Session 10 - Further glomerular damage

Question 1

What are two types of asymptomatic glomerula disease caused by?

Answer 1

• Microscopic haematuria

* Microscopic proteinuria

Question 2

What is asymptomatic glomerula disease often associated with?

Answer 2

• Hypertension

Question 3

What investigation is used for asymptomatic glomerula disease?

Answer 3

What investigation is used for asymptomatic glomerula disease?
• Cytoscopy

Question 4

What is microscopic haematuria cuased by? (3 things)

Answer 4

• Renal stones/tumours
  
  • Arteriovenous malformations
  • Glomerula disease

Question 5

What is microscopic proteinuria caused by?

Answer 5

• Non-nephrotic proteinuria <3.5g/24hrs

* Associated with glomerulonephritis

Question 6

Describe macroscopic haematuria

Answer 6

Brown/smoky colour

Question 7

What does macroscopic haematuria need to be distinguished from?

Answer 7

Haemoglobinuria, myoglobinuria and consumption of food dyes

Question 8

What is the main cause of macroscopic haematuria?

Answer 8

• IgA nephropathy

Question 9

Describe nephrotic syndorme

Answer 9

• A non-specific disorder where the kidneys are damaged and leak a large amount of protein into the urine

Question 10

What is the classic triad of symptoms in nephrotic syndrome?

Answer 10

• Proteinuria (>3.5g/24hrs
• Hypalbuminaemia
• Oedema
○ Hypelipidaemia

Question 11

How is nephrotic syndrome investigated?

Answer 11

• Biopsy from bottom of kidney to get cortex

No glomeruli in medulla

Question 12

Give three types of nephrotic syndrome

Answer 12

• Minimal change glomerulonephritis
  
  • Focal segmental glomerulosclerosis
  • Membranous glomerulonephritis

Question 13

Define nephritic syndrome

Answer 13

• A collection of sings associated with disorders affecting the kidneys (specifically glomerular disorders) characterised by having small pores in the posocytes of the glomerulus large enough to permit proteins and red blood cells

Question 14

Give 8 symptoms of nephritic syndrome

Answer 14

• Rapid onset
  
  • Oliguria
  • Hypertension
  • Generalised oedema
  • Haematuria with smoky brown urine
  • Normal serum albumin
  • Variable renal impairment
  • Urine contains blood protein and red blood cell casts

Question 15

Differentiate between nephrotic and nephritic syndrome in terms of onset speed

Answer 15

• Nephrotic - Insidious

* Nephritic - Abrupt

Question 16

Differentiate between nephrotic and nephritic syndrome in terms of oedema

Answer 16

• Nephrotic - Lots of oedema

* Nephritic - less than nephritic

Question 17

Differentiate between nephrotic and nephritic syndrome in terms of blood pressure

Answer 17

• Nephrotic - No change

* Nephritic - Increase

Question 18

Differentiate between nephrotic and nephritic syndrome in terms of JVP

Answer 18

• Nephrotic - No change/Decrease

Nephritic - Increase

Question 19

Differentiate between nephrotic and nephritic syndrome in terms of Proteinuria

Answer 19

• Nephrotic - Lots of proteinuria

* Nephritic - Some protein uria

Question 20

Differentiate between nephrotic and nephritic syndrome in terms of Haematuria

Answer 20

• Nephrotic - May or may not occur

* Nephritic - Very much present

Question 21

Differentiate between nephrotic and nephritic syndrome in terms of Red cell casts

Answer 21

• Nephrotic - Absent

* Nephritic - Present

Question 22

Differentiate between nephrotic and nephritic syndrome in terms of Serum albumin

Answer 22

• Nephrotic - Decrease

* Nephritic - No change/slightly reduced

Question 23

What are the eight main ways in which nephrotic and nephritic syndrome differ?

Answer 23

• Onset
• Oedema
• Blood pressure
• JVP
• Proteinuria
• Haematuria
• Red cell casts
• Serum albumin

Question 24

What is rapidly progressive glomerulonephritis?

Answer 24

• A clinical situation in which glomerular injury is so severe that renal function deteriorates over a couple of days
• Patient may present as a uraemic emergency with evidence of extrarenal disease
• Associated with cresentic glomerulonephritis

Question 25

What is the natural progression of glomerulonephritis, and what are the three main symptoms?

Answer 25

• Chronic kidney injury
• Hypertension
• Dipstick abnormalities
• Uraemic syndrome
What is chronic renal failure associated with?
• Small, smooth shrunken kidneys
Give five main symptoms of chronic renal failure 
• Tiredness and lethargy
• Breathlessness
• Nausea and vomiting
• Aches and pains
• Sleep reversal