Flashcards in Genitourinary Deck (378)
How does hyperkalaemia appear in ECG and what is the treatment?
tall tented t waves
small absent p waves
increase PR interval
IV calcium gluconate, Iv insulin and dextrose, ion exchange resins
NICE definition for acute renal failure?
rise in serum creatinine of 26+mmol/L in 48hrs
50% rise in serum creatinine in past 7 days
drop in urine output to 0.5ml/kg/h for 6 hours
(different for children)
What is glomerulonephritis?
disease of the glomeruli, inflammation
What is the most common cause of end stage renal failure?
How does glomerulonephritis present?
leaky glomeruli, haematuria, proteinuria, hypertension, decreased kidney function, end stage kidney failure, oedema, low urine sodium and fractional excretion of sodium
Why is urine sodium low in glomerulonephritis?
due to congestion of afferent arterioles, so kidney perceives there to be less blood coming to the kidneys
What tests should be done in glomerulonephritis?
urines and bloods, complete metabolic profile, azotemia, elevated creatinine, 24 hr urine protein, renal biopsy
What is the difference between nephritic and nephrotic syndome?
all glomerulonephritis cause nephritic syndrome (RBC in urine), and have the ability to cause nephrotic syndrome if proteinuria is severe enough (>3.5g/day) which can then lead to hypoalbuminaemia and hyperlipidaemia
Causes of glomerulonephritis?
autoimmune with glomerular (anti-GBM) or non glomerular (immune complexes) antigens
non immunological e.g. DM
What is acute nephritic syndrome and how does it present?
AKI with rapid deterioration in function, presenting with oliguria, hypertension, oedema and increased intravascular fluid
What are the causes of acute nephritic syndrome?
ANCA associated vasculitis
goodpastures syndrome (antiglomerular basement membrane disease)
SLE, systemic sclerosis
post streptococcal infection
nephropathy/Henoch Schonlein purpura (variant of IgA nephropathy)
How does acute nephritic syndrome appear on histology?
acute, severe, rapidly progressive
proliferative, membranous, membranoproliferative, cresecnteric
Bowman's space filled with fibrin, epithelial cells and inflammatory cell matrix to form crescents
What are the 4 types of glomerular disease and how do they differ?
diffuse - all glomeruli
focal - some glomeruli
global - all of the glomerulus
segmental - part of the glomerulus
What can cause proteinuria?
transient, orthostatic, glomerula abnormalities, increased GFR, reduced renal mass, hypertension, tubular proteinuria
How does nephrotic syndrome present?
heavy proteinuria, hypoalbuminaemia, periorbital edema (especially on walking), hyperlipidaemia, scrotal vulvul leg and ankle edema, ascites, breathlessness
Causes of nephrotic syndrome?
primary, DM, amyloidosis, infections, SLE, drugs, malignancy, malaria
What are the 3 types of primary nephrotic syndrome and who are they most common in?
minimal change - children and adults
membranous - caucasian adults
focal segmental glomerulosclerosis - black adults
Management of nephrotic syndrome?
treat complications of fluid state and clotting abnormalities, treat underlying cause, diuretics, ACE-I, ARBs, spironalactone, anticoagulation, salt restriction, NSAIDs
How does minimal change nephrotic syndrome appear?
normal biopsy, but fused podocytes of ECM
Treatment of minimal change nephrotic syndrome?
How does membranous nephrotic syndrome appear?
thickened basement membrane due to immune complex formation or drugs, antiphospholipase A2 receptor antibody positive
Treatment of membranous nephrotic syndrome?
How does focal segmental nephrotic syndrome appear?
scarring focal to only some glomeruli involved and segmental
Treatment of focal segmental nephrotic syndrome?
What is IgA nephropathy?
abnormality in IgA glycosylation leading to mesangium deposition and mesangeum proliferation
What is the most common cause of asymptomatic glomerulonephritis?
Treatment of IgA nephropathy?
BP control, ACE-I and ARBs, immunosuppression if aggressive
What are the two causes of asymptomatic glomerulonephritis?
iga nephropathy and thin membrane disease
How will asymptomatic glomerulonephritis present?
incidental haematuria and proteinuria, kidney function and BP are normal