Clinical Presentation Of Kidney Disease Flashcards Preview

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Flashcards in Clinical Presentation Of Kidney Disease Deck (16):
0

Define glomerular proteinuria

Increase in permeability of glomerulus to proteins - get abnormal filtration and excretion of proteins

1

Define tubular proteinuria

Low molecular weight proteins which are normally filtered and then reabsorbed by the PCT, but remain in the tubule due to tubulointerstitial disease that impair function
Increased excretion of these smaller proteins

2

Define overflow proteinuria

Increased production of smaller proteins leads to rate of filtration exceeding Tm for reabsorption in PCT.

(Usually occurs with overproduction of monoclonal immunoglobulin light chains in multiple myeloma and plasma cell dyscrasias)

3

What can cause haematuria?

UTIS
Polycystic kidneys
Renal stones
Renal/bladder tumours
Arteriovenous malformations
Kidney/glomerular disease

4

Which patients require a cystoscopy of they have haematuria?

Over 45yrs

5

If you have haematuria as well as proteinuria and/or hypotension, what are you more likely to have?

Glomerular disease

6

Causes of red/brown urine? (Macroscopic haematuria)

Glomerular disease
Haemoglobulinuria
Myoglobulinuria
Consumption of food dyes eg beetroot

7

Investigations if there is haematuria?

FBC (infection, chronic blood loss)
U&Es (renal function)
Midstream urine specimen (MSU - check for infection and parasites)
Cystoscopy if bladder cause is suspected
Autoimmune scan for glomerulonephritis
CT scan/ultrasound if renal cause is suspected

8

What is nephrotic syndrome?

A non-specific disorder where podocytes are damaged, leaking a large amount of protein into the urine

9

What are the findings of nephrotic syndrome?

Classical triad
-proteinuria (>3.5g/24hrs)
-hypoalbuminaemia
-oedema (low protein in blood)

Plus
-hyperlipidaemia
-Muehrcke's bands

10

How is nephrotic syndrome diagnosed?

Renal biopsy - needle guided by ultrasound
(Aimed at bottom of the kidney to ensure cortex is biopsied)

11

Causes of nephrotic syndrome?

Minimal change disease/glomerulonephritis
Focal segmenting glomerulosclerosis (scarring)
Membranous glomerulonephritis (autoimmune destruction of basement membrane)

12

What is nephritic syndrome?

A collection of signs associated with disorders affecting the kidneys (specifically glomerular disorders)
Characterised by having pores in the podocytes large enough to permit proteins and RBCs

13

What is the main difference between nephrotic and nephritic syndrome?

Nephritic has haematuria

14

Clinical presentation of nephritic syndrome?

Rapid onset
Oliguria
Hypertension
Generalised oedema
Haematuria with smoky brown urine
Normal serum albumin
Variable renal impairment
Urine contains blood protein and red cell casts

15

What does nephritic syndrome often accompany?

Post-streptococcal glomerulonephritis in children
As a result of other glomerulonephridites