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Flashcards in Nephrology Deck (108)
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1

Define oliguria

Reduced urine output, usually less than 0.5 ml/kg/h

2

What does specific gravity on urinalysis measure?

Osmolality of urine
Increased osmolality in diabetes, dehydration, adrenal insufficiency
Decreased osmolality in diabetes insipidus, renal failure

3

What are casts (found on urinary microscopy)?

Cylindrical bodies formed in lumen of distal tubules, usually due to breakdown/inflammatory processes

4

List indications for renal biopsy

Unexplained renal failure
Acute nephritic syndrome
Unexplained proteinuria/haematuria
Planning therapy
Autoimmunity (SLE, Goodpasture's, GPA)

5

List contraindications to renal biopsy

Abnormal clotting
Hypertension over 160/90
Single kidney
Chronic renal failure with small kidney
Abnormal anatomy

6

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

7

List the main conditions for upper and lower UTI

Upper: pyelonephritis
Lower: urethritis, cystitis, prostatitis

8

List aetiology/risk factors for UTI

Females (short, wide urethra)
Sexual intercourse
Spermicide use
Pregnancy
Menopause
Immunosuppression
Catheterisation
UT obstruction (stones)

9

List the main organisms that cause UTI's

E. coli
Klebsiella
Enterococci
Proteus
Pseudomonas (esp catheters)
Staph saphrophyticus in women of child-bearing age

10

List clinical features of upper UTI

Loin pain
Tender
Fever
Rigors
Vomiting
Oliguria

11

List clinical features of lower UTI

Frequency
Dysuria
Haematuria
Suprapubic pain
Backache
Urgency
Strangury

12

What investigations would you do for suspected UTI?

Mid-stream urine sample
Urinalysis
Microscopy/culture
Bloods: FBC, U+E, CRP
US scan, IV urogram, cystoscopy

13

Outline management of UTI

Drink lots of fluids and pee often
Cranberry juice
Empirical therapy: trimethoprim/nitrofurantoin
Hospital therapy: gentamicin
GP therapy: co-amoxiclav/co-trimoxazole
Levofloxacin in men may be needed

14

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%

15

What is the commonest type of glomerulonephritis worldwide?

IgA nephropathy

16

List clinical features of IgA nephropathy

Episodic macroscopic haematuria
Post-URTI
Proteinuria

17

What investigations would you do for IgA nephropathy?

Renal biopsy
Immunofluorescence shows IgA and C3 deposits

18

Outline management of IgA nephropathy?

Prednisolone
Cyclophosphamide if progressively worsening renal function

19

What is Goodpasture's disease?

Anti-glomerular-basement-membrane antibodies destroy type IV collagen of the glomerulus

20

List clinical features of Goodpasture's syndrome

Macroscopic haematuria
Oliguria
Haemoptysis
Renal failure

21

What investigations would you do for Goodpasture's syndrome?

Antibody screen
Urine output
IgG detection
Presence of crescents on renal biopsy

22

Outline management of Goodpasture's syndrome

Plasmapharesis
Steroids
Cytotoxics

23

List aetiology/risk factors for rapidly progressive glomerulonephritis

Immune complex -mediated
Post-infection
Henoch-Schonlein purpura
IgA nephropathy
Vasculitis (GPA, EGPA)
Goodpasture's syndrome
Drugs

24

List clinical features of rapidly progressive glomerulonephritis

Systemic upset
Fever
Haemoptysis
Pulmonary haemorrhage

25

What investigations would you do for rapidly progressive glomerulonephritis?

Renal biopsy shows crescents
Antibody screen (ANCA)

26

Outline management of rapidly progressive glomerulonephritis

High dose (IV) methylprednisolone + cyclophosphamide
Plasmapharesis

27

What is nephrotic syndrome?

Protein leakage into urine due to non-proliferative damage to the glomerular basement membrane

28

List the core triad of features of nephrotic syndrome

More than 3g of protein in urine in 24h
Hypoalbuminaemia
Oedema

29

What are the principles of management of nephrotic syndrome?

Restrict sodium (reduce oedema)
Diuretic
ACE inhibitor

30

What is the commonest cause of nephrotic syndrome in children?

Minimal change nephropathy