Urology Flashcards
What are the features of nephritic syndrome?
Hypertension
Haematuria
Oliguria
Granular casts
What are the main features of nephrotic syndrome?
+++ proteinuria (greater than 3.5g in 24 hours)
Low albumin causing a reduced osmotic pressure and resulting Widespread oedema
Raised lipids in both the serum and the urine (hypercholesterolaemia)
Low antithrombin-III
Propensity for DVTs/PEs to develop
Reduced venous return > reduced renal blood flow from heart > reduced GFR and raised Renin
Symptoms of nephrotic syndome
Dyslipidaemia - xanthelasma and xanthmata
Hypoalbuminaemia - fatigue, leukonychia, oedema and breathlessness (if pleural oedema/pleural effusion)
Frothy urine due to increased protein
Suspect nephrotic syndrome? Investigations
Urinalysis
FBC, LFTs and Calcium
CRP and glucose
Serum and urine immunoglobulins to screen for HIV, Hep B/C and autoimmune diseases
CXR to look for pleural effusions/oedema
USS of kidneys
Renal biopsy
At what time does acute kidney injury become chronic kidney disease?
3 months
What is considered to be a healthy GFR?
100-120 ml/min/1.73m2
Slightly less in women
GFR decreases with age
Causes of CKD
Hypertension
Diabetes
Systemic diseases e.g. SLE, RA
Infections e.g. HIV
Medications e.g. long term use of NSAIDs
Toxins (tobacco)
CKD causes more urea to be present in the blood - what are the sequaelae of this?
General symptoms such as nausea and loss of appetite
Encephalopathy causing asterixis (tremor and flapping of hands) and possibly coma
Increased bleeding, as more urea in the blood prevents platelets from adhering to each other as well, reducing the ability to form clots
Uraemic frost - urea crystals deposit on the skin
A GFR below what indicates CKD?
Below 90 ml/min/1.73m2
CKD stage 1 GFR
90 or greater
CKD stage 2 GFR
60-89
CKD stage 3 GFR
30-59
CKD stage 4 GFR
15-29
CKD stage 5 GFR
Below 15
