Flashcards in Lecture 7: Haematuria and Proteinuria Deck (45)
Loading flashcards...
1
Clinical Presentation and Clinical Problem associated with generalised Parenchymal kidney Disease
Clinical presentation:
Clinical Problem:
2
Clinical Presentation and Clinical Problem associated with generalised Collecting System Abnormality kidney Disease
Clinical presentation:
Clinical Problem:
3
Clinical Presentation and Clinical Problem associated with generalised Focal leson assoc. kidney Disease
Clinical presentation: Haematuria, backache
Clinical Problem:
4
Extremes of changed glomerular function
Blocked Leaky
Siv b/w
- may or may not ahve lead to a change in GFR
5
Blocked (glomerular) filter
Blocked filter = reduced GFR
- acute Kidney injury
- chronic kidney disease
6
Proteinuria
Kidney handle 150L filtrate/day
Normal humans <150mg/24hrs.
Barriers to urinary protein:
1. Glomeruli - filters protein
2. Tubules - reabsorbs and filters
7
Affect of damaged glomerulus + High Blood Pressure
1. Increased leaked protein --> Proteinuria
2. High Blood pressure --> Increased damage to glomerulus --> worsening of situation/leakiness
8
Leaky filter
Leaking of blood or protein through glomerulus
Kidney function may be normal
Creatinine goes through glomerular filter, but not proteins
Note: every glomerulus will leak a little bit of protein into our urine
9
Proteinuria
Mainly albumin
Other proteins in small amounts
Measurements:
1. 24 hour urine --> annoying
2. Albumin: creatinine
3. Protein : creatinine
Note: 2x ratios are good surrogates replacing 24hour urine collection
10
Microalbuminuria
(albumin:creatinine ratio)
30-300 albumin/24 hours
ACR: x < 2.5 - y - 25 < z (mg/mmol/24 hours)
x= normal y= MA z= proteinuria
Causes: Diabetes Mellitus, Fever, Exercise, HF, Poor Glycemic control
11
Diabetes Mellitus relatively increases risk of..
Heat disease
Eye disease
Kidney fialure
12
Nephrotic Sydrome
Signs of nephosis: Proteinuria, Hypoalbuminaemia, odema
>3.5 g/day urinary protein
- eat protein but pee out more than they can eat
Symptoms:
1. Frothy urine
2. Reduced metabolism (VLDL - LDL) --> Increased Tryglycerides
3. Blood clots --> Pulmonary embolism
4. Normal or impaired Renal function/GFR
5. Low plasma oncotic pressure --> Increased lipoprotein production by liver --> increased cholesterol production --> hypercholesterolemia --> increase risk of vascular disease
13
Mechanism for Oedma
Increased albumin excretion --> Food and liver cant keep up with making enough albumin --> Low levels of protein in blood --> Reduced vascular oncotic pressure --> Increased egression of fluid into interstitial space (in an attempt to balance colloid oncotic and hydrostatic pressure b/w BV and tissues
14
Reason for Nephrotic Syndrome Oedema
Decreased protein and increased water in vasculature --> Decreased vascular oncotic pressure and increased hydrostatic pressure --> trying to balance equilibrium by pushing water into Extracellular spaces (cannot move proteins through filter) --> odema
15
Starling's Equation
Flux = capillary permeability (intravascular hydrostatic pressure - interstitial hydrostatic pressure) - (intravascular oncotic pressure - interstitial oncotic pressure)
Capillary hydrostatic P: pushes fluid out of vessel if high
Capillary oncotic pressure : pulls fluid into vessel if high. Derived from plasma proteins
16
Glomerular injury --> Odema
Glomerular injury --> protein leakage into interstitial space (bowmans space) --> Decrease in Plasma volume and Cardiac output --> Arterial hypervoluemia --> stimulation of RAAS --> Sodium and H2O retention --> Expansion of sodium space --> Odema
17
Relationship b/w Lipids and cholesterol and Nephrotic syndrome
2. Reduced metabolism (VLDL - LDL) --> Increased Tryglycerides
5. Low plasma oncotic pressure --> Increased lipoprotein production by liver --> increased cholesterol production --> hypercholesterolemia --> increase risk of vascular disease
18
Thrombolism
Risk factor of Nephrotic Syndrome
Pathophysiology not well understood (Risk 10%)
Nephrotic syndrome --> increase risk of DVT and pulmonary emboli --> clot in leg/femoral artery --> swollen, red and painful --> risk of embolus --> travels to lungs --> right heart failure --> death
19
Infection
Reduced antibody production and decreased complement pathway
Increased bacterial infection and chicken pox in children
20
Protein malnutrition
Risk in nephrotic syndrome/ Microalbuminuria / proteinuria
Protein malnutrition --> wasted, lost weight and unwell
21
Diabetic Neuropathy
Increased lumps of matrix int he glomerulus = leakage of protein into the urine
Type I Hyperglycaemia --> high serum glucose --> increased GFR/hyperfiltration due to high hydrostatic pressure
- IF have good glycaemic and BP control can have normal GFR w/o protein leaking
BUT Low GFR --> leak protein into urine Preceding decline due to kidney damage/Nephrotic syndrome
** graph
22
CKD
Often due to glomerular disease
Other major cause is diabetes (would just have protein in blood)
Blood or protein in urine (only protein in DM)
CKFailure
Main treatment is controlling BP (ACE inhibitors)
23
AKI
Pre renal, renal, post renal
Rena; = intrinsic (specific to kidneys) AKI --> Acute Tubular necrosis (from prerenal/drugs) --> Acute glomerulonephritis --> may have proteinuria
24
Acute Tubular Necrosis
Due to:
1. Prerenal inadequate treatment
2. Drugs/toxins
No blood or protein in urine
Just decreased GFR (renal function) due to blocked filter
25
Acute Glomerulonephritis
= Rapidly progressive glomerulonephritis = Acute Renal Failre
Leaky glomeruli AND Blocked (fluid overload): Blood +/- protein
May have nephritic syndrome
26
Nephritic Syndrome
Occurs in Acute/Rapidly progressive glomerulonephritis/ Acute Renal failure
Leaky + Increased GFR
Fluid overload as only able to excrete a limited amount of fluid per day --> peripheral and pulmonary oedema
Symptoms/Signs:
1. Unwell
2. Oliguric
3. Hypertensive --> 4. Volume overload --> pulmonary/peripheral oedema
5. Signs of other Multi-System disease:
a) haemoptysis b) rash c) arthritis d) fever
6. MSU (blood/protein) --> Red Clast cells
27
Diagnosis of Nephritis syndrome/ Rapidly progressive/Acute Glomerulonephritis
1. Kidney Biopsy
2. Blood in urine (sometime protein)
--> Red Clast cells = Broken down RBC all clumped together
28
Nephrotic syndrome vs nephritic syndrome
NephrOtic syndrome: Oedema, Proteinuria, Hypoalbuminuria, Renal Function/GFR can be normal or impaired
Nephritic syndrome: ARI, Hypertension --> Fluid overload --> Pulmonary and peripheral oedema, RBC in urine --> Clast cells (damaged RBC cell clumps) in blood sample
29
Haematuria
Micro - in most people
Macro - clots if severe
Note: If blood in urine --> NEED TO EXCLUDE CANCER
- high chance is catch early
30
