Renal Wrap Up Flashcards
RBC casts = ?
NEPHRITIC SYNDROME!!!!!!!!!
What are some of the symptoms of Lupus in general?
Butterfly Rash!
Arthritis, polyarthralgia
Serum complement DECREASED
Antinuclear antibodies INCREASED
RBC casts
WHO classification of LUPUS Nephritis
I = normal histology II = Mesangial proliferation III = Focal Proliferative Lupus Nephritis IV = DIFFUSE PROLIF (CRESCENTIC) V = Membranous VI = ESRD
Types of Casts and where they are Seen
RBC Casts –> NEPHRITIC
Waxy Casts –> NEPHROTIC
Renal Tubular Epithelial Cell casts –> ACUTE TUBULAR NECROSIS
WBC Casts –> seen in INTERSTITIAL NEPHRITIS or PYELONEPHRITIS
RPGN
Subnephrotic urine protein with renal failure setting in over the course of weeks to months is rapidly progressive glomerulonephritis (RPGN). There are ruptures in the basement membrane allowing RBCs to spill into Bowman’s space that end up as casts in the urine.
Acute Renal Failure Causes?
Pre- Renal –> dehydration, CHF (decreased BF to kidney), hemorrhage (decreased BF to kidney) –> treat by improving CO and replacing fluid
Renal causes –> acute glomerulonephritis, acute interstitial nephritis, transplant rejection, vasculitis, acute tubular necrosis
Post-renal –> obstructive – Stones, bladder outlet obstruction (BPH), tumors and retroperitoneal fibrosis (fibrosis wraps around ureters) –> relieve obstruction to treat
What if a patient presents with acute renal failure and a pulmonary component?
GOODPASTURES (anti-glomerular BM antibody test)
or WEGENERS (cANCA and pANCA test)
or SLE (less likely in males without a rash, but still possible!!!) - do ANA test
How do you TREAT lupus nephritis?
Steroids + Mycophenolate mofetil (anti-nucleotide that prevents incorporation of nucleotides into dividing white cells)
Steroids + Cyclophosphamide (alkylating)
Treating Wegener’s or Goodpastures?
Steroids + oral cyclophos
Plasmapheresis for Goodpasture’s to remove the anti-glomerular basement membrane antibodies (not sure if it works in Weg’s)
African American patient presents with FROTHY URINE (protein!), LOW ALBUMIN, HIGH CHOLESTEROL?
Nephrotic Syndrome
High grade proteinuria, edema, hypoalbuminemia (and maybe hyperlipidemia b/c of overactive liver seeing less protein and making more!)
DUE TO:
MCD (Children)
MGN (Most Common)
FSGS (African American, AIDS, younger)
also, amyloidosis, nodular sclerosis (DM)
Treatment? High dose steroids
MOST LIKELY TRANSFORM TO ESRD in 1-20 years (FSGS)
What could a biopsy for ESRD look like?
Sclerosed glomeruli, very few tubules, interstitium filled with inflammatory cells, blood vessels with thickened arterial walls with a narrowed lumen
Signs and symptoms for ESRD?
Anorexia, nausea, vomiting
Anemia decreased EPO production in non-functional kidneys!
HTN changes in the retina (FLAME hemorrhages, cotton wool spots, hard exudates, arterial narrowing)
Significantly damaged heart on cardiac exam 4th heart sound, ventricle thickness
Types of Dialysis?
Hemodialysis –> AV fistula in the arm –> attached to a dialysis machine for treatment 4x/week
Peritoneal dialysis –> involves the placement of a catheter into the peritoneum through which the diastylate flows –> fills the peritoneal cavity and is left there for 4-5 hours to allow the toxins to move out of the blood and into the fluid and the nutrients to move out of the fluid and into the blood; every 4-5 days
ULTIMATE GOAL is to get a kidney transplanted (in the pelvis, hooked up to iliac vasculature)
Managing ESRD
Dialysis
Anemia treatment by iron and EPO stimulating agents
Prevention of metabolic bone disease (can’t excrete phosphorus with ESRD, builds up, binds calcium, stimulates PTH to remove calcium from bones) –> give low phosphorous diets, phosphorous binders with meals, calcimimetic agents
Nutrient replacement –> get serum albumin to 4g /dL –> supplements, protein powders; replace water soluble vitamins and folic acid (both lost in dialysis)
Treat inflammation and oxidative stress constant states in ESRD can lead to CV disease –> give ACEI, antioxidants, ARBs
HTN management (antihypertensives)
Psychosocial treatment
Education
