Nephrology Flashcards
(27 cards)
1.Pathophysiology of SIADH
Inappropriate release of ADH (Posterior pituitary gland) resulting in EUvolaemic Hyponatraemia (Dilutional)
ADH acts at the level of the collecting ducts to reabsord H20
5 Causes of SIADH
1) Malignancy - SCLC
2) Neurological - Stroke, SDH, SAH, Encephalitis/Meningitis
3) Infections - TB, Pneumonia
4) Drugs - SSRI, Tetracyclines, Carbamazepine, Sulphonylureas, Vincristine, Cyclophosphamide
5) Other - PEEP
Investigations for SIADH
Paired Urine and Plasma Osmolalit (Urine Osm >100 mOSm compared to plasma
Paired Urine and Plasma sodium - Urinary Na+ >40
Management of SIADH
1st line ) Fluid restriction
2nd line) Demeclocycline
3rd line) Vasopressin Receptor antagonists
Adverse outcome for rapid correction of Na+ during hyponatraemia
Central pontine myelinolysis
What are the post-op complications of renal transplant
Graft failure: Hyperacute, Acute (<6months), Chronic (>6Months)
Vascular thrombosis
UTI
Urine leakage
Causes of Hyperacute graft failure of renal transplant (Minutes-Hours)
IgG mediated antibody response usually due to prior sensitisation against HLA/ABO antigens on graft
Causes of acute graft failure of renal transplant (<6month
Cytoxic T cell mediated
- Could be due to CMV infection
NB - Rx with steroids/immunosuppression
Causes of chronic graft failure of renal transplant (>6motnhs)
Both cell and antibody mediated
How would you characterise Haematuria
Non-visible vs Visible Haematuria
How would you further characterise non-visible haematuria
Transient v persistent (Dipstick +ve on 2/3 tests 2-3 weeks apart)
Causes of transient Non-visible haematuria (Six)
Streaneous exercise (March haemoglobinuria)
UTI
Sexual intercourse
Menstruation
Non-UTI cuases - Beetroot
Iatrogenic - Rifampicin, Doxorubicin
Causes of persistent Non-visible haematuria (4)
Cancer - Renal, prostate, Bladder
Stones
Prostatis
BPH
Urethreitis
Renal causes - iGa NEPHROPATHY
Urgent 2 week wait referral criteria for haematuria
Age >45 with Visible haematuria and -ve UTI or after UTI treamtent
Age >60 and unexplained Visible haemturia with Dysuria/Raised WCC
Criteria for non urgent referral to Urology
Age >60 with recurrent UTI
Investigations for non-visible haematuria
Urine Dip
Protein:Creatinine ratio
Albumin:Creatinine ratio
+/- Urine for MCS
What is Minimal change disease
Usually a nephrotic syndrome that is idiopathic
Causes of Minimal change disease
Idiopathic - Mainly
Other:
-Hodgkins lymphma (Cytokine release from Reed-sternberg cells)
- Thymoma
- Infectious Mononucleosis (EBV virus)
Population affected by Minimal Change disease
75% Children
25% Adults
Presentation of Minimal Change disease
Nephrotic syndrome - Oedema - Facial, peripheral oedema
Normotensive
Investigations of Minimal change disease
Serum Albumin - <30
Urine Protein:Creatinine ration - >1000 9Very high
Light microscopy - NORMAL Nil immune complexes to be seen
Electron microscopy - Podocyte effacement
Complications of MCD
Low albumin - Pro-thrombotic state
(Consider Apixaban)
Managament of Minimal change disease
1st line - glucocorticoids - Prednisolone
2nd line - Cyclophosphamide
3rd line - Rituximab (CD 20 inhibitor)
Pathophysiology of Minimal change disease
T-Cell mediated and Cytokine mediated damage to podocytes
This increases the permeability of the glomerular basement membrane
Resulting in proteinurea
Hyperlipidaemia - Due to increase hepatic synthesis in response to hypoalbuminaemia
