Urology General

Question 1

what is the main difference between nephrotic and nephritic syndromes?

Answer 1

Nephrotic - more proteinuria.

Nephritic - more haematuria.

Question 2

how much function does the kidney have at birth, when does it reach full function?

Answer 2

at birth - 20-30% of full function.

Full function should be reached by 2 years.

Question 3

what are the 3 layers of the glomerular basement barrier?

Answer 3

• fenestrated endothelium cells
• the glomerular basement membrane
• the podocytes (epithelial cells) with slit diaphragms

Question 4

what layer does minimal change disease affect?

Answer 4

The podocytes (epithelial cells)

Question 5

which cells support the glomerulus?

Answer 5

mesangial cells

Question 6

what is a normal protein:creatinine level?

Answer 6

Pr”CR < 20 is normal

Question 7

What protein creatinine level signifies nephrotic syndrome?

Answer 7

> 250

Question 8

how much protein in the urine is abnormal?

Answer 8

> 3+

Question 9

what is the triad seen in nephrotic syndrome?

Answer 9

Hypoalbuminaemia
High proteinuria
Oedema

Question 10

What are other features/signs of nephrotic syndrome?

Answer 10

frothy urine
pallor
high cholesterol
triglycerides 
high blood pressure 
hyper coagulability 
look well 
inflated weight (from the oedema)
Can be hypo, Normo or hypertensive.

Question 11

what is the most common cause of nephrotic syndrome in children?

Answer 11

Minimal change disease (95%)

Question 12

what is the pathophysiology of minimal change disease?

Answer 12

theres nephrotic syndrome (hypoalbuminia, proteinuria and oedema) which occurs in ISOLATION without any other pathologies.

Question 13

what are the rare secondary causes of minimal change disease?

Answer 13

Focal segmental glomerularsclerosis
HIV
Infection 
Diabetes
Intrinsic kidney disease 
Hepatitis
Malaria

Question 14

what does the renal biopsy show in minimal change disease?

Answer 14

isn’t usually done unless theres a reason to - is usually normal and nothing can be found

Question 15

what is seen in the urine in minimal change disease?

Answer 15

Hyaline casts

small molecular weight proteins

Question 16

What is the typical presentation and signs of minimal change disease?

Answer 16

2-5yrs
oedema
proteinuria
normal blood pressure 
no frank haematuria
normal kidney function

Question 17

what is the management for nephrotic syndrome (most likely caused by minimal change disease)?

Answer 17

prednisolone - 4 weeks then taper off for 8 weeks
low salt diet

Optional:
loop diuretics (for oedema)
Antibiotic prophylaxis
albumin infusion

Question 17

what are the outcomes of steroid treatment for nephrotic syndrome?

Answer 17

80% respond to steroids - then 80% of these people relapse and need further steroids

some become steroid dependent (and have nephrotic syndrome when they come off the steroids)

some become steroid resistant

Question 18

what is the most likely cause of nephrotic syndrome if the patient is steroid resistant?

Answer 18

focal segmental glomerulosclerosis

Question 19

What is the treatment for nephrotic syndrome that’s steroid resistant?

Answer 19

ACE inhibitors

Immunosuppressants - tacrolimus, rituximab, cyclosporin.

Question 20

what are the main complications of nephrotic syndrome?

Answer 20

hypovolaemia 
oedema
thrombosis
infection 
acute or chronic renal failure
relapsing nephrotic syndrome

Question 21

what is nephritis?

Answer 21

inflammation of the nephrons of the kidneys

Question 22

what does nephritis result in?

Answer 22

reduced kidney function
haematuria
proteinuria (BUT NOT AS MUCH AS IS SEEN IN NEPHROTIC SYNDROME)

Question 23

what causes nephritis?

Answer 23

Post streptococcal glomerulonephritis

IgA nephropathy

Question 24

what is post streptococcal glomerulonephritis?

Answer 24

occurs 1-3 weeks after strep infection (usually tonsillitis)

the immune complexes and antibodies get stuck in the glomeruli and cause AKI.

Question 25

what is the management for post streptococcal glomerulonephritis?

Answer 25

supportive:
80% make a full recover.

Some get progressively worse:
Antihypertensive medications
Diuretics

Question 26

what is IgA nephropathy also known as?

Answer 26

Berger’s Syndrome

Question 27

What is IgA nephropathy?

Answer 27

When deposits of IgA in the nephrons cause inflammation.

Usually presents in teenagers and young adults.

Question 28

which layer does post streptococcal glomerulonephritis affect?

Answer 28

endothelial cells

Question 29

how is IgA nephropathy treated?

Answer 29

immunosuppressants:
steroids
Cyclophosphamide