Urology General Flashcards
what is the main difference between nephrotic and nephritic syndromes?
Nephrotic - more proteinuria.
Nephritic - more haematuria.
how much function does the kidney have at birth, when does it reach full function?
at birth - 20-30% of full function.
Full function should be reached by 2 years.
what are the 3 layers of the glomerular basement barrier?
- fenestrated endothelium cells
- the glomerular basement membrane
- the podocytes (epithelial cells) with slit diaphragms
what layer does minimal change disease affect?
The podocytes (epithelial cells)
which cells support the glomerulus?
mesangial cells
what is a normal protein:creatinine level?
Pr”CR < 20 is normal
What protein creatinine level signifies nephrotic syndrome?
> 250
how much protein in the urine is abnormal?
> 3+
what is the triad seen in nephrotic syndrome?
Hypoalbuminaemia
High proteinuria
Oedema
What are other features/signs of nephrotic syndrome?
frothy urine pallor high cholesterol triglycerides high blood pressure hyper coagulability look well inflated weight (from the oedema) Can be hypo, Normo or hypertensive.
what is the most common cause of nephrotic syndrome in children?
Minimal change disease (95%)
what is the pathophysiology of minimal change disease?
theres nephrotic syndrome (hypoalbuminia, proteinuria and oedema) which occurs in ISOLATION without any other pathologies.
what are the rare secondary causes of minimal change disease?
Focal segmental glomerularsclerosis HIV Infection Diabetes Intrinsic kidney disease Hepatitis Malaria
what does the renal biopsy show in minimal change disease?
isn’t usually done unless theres a reason to - is usually normal and nothing can be found
what is seen in the urine in minimal change disease?
Hyaline casts
small molecular weight proteins
What is the typical presentation and signs of minimal change disease?
2-5yrs oedema proteinuria normal blood pressure no frank haematuria normal kidney function
what is the management for nephrotic syndrome (most likely caused by minimal change disease)?
prednisolone - 4 weeks then taper off for 8 weeks
low salt diet
Optional:
loop diuretics (for oedema)
Antibiotic prophylaxis
albumin infusion
what are the outcomes of steroid treatment for nephrotic syndrome?
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
what is the most likely cause of nephrotic syndrome if the patient is steroid resistant?
focal segmental glomerulosclerosis
What is the treatment for nephrotic syndrome that’s steroid resistant?
ACE inhibitors
Immunosuppressants - tacrolimus, rituximab, cyclosporin.
what are the main complications of nephrotic syndrome?
hypovolaemia oedema thrombosis infection acute or chronic renal failure relapsing nephrotic syndrome
what is nephritis?
inflammation of the nephrons of the kidneys
what does nephritis result in?
reduced kidney function
haematuria
proteinuria (BUT NOT AS MUCH AS IS SEEN IN NEPHROTIC SYNDROME)
what causes nephritis?
Post streptococcal glomerulonephritis
IgA nephropathy
what is post streptococcal glomerulonephritis?
occurs 1-3 weeks after strep infection (usually tonsillitis)
the immune complexes and antibodies get stuck in the glomeruli and cause AKI.
what is the management for post streptococcal glomerulonephritis?
supportive:
80% make a full recover.
Some get progressively worse:
Antihypertensive medications
Diuretics
what is IgA nephropathy also known as?
Berger’s Syndrome
What is IgA nephropathy?
When deposits of IgA in the nephrons cause inflammation.
Usually presents in teenagers and young adults.
which layer does post streptococcal glomerulonephritis affect?
endothelial cells
how is IgA nephropathy treated?
immunosuppressants:
steroids
Cyclophosphamide
