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nephro-urology Flashcards

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1
Q

primary causes of glomerulonephritis

A
  1. IgA nephropathy - few days after URTI
  2. post strep glomerulonephritis - 1-3 weeks after strep throat/ 3-6 weeks after skin infection
  3. goodpastures
  4. focal segmental glomerulonephritis
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2
Q

type of reaction post strep glomerulonephritis

A

type 3 hypersensitivity reaction

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3
Q

secondary causes of glomerulonephritis

A
  1. lupus nephritis
  2. wegeners glomerulonephritis
  3. HSP
  4. HUS
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4
Q

presentation of glomerulonephritis

A
  1. haematuria/ proteinuria
  2. acute nephritic syndrome
  3. nephrotic syndrome
  4. rapidly progressing crescenteric glomerulonephritis
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5
Q

describe features of nephritic syndrome

A
  1. haematuria
  2. reduced renal function
  3. oliguria
  4. hypertension
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6
Q

diagnostic indicators of post strep glomerulonephritus

A
  1. low C3 , normal C4, low CH50
  2. biopsy - granular deposits of IgG and C3 in capillary loops
  3. ASOT titres +ve
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7
Q

diagnostic indicators of lupus nephritis

A

low C3 and low C4

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8
Q

When is a biopsy indicated in glomerulonephritis

A
  1. creatinine abnormal at 6 weeks
  2. low C3 beyond 3 months
  3. proteinuria beyond 6 months
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9
Q

biopsy of IgA nephropathy

A

IgA deposits in glomerular mesangium

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10
Q

management of glomerulonephritis

A

depends on cause…
1. penicillin if post strep
2. diuretics
3. ACE-I
4. dialysis - if severe overload hyperkalaemia ologuria

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11
Q

Primary causes of nephrotic syndrome

A
  1. minimal change disease ** (90%) - steroid sensitive
  2. focal segmental glomerulosclerosis (10%) - poorer prognosis, not steroid sensitive
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12
Q

triad of nephrotic syndrome

A
  1. proteinuria >1g/m2/day
  2. hypoalbuminaemia <25 g/L
  3. oedema
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13
Q

symptoms of nephrotic syndrome

A
  1. low albumin - causes oedema + proteinuria
  2. loss of anti thrombin 3, protein C&s - risk of thrombosis by renal blood vessels or sagitall sinus vessels
  3. loss of immunoglobulin s- increased risk of pneumococcal/ cellulitis/ peritonitis
  4. hyperlipidaemia
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14
Q

1st line investigations for nephrotic syndrome

A
  1. urinanalysis
  2. protein: creatinine ratdio
  3. FBC, Bone, albumin, LFT, U&e
  4. Height and weight
  5. BP
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15
Q

atypical features of nephrotic syndrome

A
  1. age <1 y/o or >12 y/o
  2. macroscopic haematuria
  3. HTN
  4. low C3
  5. Raised creatinine
  6. family history
  7. unresponsive to steroids after 6 weeks
  8. systemic features
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16
Q

2nd line investigations in atypical features of nephrotic syndrome

A
  1. complement C3/C4
  2. dsDNA, ANA, ANCA
  3. RENAL USS
  4. renal biopsy
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17
Q

management of 1st presentation of nephrotic syndrome

A
  1. prednisolone 60mg/m2/day for 16 weeks and then 40mgs for further 4 weeks
  2. penicillin prophlaxis
  3. pPI
  4. weight monitoring and fluid intake
  5. pneumococcal vaccination
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18
Q

if not responding to steroids after 4 weeks in nephrotic syndrome

A
  1. tacrolimus
  2. ACE-I
  3. ritixumab
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19
Q

if relapsing (>2 relapses in 6 months) of nephrotic syndrome…

A
  1. alternate day prednisolone
  2. wean over 6 months

relapse: >3 proteinuria on dipstick for 3 consecutive days

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20
Q

triad of haemolytic uraemic syndrome

A
  1. microscopic haemolytic anaemia
  2. AKI
  3. thrombocytopenia
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21
Q

causes of haemolytic uraemic syndrome

A
  • shiga toxin producing E.coli - e.coli 0157 ** from contaminated food or fary yard animal faeces
  • strep pneumoniae
  • HIV
  • SLE
  • medications e.g. cytotoxins calcineurin inhibitors
  • hereditary mutations
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22
Q

diagnosis of HUS

A
  1. stool sample
  2. FBC - anaemia , thrombocytopenia
  3. blood film * - fragmented RBC (shistocytes)
  4. u&e - raised urea and creat
  5. CRP - raised
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23
Q

