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Flashcards in Genitourinary Deck (378)
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181

How does hyperkalaemia appear in ECG and what is the treatment?

tall tented t waves
small absent p waves
increase PR interval
wide QRS

IV calcium gluconate, Iv insulin and dextrose, ion exchange resins

182

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)

183

What is glomerulonephritis?

disease of the glomeruli, inflammation

184

What is the most common cause of end stage renal failure?

glomerulonephritis

185

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

186

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

187

What tests should be done in glomerulonephritis?

urines and bloods, complete metabolic profile, azotemia, elevated creatinine, 24 hr urine protein, renal biopsy

188

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

189

Causes of glomerulonephritis?

autoimmune with glomerular (anti-GBM) or non glomerular (immune complexes) antigens

non immunological e.g. DM

190

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

191

What are the causes of acute nephritic syndrome?

ANCA associated vasculitis

goodpastures syndrome (antiglomerular basement membrane disease)

SLE, systemic sclerosis

post streptococcal infection

crescentric IgA

nephropathy/Henoch Schonlein purpura (variant of IgA nephropathy)

192

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

compress glomerulus

193

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

194

What can cause proteinuria?

transient, orthostatic, glomerula abnormalities, increased GFR, reduced renal mass, hypertension, tubular proteinuria

195

How does nephrotic syndrome present?

heavy proteinuria, hypoalbuminaemia, periorbital edema (especially on walking), hyperlipidaemia, scrotal vulvul leg and ankle edema, ascites, breathlessness

196

Causes of nephrotic syndrome?

primary, DM, amyloidosis, infections, SLE, drugs, malignancy, malaria

197

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

198

Management of nephrotic syndrome?

treat complications of fluid state and clotting abnormalities, treat underlying cause, diuretics, ACE-I, ARBs, spironalactone, anticoagulation, salt restriction, NSAIDs

199

How does minimal change nephrotic syndrome appear?

normal biopsy, but fused podocytes of ECM

200

Treatment of minimal change nephrotic syndrome?

steroids

201

How does membranous nephrotic syndrome appear?

thickened basement membrane due to immune complex formation or drugs, antiphospholipase A2 receptor antibody positive

202

Treatment of membranous nephrotic syndrome?

supportive, immunosuppresives

203

How does focal segmental nephrotic syndrome appear?

scarring focal to only some glomeruli involved and segmental

204

Treatment of focal segmental nephrotic syndrome?

steroids, immunosuppression

205

What is IgA nephropathy?

abnormality in IgA glycosylation leading to mesangium deposition and mesangeum proliferation

206

What is the most common cause of asymptomatic glomerulonephritis?

IgA nephropathy

207

Treatment of IgA nephropathy?

BP control, ACE-I and ARBs, immunosuppression if aggressive

208

What are the two causes of asymptomatic glomerulonephritis?

iga nephropathy and thin membrane disease

209

How will asymptomatic glomerulonephritis present?

incidental haematuria and proteinuria, kidney function and BP are normal

210

3 main functions of the kidney?

water regulation, salt regulation, acid/base regulation