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Glomerulonephritis/Polycystic Kidneys > Investigations > Flashcards

Investigations Flashcards

1
Q

What are the bedside tests for renal problems?

A
  • Urine dip

- BP - usually HTN

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2
Q

What investigations would be done for ADPKD?

A
  • US - fluid filled cysts with large irregular kidneys
  • CT - shows cysts in liver
  • U+E’s
  • Urine dip - culture
  • FH
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3
Q

What does specific gravity on a urine dip indicate?

A
  • ~1.001 - excessive hydration, diabetes insipidus, ATN
  • ~1.035 - dehydration, SIADH, CHF, cirrhosis, glycosuria, proteinuria, recent IV contrast
  • Fixed at 1.010 - advanced kidney failure
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4
Q

What does pH, heme and glucose show on a urine dip?

A
  • pH - renal tubular acidosis, monitoring alkalinization to prevent precipitation of myoglobin in rhabdomyolysis and aid elimination of certain drugs, differentiation of kidney stones, alkalaemia (sometimes UTI)
  • Glycosuria - hyperglycaemia, proximal tubule dysfunction
  • Heme - UTI, renal stone, nephritis syndrome, rhabdomyolysis (more dysmorphic if leaking from glomeruli than bleeding vessels or ureters etc)
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5
Q

What does protein indicate on a urine dip?

A
  • Most sensitive for albumin
  • Glomerular disease e.g. diabetic nephropathy, overflow proteinuria e.g. multiple myeloma, rhabdomyolysis, intravascular hemolysis
  • Post renal proteinuria e.g. UTI
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6
Q

What are the types of nephrotic syndrome?

A
  • Minimal change
  • Focal Segmental Glomerulosclerosis (FSGS)
  • Membranous glomerulonephritis
  • Membranoproliferative glomerulonephritis
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7
Q

What would be seen on investigation of the different nephrotic syndrome types?

A
  • Minimal change - effacement of podocytes on electron microscopy, commonest cause in children
  • FSGS - scarring in glomerulus with only some glomeruli affected and only parts of glomerulus affected - commonest cause in adults
  • Membranous glomerulonephritis - immune deposits on basement membrane + second membrane forms over these with irregular spikes (silver stain)
  • Membranoproliferative glomerulonephritis - immune deposits on basement membrane and mesangium
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8
Q

What are the different types of nephritic syndrome?

A
  • Acute glomerulonephritis (post-streptococcal glomerulonephritis)
  • IgA nephropathy
  • Rapidly progressive glomerulonephritis (crescenteric glomerulonephritis)
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9
Q

What confirms IgA nephropathy?

A

Biopsy: immunofluorescence or immunoperoxidase studies detect mesangial IgA deposits

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10
Q

How would you investigate rapidly progressive glomerulonephritis?

A

Immunofluorescence:

  1. Type 1: linear (anti-GBM brings to collagen of GBM)
  2. Type 2: granular (immune complex deposition)
  3. Type 3: negative
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11
Q

How is HSP diagnosed?

A

Usually clinical, confirmed with positive IF for IgA + C3 in skin (also ESR + ANCA).
Renal biopsy identical to IgA nephropathy.

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12
Q

What are the different types of vasculitis?

A
  1. Large vessels: takayasu + GCA e.g. aorta
  2. Medium vessels: polyarteritis nodosa (PAN), Kawasaki disease e.g. interlobar, renal
  3. Small vessels: 2 groups e.g. arterioles, venules - ANCA associated, HSP, cryoglobulinamia, SLE
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13
Q

What blood tests are done for glomerular disease?

A
  • FBC
  • U+E
  • Bone + lipid profile
  • Coagulation screen
  • HbA1c
  • ESR CRP
  • Immunology screen
  • Hepatitis serology
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14
Q

What would urinalysis and microscopy for nephrotic syndrome show?

A
  • Frothy
  • High specific gravity
  • Very high protein
  • Fatty casts
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15
Q

What would urinalysis and microscopy for nephritic syndrome show?

A
  • Red or brown urine
  • High specific gravity
  • High protein
  • +/- leukocyte
  • Dysmorphic RBCs
  • RBC casts
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16
Q

How would you diagnose ADPKD?

A
  • 15-39yrs >/= 3 cysts (unilateral/bilateral)

- 40-59yrs >/= 2 cysts in each kidney

17
Q

How would you diagnose proliferative glomerulonephritis?

A

Proliferative glomerulonephritis with electron dense deposits. Immunoglobulin deposition distinguishes immune-complex-associated disease from C3 glomerulopathy (C3 nephritic factor defect).

18
Q

What investigations would be done for vasculitis?

A
  • Increaed ESR/CRP
  • ANCA might be +ve
  • Increased creatinine if renal failure
  • Urine: proteinuria, haematuria, casts on microscopy
  • Angiography +/- biopsy may be diagnostic
19
Q

What are the investigations for GCA?

A
  • Increased ESR/CRP
  • Increased platelets
  • Increased ALP
  • Decreased Hb
  • Temporal artery biopsy within 14days of starting steroids (skip lesions can occur so might be -ve)
20
Q

What are the investigations for polyarteritis nodosa (PAN)?

A
  • Increased WCC
  • Mild eosinophilia
  • Anaemia
  • Increased ESR
  • Increased CRP
  • ANCA -ve
  • Renal or mesenteric angiography
  • Renal biopsy

Glomerulonephritis/Polycystic Kidneys (4 decks)

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