complications of HUS

A

1.pancreatitis
2. myocarditis
3. encephalopathy

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24
Q

management of HUS

A
  1. IV fluids (0.9% saline)
  2. dialysis / haemofiltration

5% mortality
30-40% chronic renal injury

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25
definition of AKI
1. urine < 0.5ml/hr/kg for 6 hours 2. increased serum creatinine to 1.5 x baseline 3. rise in serum creatinine by 26.5 umol in 48 hours
26
pre renal causes of AKI
1. extracellular fluid deficiency e.g. DKA, burns, diarrhoea, haemorrhage 2. 3rd space fluid loss e.g. sepsis 3. heart failure
27
intrinsic causes of AKI
1. renal tubular acidosis 2. congenital e.g. lupus nephritis 3. vascular e.g. renal vein thrombosis, HUS *** 4. toxins e.g. NSAIDs, gent, contrast, furosemide 5. acute glomerulonephritis
28
post renal causes of AKI
1. neuropathic e.g. transverse myelitis, spinal tumour 2. obstruction e.g. stones, tumour 3. posterior urethral valves
29
causes of chronic kidney disease
1. chronic glomerulonephritis 2. HUS 3. polycystic kidney disease 4. systemic e.g. HSP, SLE 5. hereditary e.g. alport, nephronophthisis , reflux, obstructions
30
presentation of chronic kidney disease
- fatigue, lethargy - anaemia - vit D deficiency (increased PTH - low vit D, low calcium and increased phosphate) - hypertension - faltering growth
31
indications for acute dialysis
1. persistent severe hyperkalaemia 2. severe symptomatic uraemia 3. severe ECF volume overload 4. hyponatraemia <120 or hypernatraemia >155 5. severe metabolic acidosis 6. removal of toxins
32
complications of haemodialysis
1. depression 2. anaphylaxis 3. hypotension 4. catheter sepsis 5. thrombosis
33
complications of peritoneal dialysis
1. peritonitis 2. weight gain 3. blocked catheters 4. hyperglycaemia 5. hernia
34
management of renal transplant patients
1. calcineurin inhibitors e.g. tacrolimus 2. mycophenolate/ azathioprine 3. corticosteroids 4. infection prophylaxis e.g. co-trimoxazole 5. enoxaparin -> aspirin
35
complications of renal transplant
1. acute rejection 2. hypertension 3. infection 4. vascular thrombosis 5. malignancy
36
describe type 1 distal renal tubular acidosis
- usually inherited - defects in H+ secretion causing acidosis - ph >5.5
37
describe type 2 proximal renal tubular acidosis
- usually secondary to metabolic disease e.g. cystinosis, wilsons, galactosaemia - defect in bicarb reabsorption - ph <5.5
38
features of fanconi syndrome
1. polyuria 2. glycosuria 3. hypokalaemia 4. low phosphate
39
presentation of type 1 distal renal tubular acidosis
- faltering growth - renal stones - vomiting - polyuria, polydipsia - muscle weakness
40
what is bartter syndrome
defective functioning of Na/K/Cl cotransporter in the thick acsending loop of henle. causes hyperplasia of juxtaglomerular apparatus
41
presentation of bartter syndrome
- severe salt wasting - dehydration - dysmorphic - triangular face, protruding ears, large eyes - faltering growth - fatigue - polyuria
42
diagnosis of bartter syndrome
1. hypokalaemia 2. hypochloraemia 3. metabolic alkalosis 4. hypercalcuria + raised renin/aldosterone (with normal BP), hyponatraemia, hypocalcaemia
43
describe gitelman syndrome
loss of Na and Cl and excess K via NaCL channel in the distal convulate dtubule
44
diagnosis of gitelman syndrome
- low magnesium ** - reduced calcium in urine - hyponatraemia - hypochloraemia - hypokalaemia - hypercalcaemia
45
describe goodpastures disease
autoantibodies against alpha3 chain of type IV collagen in alveolar and glomerular basement membranes
46
presentation of goodpastures disease
1. renal - rapidly progressing glomerulonephritis 2. pulmonary - cough, dyspnoea, haemoptysis
47
diagnosis of goodpastures disease
1. anti GBM antibodies * 2. ANCA +ve 3. Renal biopsy 4. CXR - pulmonary haemorrhage
48
risk factors for UTIs
1. boys < 6 months and girls >6 months 2. VUR 3. renal calculi 4. spinal lesions 5. constipation
49
diagnosis of UTI
1. clean catch mid stream urine microscopy ** 2. need LP if <1 month old
50
atypical UTI features
