Week 11: Nephrotic and Nephritic syndrome Flashcards
RENAL CELL CARCINOMA is more associated with proteinuria/ haematuria
Proteinuria
RENAL TUBULAR ACIDOSIS is more associated with proteinuria/ haematuria
Proteinuria
MYELOMA is more associated with proteinuria/ haematuria
Proteinuria
What is considered a normal eGFR in healthy males/ females
130 ml/min/1.73m2 in MALE
120 ml/min/1.73m2 in FEMALE
Nephrotic/ nephritic syndrome is associated with haematuria/ proteinuria
Nephrotic syndrome: Proteinuria
Nephritic syndrome: haematuria
Nephrotic/ nephritic syndrome has acute/ insidious onset
Nephrotic syndrome: insidious onset
Nephritic syndrome: acute onset
Nephrotic/ nephritic syndrome is associated with raised JVP
Nephritic syndrome is associated with raised JVP
Nephrotic/ nephritic syndrome is associated with oedema
Nephrotic syndrome is associated with oedema
General pathology for all nephritic syndromes
Immune problem at glomerulus
General pathology for all nephrotic syndromes
Problem with GBM (structural/ function abnormalities of podocytes)
Nephrotic syndrome is defined by
- what amount of proteinuria
- what other 3 features
- Proteinuria >3.5g in 24h
- Hypo-albuminaemia <25g/L
- Oedema
- Hyperlipidaemia
Features consistent with nephritic syndrome
- Urine content
- Blood content
- Urine amount
- other extra renal features
- Haematuria (microscopic/ visible)
- Proteinuria (<2g in 24h)
- Uraemia
- Oliguria
- Hypertension
- Oedema (sacral, ankle, periorbital)
General complications of nephrotic syndrome
- Sepsis (loss of immunoglobulin)
2. Venous thrombosis (loss of clotting factors)
General complications of nephritic syndrome
Salt and water retention leading to
- Hypertension
- Oedema
What type of disease does blood at the start of urinating indicate
Urethral disease
What type of disease does blood at the start of urinating indicate
Bleeding from prostate/ base of bladder
What type of disease does constant blood throughout urinating indicate
Bleeding from bladder/ kidneys
Most common cause of haematuria
- overall
- > 40yo
- > 55yo
Overall: UTI/ transient unexplained
> 40yo: cancer (bladder/ kidney/ prostate)
> 55yo: BPH
Pts who are >60yo and have what kidney symptoms should have a 2 week referral
- Unexplained visible haematuria AND
2. Dysuria OR raised WBC
Pts who are >45yo and have what kidney symptoms should have a 2 week referral
- Unexplained visible haematuria (no UTI) OR
2. Visible haematuria that persists/ recurs after successful UTI tx
Who should be referred to urology for asymptomatic microscopic haematuria
- Age >35yo
2. Smokers/ ex-smokers
2 most common causes of nephrotic syndrome
- Diabetes
2. Pre-eclampsia
Causes of physiological proteinuria
- Orthostatic (common in adolescents)
- Exercise
- Transient with fever
- Transient with UTI
Causes of pathological proteinuria
- Glomerulonephritis
- Vasculitis
- Decreased reabsorption of proteins in tubules (eg immunoglobulins)
- Too many plasma proteins causing overflow (eg light chains in myeloma, Hb in haemolysis)
- Post-renal causes: stones, tumours, UTI
