Nephrotic And Nephritic and infection

Question 1

Define nephritic syndrome

Answer 1

Inflammation of the glomerular capillaries 
Haematuria 
Plus minus proteinuria 
Oligouria
Hypertension

Question 2

Define nephrotic syndrome

Answer 2

Proteinuria more than 3.5g
Hyperlipidemia 
Hypoalbuminemia
Peripheral oedema 
Injured podocytes

Question 3

Give causes of nephritic syndrome

Answer 3

bIg Al Good ANd CAring

Iga nephropathy
Alport syndrome (also hearing loss and eye problems)
Goodpasture syndrome
Vasculitis eg wegeners, (ANCA)

Question 4

Which syndrome has hyperlipidemia and which has oligouria

Answer 4

Hyperlipidemia is nephrotic
Oligouria is nephritic

When you have an infection you don’t want to wee

Question 5

Name three hypertensive causes of renal damage

Answer 5

Chronic hypertension (eyes and LV hypertrophy first), involving intimal thickening and glomerulosclerosis

Renal artery stenosis- acute, evidence of atherosclerosis elsewhere,ischaemic so RAAS activation, worse with ACEi

Acute hypertension- sudden rise, hemolytic anemia, fibrinoid necrosis, ischaemic so RAAS activation, AKI, rapid renal failure, an emergency

Question 6

Name a structural defect in boys that could cause UTIs

Answer 6

Posterior urethral valve

Question 7

Name infectious causes of bladder damage and what they do

Answer 7

Schistosomiasis- flukes live in bladder and can lie dormant, cause calcification, bladder cancer, stenosis of VUJ, chronic cystitis. Note haematobium does this, mansonii and japonicum only do GN not cancer

TB- sterile Pyuria because can’t culture it, calcification, ESRD, abscess, stricures

GN can be caused by hiv, hep b/c, staph endocarditis, strep, malaria

Question 8

Causes of UTIs

Answer 8

Structural problem eg posterior urethral valve in boys
Relaxed vesicoureteric junction so ureteric reflux
Fs have shorter urethras
Obstruction from enlarged prostate, pregnancy
Neurological incomplete emptying
Personal hygiene eg gut flora

Question 9

In ten women with UTI like symptoms, what will their diagnoses be?

Answer 9

Five will have cystitis ie significant bacteruria

Five will have urethral syndrome which is low bacteria, gonorrhea, mechanical or physical causes

Question 10

Symptoms of lower and upper UTIs

Answer 10

Lower is cystitis presenting with frequency, urgency, dysuria

Upper is pyelonephritis presenting with fever, loin pain

Question 11

What is a complicated UTI

Answer 11

UTI associated with abnormalities eg structural problems, abnormal infectious cause like klebsiella, or a reason why they have it like diabetes, or complication like sepsis or fever

Question 12

How do you treat different UTIs

Answer 12

Uncomplicated three day trimethoprim
Complicated seven days trimethoprim
Pyelonephritis IV co-amoxiclav plus two weeks trimethoprim

Question 13

Which organism causes UTIs in females 17-27 and which if surgery/IV drug user/catheter

Answer 13

Staph saprophyticus causes 10% if F 17-27

Staph epidermidis if invasive things

Question 14

In what cases could you prescribe UTI prophylaxis

Answer 14

3 or more UTIs a year trimethoprim nightly 7

Question 15

Causes of haematuria

Answer 15

Cancer
IgA nephropathy
UTI
nephritis 
BPH 
Renal calculi 
Patients on warfarin, LMWH

Question 16

Causes of acute urinary retention

Answer 16

Infection, BPH, prolapses, general anaesthetic, spinal cord injury

Question 17

When should you catheterise

Answer 17

Acute urinary retention
Acute on chronic ie they can’t wee
If you need to monitor fluid balance eg sepsis, trauma
High pressure chronic retention

Question 18

What is chronic Urinary retention

Answer 18

More than 800ml full, painless

Question 19

What are most stones made of

Answer 19

Calcium oxalate

Question 20

What inhibitor in urine prevents stone formation

Answer 20

Citrate

Question 21

Describe stone treatments

Answer 21

Shock treatment, ureteroscopy (flexible tube inserted to remove small medium stones), nephrostomy (tube through skin for pyelonephritis and infected obstruction)

Question 22

Define AKI

Answer 22

Abrupt decline in actual GFR
Less than 0.5ml/kg/hr
Raised serum creatinine and urea
May cause acidosis from reduced acid excretion and reduce reabsorption of HCO3. This can cause hyperkalemia

Question 23

Causes of AKI

Answer 23

Pre renal- hypovolemia, systemic vasodilation eg sepsis, double whammy of nsaids constricting afferent and ACEi dilating efferent. Basically reduced renal blood flow

Intrinsic- ATN eg caused by nephrotoxins, ischaemia, sepsis. Cells are damaged not dead. Also thrombotic microangiopathy from malignant hypertension. Or acute interstitial nephritis with eosinophil invasion

Post renal- obstructive blocking both kidneys or last functioning one. Get dilation of renal pelvis called hydronephrosis. Eg from stones, cancer, prostate

Question 24

What can you Agive to protect the heart in AKIs and why

Answer 24

Can cause acidosis which causes hyperkalemia which can cause arrhythmias so give calcium gluconate

Question 25

What investigations should you do in akis

Answer 25

All should have urinalysis USS within twenty four hours unless pre renal cause Biopsy if pre and post ruled out Microscopy if infection

Question 26

Why does pregnancy increase risk of UTI

Answer 26

Baby presses on bladder so more reflux potential | Also hormones mean more relaxed vesicoureteric junction.

Question 27

What is the anion gap and what would a high anion gap indicate

Answer 27

Cations minus the anions | High anion gap indicates metabolic acidosis

Question 28

How does serum urea Change in volume depletion, upper GI bleeds and malnutrition?

Answer 28

Volume depletion increases because GFR reduced Upper GI bleed increased because blood broken down Malnutrition decreased because less to metabolise

Question 29

Define oligouria

Answer 29

Less than 500ml day Less than 20ml hour Happens in nephritis

Question 30

When are red cell casts found?

Answer 30

Glomerulonephritis

Question 31

Describe stages of diabetic nephropathy (and state of nephrotic or nephritic)

Answer 31

Obvz nephrotic Stage 1 increased GFR, hyperfiltration, hypertrophy Stage 2 latent:, mesangial expansion caused by hyperglycaemia, GBM thickening Stage 3 microalbuminemia- protein starts to appear in urine, injured podocytes, GFR falls to normal Stage 4 overt proteinuria- low GFR, systemic hypertension, can see protein on normal dipstick, hyalinosis of arterioles Stage 5 ESRD

Question 32

What’s the management for diabetic nephropathy at different stages

Answer 32

If at stage two latent or stage three microalbuminemia May be reversible so do primary prevention: tight BP and glucose control can reverse hyperfiltration and microalbuminemia If already at overt proteinuria can’t prevent, but can manage hypertension with statins, exercise, RAAS inhibition, stop smoking, don’t have huge protein intake