Summary Flashcards
Describe a UTI
Can have pyelonephritis, cystitis, prostatitis, and epididymis/ testis
In children can cause CRF
Usually bowel organisms like E. coli, proteus, klebsiella, and enterococcus
What are the symptoms of UTI in children?
Diarrhoea, excessive crying, fever, nausea, vomiting and not eating
What are the symptoms of a UTI in adults?
Flank pain, dysuria, cloudy offensive urine, urgency, chills, strangury and confusion in elderly
Acute pyelonephritis - pyrexia, poor localisation, loin tenderness signs of dehydration and turbid pain
What are the investigations for a UTI?
Urinalysis - blood, leucocytes and nitrates
Microbiology - bacteriuria >10^5
If man or child then consider US or IVU
What is the treatment for UTIs?
Fluids and antibiotics - amoxicillin, cephalosporin, and trimethoprim
Severe - IV antibiotics
Describe reflux nephropathy
Kidney damage or scarring caused from urine flowing backwards from bladder into kidneys - reflux and infection
UTIs in children
What is the treatment for reflux nephropathy?
Surgery
Describe minimal change disease
Type of non-proliferative glomerulonephritis - inflammation of glomerulus
Commonest form in children
Prognosis is favourable and underlying cause is unknown
What are the symptoms and signs of minimal change disease?
Sudden onset oedema in days
Nephrotic syndrome - oedema, nephrotic range proteinuria >3.5g or 350mg creatinine, hypoalbuminemia <35g/l, and dyslipidaemia
Haematuria, hypertension and proteinuria
What is the treatment for minimal change disease?
Prednisolone for 16 weeks
Once remission achieved then slow taper for 6 months
Initial relapse treated by steroids then further are with cyclophosphamide, cyclosporine, tacrolimus and others
Describe focal and segmental glomerulosclerosis
Type of non-proliferative glomerulonephritis
Is a syndrome of multiple disease
High chance progression to ESRD
What are the symptoms and signs of focal and segmental glomerulosclerosis?
Nephrotic syndrome - oedema, proteinuria >3.5g or 350mg of creatinine, hypoalbuminemia <35, and dyslipidaemia
Haematuria, proteinuria, and hypertension
What is the treatment of focal or segmental glomerulosclerosis?
Generally steroid resistant
Trial steroids for positive response
Alternative - cyclopsorin, cyclophosphamide and rituximab
Describe membranous nephropathy
Type of non-proliferative glomerulonephritis and commonest cause of nephrotic syndrome in adults
Majority of cases are idiopathic
What are the investigations for membranous nephropathy?
Serology markers - anti-phospholipase A2 receptor antibody and thrombospondin type 1
Renal biopsy - thickened glomerular basement membrane
Immunofluorescence - diffuse IgG uptake
What is the treatment for membranous nephropathy?
General measure for 6 months
Immuno-suppression if symptomatic - rising proteinuria and deteriorating renal function
Cyclophosphamide and steroids for 6 months
Tacrolimus and Rituximab
Describe IgA nephropathy
Type of proliferative glomerulonephritis - characterised by IgA deposition
Most common in 20-30s years
What is the symptoms of IgA nephropathy?
Microscopic haematuria, proteinuria, nephritic syndrome and IgA crescent glomerulonephritis
Nephritic - haematuria, dysmorphic RBCs, and cellular casts
Hypertension
What is the treatment for IgA nephropathy?
High dose prednisolone and other immunosuppression drugs
Describe post infectious glomerulonephritis
Type of proliferative glomerulonephritis - immunological mediated glomerular injury
Follows 10-21 days after infection
What is the treatment for post infectious glomerulonephritis?
Antibiotics given for infection and supportive measures with control of fluids
Loop diuretics and anti-hypertensives
Describe anti-GBM disease
Type of proliferative glomerulonephritis - immune mediates pathology involving antibodies against GBM antigens
Possible lung haemorrhage
What is the investigations for Anti-GBM glomerulonephritis?
Anti-GBM antibodies in serum and kidney
IgG deposits on kidney biopsy
What is the treatment for anti-GBM glomerulonephritis?
Aggressive immunosuppression - steroids, steroids, plasma exchange and cyclophosphamide