
Poor early glycaemic control can have a legacy of enduring (or irreversible) renal impairment.
Compare PCR with ACR.
How are these ratios converted to g/day?
PCR is Protein : Creatinine ratio while ACR is the albumin : creatinine ratio.
Divide the ratios by 100 to get the daily grams.
What PCR is necessary for a total protein score that is in nephrotic range?
Nephrotic range is 3.5 g/day, so the PCR must be 350.
By what percentage dose GFR decrease each decade?
10%
Can GFR be too high or too good?
What might a HIGH GRF indicate?
What complication can arise from the high GFR?
Yes.
Hyperfiltration.
Glomerular sclerosis.
Can the TPro be in nephrotic range without nephrotic syndrome?
Yes.
What is the ‘two hit’ hypothesis of renal disease?
How might this ‘two hit’ be seen clinically/biochemically?
What is they key message in the hypothesis?
Renal disease can arise from a primary insult - which may or may not resolve. Regardless, that insult causes a secondary insult for the remaining nephrons as they compensate (do the work of the entire kidney).
The Cr rise may be delayed.
Even small AKI can cause considerable CKI.
Will MOST people with stage 4 CKI progress to stage 5? What is the major consequence of stage 4 CKI?
No.
CKI is a huge RF for CVD.