1. non E.coli organism 2. seriously ill or sepsis 3. poor urine flow 4. failure to respond to abx in 48 hours 5. abdomen/ bladder mass 6. raised creatinine
51
investigations for <6 months old with UTI
NON COMPLICATED - USS within 6 weeks ATYPICAL/ RECURRENT - USS in acute infection, DMSA and MCUG in 6 weeks
52
investigations for 6 months- 3 years old with UTI
NON COMPLICATED - Nil ATYPICAL - USS in acute or 6/52 if well but atypical bug, DMSA in 4-6 months RECURRENT - USS in 6/52 and DMSA 4-6 months
53
investigations > 3 years old
NON COMPLICATED - nil ATYPICAL - USS in acute infection RECURRENT - USS within 6 /52 and DMSA in 4-6 months
54
management of UTI
1. simple - oral trimeoprim 3/7 2. upper UTI - oral cefalexin 10 days 3. <3 months - IV abx 4. unwell - IV abx
55
definition of nocturnal enuresis
involuntary wetting during sleep (>5 y/o) at least twice a week with no congenital/acquired defect
56
risk factors for nocturnal enuresis
- boys - developmental delay - autism, ADHD, anxiety - psychological stress - obesity - constipation - family history
57
primary causes of nocturnal enuresis
1. sleep arousal difficulties 2. polyuria 3. bladder dysfunction
58
secondary causes of nocturnal enuresis (previously dry at night for >6 months)
1. psychological ** - stress, trauma, family change 2. UTI 3. diabetes 4. constipation
59
management of primary causes of nocturnal enuresis
1. reassurance 2. behavioural therapy ** 3. conditioning therapy / enuresis alarm
60
management of primary causes of nocturnal enuresis with daytime symptoms
1. refer to clinic 2. desmopressin ** - oral 200 ug at bed and fluid restrict for 1 hour before bed. 3. oxybutynin - if detrusor instability
61
stages of vesico-ureteric reflux
1 - urine tracks into non dilated ureter 2 - urine tracks into renal pelvis without dilatation 3 - mid-moderate dilatation of ureter 4 - ureteral tortuoisuty with pelvicalcayeal dilatation 5- gross dilatation and ureteral torturosity with blunted fornices
62
investigations for suspected VUR
1. MCUG - if antenatal or UTI 6 months old or USS hydronephrosis 2. DMSA - assess for renal scarring
63
management of VUR
1. prophylactic abx 2. anti cholinergic agenets e.g. oxybutynin 3. surgical correction at 2-3 y/o
64
presentation of posterior urethral valves
1. antenatal diagnosis - oligihydramnios +/- b/l hydronephrosis 2. urinary tract obstruction - urinary retention, poor stream, UTIs
65
investigations for posterior urethral valves
1. MCUG * 2. USS renal within 48 hours *** - shows hydronephrosis and bladder distension 3. renal function
66
management of undescended testes
if not descended after 3 months for surgical correction >`6 months old (no surgery >18 months)
67
presentation of testicular torsion
1. acute testicular pain - red hot swollen testes 2. nausea and vomiting 3. negative prehns signs 4. absent cremasteric reflex
68
management of testicular torsion
surgery within 6 hours of presentation PAIN RELIEF
69
Cause of polycystic kidney disease
autosomal recessive autosomal dominent - PKD1 gene on chromosome 16
70
presentation of AR polycystic kidney disease
1. antenatal diagnosis - large echogenic kidney , resp distress due to pulmonary hypoplasia 2. renal failure 3. systemic hypertension
71
presentation of AD polycystic kidney disease
1. present older 2. renal cysts 3. liver cysts 4. berry aneurysm -> SAH 5. aortic root dilatation and mitral valve prolapse
72
causes of calcium containing renal stones
MOST COMMON - hyperparathyroid/ hypercalcaemia - Bartter syndrome - renal tubular acidosis - TB, sarcoidosis - drugs - thiazide diuretics, furosemide, steroids
73
causes of struvite containing renal stones
proteus infection
74
causes of uric acid containing stones
gout lesch nyhan syndorme malignancy - tumour lysis drugs - aspirin, thiazine diuretics
75
causes of cystine stones
cystinuria 'staghorn appearance' yellow hexagonal crystals in urine
76
features of acute interstitial nephritis
- hyperkalaemia - metabolic acidosis -Hypertension - vomiting, haematuria, dysuria, abdo pain
77
causes of acute interstitial nephritis
- infections - reaction to medications e.g. ciprofloxacin, trimethoprim, erythromycin

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