Renal system Flashcards
Nephrotic Syndrome Intro
Massive proteinuria (>3.5g/24hr)
Hypoalbuminemia
Edema
Hyperlipidaemia
Hypercoagulability
Nephrotic syndrome causes
Primary Renal disorders
• Minimal change disease
• Membranous glomerulonephropathy
•Membraneproliferative glomerulonephritis
• Focal & segmental glomerulosclerosis
2° to systemic diseases
•D.M.
•Amyloidosis
• Infections (HIV , Hepatitis B& C,Plasmodium malariae
• Drugs (gold, penicillamine, NSAIDs,captopril )
• Autoimmune disorders ( SLE, rheumatoid arthritis )
• Malignancies (Hodgkin’s disease, carcinoma breast, colon, lung)
Nephrotic syndrome pathophysiology
- Altered Glomerular filtration - Proteinuria
- +ed catabolism of protein in kidney & -ed synthesis by liver - Hypoalbunemia
- Low plasma oncotic pressure - fluid leakage into interstitial - edema & salt & H2O retention
- fluid leakage - low intravascular vol. - activation of RAS & symp. system - + ed secretion of vasopressin.& -ed atrial natriuretic peptide- net result renal salt & water retention & + ed intravascular vol. & further leakage into interstitium
- Fall in oncotic pressure due to hypoalbumemia - +ed syn. of lipid by liver -hyperlipidaemia
- +ed urinany loss of antithrombin 3 - Hypercoagulability
- +ed urinary loss Igs - Infections
- Vit D deficiency - excretion of cholecalciferol binding protein - hypocalcemia
- Loss of transferrin - iron unresponsive microcystic hypochromic anaemia
Nephrotic syndrome c/f
- Edema -main. children edema - face. Adults. initially in dependent parts then generalized edema - anasarca
- Morning - face & upper limb more affected
- Fluid collection- pleural fluid, ascites , pulmonary edema
- Fever- infection
- uncommon features - arterial & venous thrombosis, pulmonary embolism & renal vein thrombosis
- urine output - normal
- Hypertension & hematuria - rare
Nephrotic syndrome investigations
a) urine analysis
Presence of protein (>3.5g/ 24 hrs) - hallmark
Microscopic examination lipid cast
Haematuria rare
b) Blood examination
Low serum albumin (<3gm/dL)
hyperlipidaemia
Blood urea & serum creatinine - Normal
c) Renal biopsy
To know type of 1° renal disease. Light microscopy, immunofluorescence, electron microscopy
Minimal change disease- light microscopy
Thickening of glomerular B.M. & subepithelial deposits of lgG & C3 are features of membranous nephropathy
Minimal change disease common in children membranous glomerulonephropathy in adults.
Nephrotic syndrome T/t.
A) GENERAL MEASURES
* control of oedema - salt restriction (1-2 gm). Diuretics
* Reduction of proteinuria - ACE inhibitor & ARBs. Daily protein loss - regained by dietary protein intake.
* Hyperlipidaemia - Lipid lowering drugs - stains (simvastatin)
* Hypercoagulability - Anticoagulants
* others- Vit D supplements
B) SPECIFIC MEASURES
* Steroids - Immunosuppressive therapy in 1° renal diseases & 2°- SLE. prednisolone
* cytotoxic/ immunosuppressive agent- a) who are steroid dependent.
b) steroid resistant c) undergo frequent relapse. Common agents - Cyclophosphamide, cyclosporin.
Nephritic syndrome Intro
Due to acute glomerulonephritis. Sudden onset of:
Oliguria
Edema
Hypertension
Hematuria
Subnephrotic proteinuria
Worsening renal functions
Nephritic Syndrome Causes
IDIOPATHIC
* Proliferation G.N.
* Rapid progressive G.N.
POST - INFECTIONS
* Streptococci
* Hepatitis B
* Malaria
* Bacterial endocarditis
MULTISYSTEM - DISORDERS
* SLE
* Henoch Schonlein purpura
* Goodpasture’s syndrome
* Wegner’s granulomatosis
Nephritis Syndrome pathophysiology
Renal outflow & GFR reduced due to obstruction of glomerular capillary
by inflammatory cells. Impaired GFR & +ed reabsorption of salt & H20 by tubules - edema & hypertension.
Injury to glomerular Capillaries - appearance of dysmorphic RBCs, red blood cell cast & protein in urine. Haematuria is macroscopic
Nephritic syndrome c/f
- onset - sudden
- -ed urine output - Oliguria ( <400ml/ day). Anuria (<50-100mL/ day)
- Edema
- Hematuria
- Hypertension
- Generalized symptoms - vomiting, anorexia, nausea, headache, malaise
Nephritic syndrome investigation
A) URINE EXAMINATION
* dysmorphic RBCs, red blood cell cast and proteinuria
* 24 hr urine output low
B) BLOOD EXAMINATION
* Blood urea & serum creatinine raised
* Other tests complement levels, anti GBM antibody, ANCA, ANA & ASO titers
* Tests like serum electrolytes, CBC
C) RENAL BIOPSY
* light microscopy, immunofluorescence, electron microscopy in distinguishing major types of acute nephritis
Nephritic syndrome T/t
A) GENERAL MEASURES
* Control of edema
* Control of hypertension - antihypertensive
* Minimize protein loss - ACE inhibitors & ARBs
* Dialysis - Control hypervolemia & uremia
B) SPECIFIC MEASURES
* Corticosteroids (prednisolone)
* immunosuppressive drugs (cyclophosphamide, cyclosporine)
* Antibiotics
* Patients who do not respond to above - Dialysis
Acute renal failure
*Sudden decline in renal ability to maintain fluid & electrolytes homeostasis & to excrete noitrogenous waste.
* Blood urea&serum creatinine raised
* decreased urine output (may be oligouric or nonoligouric)
Acute renal failure causes
1) PRERENAL FAILURE
* Hypotension or volume contraction.
* heart failure
2) INTRINSIC RENAL FAILURE
* Acute tubular necrosis
* Glomerulonephritis
* interstial nephritis
* reno vascular disease
3) POST RENAL FAILURE
* Ureteric obstruction
* Bladder outlet obstruction
Acute acute renal failure clinical manifestation
*Clinical manifestation due to azotemia.
*Usual symptoms nausea vomiting malaise & anorexia
*Cardiac manifestations are pulmonary edema, pericardial effusion & arrhythmia
*Encephalopathic features such as drowsiness, confusion, seizures and coma
* bleeding tendency due to platelet dysfunction
* Features of hyperkalemia and metabolic acidosis
* Anaemia due to blood loss
* Infection serious complication.
