Flashcards in Nephrology Deck (108)
Reduced urine output, usually less than 0.5 ml/kg/h
What does specific gravity on urinalysis measure?
Osmolality of urine
Increased osmolality in diabetes, dehydration, adrenal insufficiency
Decreased osmolality in diabetes insipidus, renal failure
What are casts (found on urinary microscopy)?
Cylindrical bodies formed in lumen of distal tubules, usually due to breakdown/inflammatory processes
List indications for renal biopsy
Unexplained renal failure
Acute nephritic syndrome
Autoimmunity (SLE, Goodpasture's, GPA)
List contraindications to renal biopsy
Hypertension over 160/90
Chronic renal failure with small kidney
UTI is highly suspected if there is bacteriuria with greater than how many organisms per mL of fresh mid-stream urine?
Greater than 10^5 organisms
List the main conditions for upper and lower UTI
Lower: urethritis, cystitis, prostatitis
List aetiology/risk factors for UTI
Females (short, wide urethra)
UT obstruction (stones)
List the main organisms that cause UTI's
Pseudomonas (esp catheters)
Staph saphrophyticus in women of child-bearing age
List clinical features of upper UTI
List clinical features of lower UTI
What investigations would you do for suspected UTI?
Mid-stream urine sample
Bloods: FBC, U+E, CRP
US scan, IV urogram, cystoscopy
Outline management of UTI
Drink lots of fluids and pee often
Empirical therapy: trimethoprim/nitrofurantoin
Hospital therapy: gentamicin
GP therapy: co-amoxiclav/co-trimoxazole
Levofloxacin in men may be needed
What is glomerulonephritis?
Immune-mediated damage to glomerulus and podocytes, causing leakage of blood +/- protein in urine
Focal if less than 50% affected, diffuse if more than 50%
What is the commonest type of glomerulonephritis worldwide?
List clinical features of IgA nephropathy
Episodic macroscopic haematuria
What investigations would you do for IgA nephropathy?
Immunofluorescence shows IgA and C3 deposits
Outline management of IgA nephropathy?
Cyclophosphamide if progressively worsening renal function
What is Goodpasture's disease?
Anti-glomerular-basement-membrane antibodies destroy type IV collagen of the glomerulus
List clinical features of Goodpasture's syndrome
What investigations would you do for Goodpasture's syndrome?
Presence of crescents on renal biopsy
Outline management of Goodpasture's syndrome
List aetiology/risk factors for rapidly progressive glomerulonephritis
Immune complex -mediated
Vasculitis (GPA, EGPA)
List clinical features of rapidly progressive glomerulonephritis
What investigations would you do for rapidly progressive glomerulonephritis?
Renal biopsy shows crescents
Antibody screen (ANCA)
Outline management of rapidly progressive glomerulonephritis
High dose (IV) methylprednisolone + cyclophosphamide
What is nephrotic syndrome?
Protein leakage into urine due to non-proliferative damage to the glomerular basement membrane
List the core triad of features of nephrotic syndrome
More than 3g of protein in urine in 24h
What are the principles of management of nephrotic syndrome?
Restrict sodium (reduce oedema)