Nephrology Flashcards
What are the three aspects of nephrotic syndrome in terms of presentation?
Proteinuria
Hypoalbuminemia
Oedema
What is minimal change disease?
Minimal change disease (MCD) is the most common form of nephrotic syndrome (a clinical condition characterised by heavy proteinuria, oedema, hypoalbuminaemia, and hyperlipidaemia) affecting children. 90% of children with nephrotic syndrome have minimal histological changes in the kidney. MCD is typically primary (idiopathic) but may also be secondary to another condition.
What is the presentation of minimal change disease?
Facial or generalised oedema
History of viral illness (gastroenteritis)
Can be associated with lymphoma or leukaemia
Dyspnoea from resp complications
Normal blood pressure
No Frank haematuria
Normal renal function
In what circumstances of nephrotic syndrome would you consider a renal biopsy?
Suggestions of autoimmune disease
Abnormal renal function
Steroid resistance
What is the management of nephrotic syndrome?
8 weeks prednisolone
Low salt diet and fluid restriction
Albumin and furosemide
What is the management of steroid resistant nephrotic syndrome?
Secondary immunosuppression
Name a steroid resistant nephrotic syndrome?
Focal Segmental Glomerulosclerosis (FSGS)
What is the presentation of nephritic syndrome?
Haematuria and proteinuria Reduced GFR Oliguria Fluid overload Raised JVP oedema Hypertension Worsening renal failure = Rapidly Progressive GN
What investigations should be done in glomerulonephritis?
Urinalysis-exclude UTI
Comprehensive metabolic profile-may see hyperkalaemia, hyponatraemia
Glomerular filtration rate (GFR)
Full blood count-raised creatinine, anaemia
Lipid profile
Spot urine albumin:creatinine ratio (ACR)
Ultrasound of kidneys
Investigations to consider
Erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP)
Renal biopsy
Complement levels, bacterial culture and ASOT (to look for acute post infectious GN)
What is the management of post infectious GN?
Antibiotic
Support the 5 renal functions
Electrolyte / acid base
Diuretics
What is the presentation of Henoch Schonlein Purpura/IgA related vasculitis?
Mandatory palpable purpura One of 4 1. Abdominal pain 2. Renal involvement 3. Arthritis or arthralgia 4. Biopsy - IgA depostition
What is the management of IgA vasculitis?
Immunosuppression - Prednisolone / cyclophosphamide
Use ACE inhibitors to reduce proteinuria
What is IgA nephropathy?
Most common glomerulonephritis IgA nephropathy (IgAN) is defined by the presence of dominant or co-dominant mesangial IgA immune deposits, often accompanied by C3 and IgG in association with a mesangial proliferative glomerulonephritis of varying severity. 1-2 days after URTI Non streptococcal post infectious GN Usually older children and adults Clinically Recurrent macroscopic haematuria Chronic microscopic haematuria Varying degree of proteinuria Clinical diagnosis and biopsy Treat with Ace inhibitor and immunosuppression
What is an acute kidney injury?
Abrupt loss of kidney function, resulting in the retention of urea and other nitrogenous waste products and in the dysregulation of extracellular volume and electrolytes
Serum creatinine: > 1.5x age specific reference creatinine (or previous baseline if known)
Urine output<0.5 ml/kg for > 8hours
What are the criteria for acute renal failure?
Anuria/oliguria (<0.5ml/kg/hr)
Hypertension with fluid overload
Rapid rise in plasma creatinine
