Nephrotic syndrome, hydronephrosis, nephropathies + HUS

Question 1

Describe IgA nephropathy

Answer 1

Occurs days after URTI or gastroenteritis Gross haematuria + RBC casts in urineNephritic syndrome

Question 2

Describe post strep glomerulonephritis

Answer 2

Occurs weeks after strep infection (6 weeks after impetigo, 2 weeks after strep throat)
Type 3 hypersensitivity - IgG + IgM deposit in kidneys
Nephritic syndrome
Causes haematuria, HTN, oliguria, oedema

Question 3

Describe Goodpasture’s syndrome

Answer 3

Anti GBM AbType 2 hypersensitivity reaction IgG ab - damage basement membrane Lung damage = cough, haemoptysisNephritic syndrome - haematuria, HTN, oedema Treat with steroids

Question 4

Describe haemolytic uraemic syndrome

Answer 4

Blood clots in kidneys cause RBC break down + decrease in kidney function + nephritic syndrome Triggered by bloody diarrhoea Caused by E coli

Question 5

Describe diabetic nephropathy

Answer 5

Causes damage to kidneys from glucose, microalbuminuria Causes nephrotic syndrome Treat with ACEi

Question 6

What is nephrotic syndrome?

Answer 6

Disease causing inflammation to kidney that causes protein loss, low albumin in the blood + high cholesterol
Causes oedema, hypovolemia, AKI

Question 7

Causes of nephrotic syndrome

Answer 7

Minimal change disease, diabetic nephropathy, amyloidosis, SLE

Question 8

Management of nephrotic syndrome

Answer 8

ACEi or ARBs
Sodium restriction
Loop diuretics
Statins

Question 9

Presentation of urinary tract obstruction

Answer 9

Pain, change in urine output, haematuria, increased serum creatinine
Distended abdomen, abdo mass

Question 10

Assessment + management of urinary tract obstruction

Answer 10

US

CT if kidney stones suspected

Question 11

Complications of urinary tract obstruction

Answer 11

Tubular atrophy

Renal injury

Question 12

Genetics of polycystic disease

Answer 12

Autosomal dominant, defect on chromosome 16

Question 13

S+S of polycystic disease

Answer 13

HTN 
hematuria 
Proteinuria 
Decreased kidney function 
Flank pain due to hemorrhage, calculi or UTIs are common 
May present with cysts in other organs

Question 14

Diagnosis of polycystic disease

Answer 14

Usually due to routine bloods in positive family history
US, then MRI if needed for asymptomatic
CT/ MRI for symptomatic pts

Question 15

Management of polycystic disease

Answer 15

ACEi or ARBs for HTN
Tolvaptan
Dialysis if needed

Question 16

Causes of urethral strictures in men

Answer 16

Trauma
Infection
Catheterisation

Question 17

S+S of urethral stricture

Answer 17

Chronic obstructive voiding symptoms:
Decreased stream
Incomplete bladder emptying 
Recurrent UTIs 
Urinary spraying 
Dysuria 
Ejaculatory dysfunction

Question 18

Investigations for ?urethral stricture

Answer 18

Cystourethroscopy, retrograde urethrogram, voiding cystourethrogram or US urethrography

Question 19

Management of urethral stricture

Answer 19

Abx prophylaxis prior to cystourethroscopy or surgery

Question 20

What is vesicoureteral reflux?

Answer 20

Retrograde passage of urine from bladder to upper urinary tract

Question 21

2 types of vesicoureteral reflux

Answer 21

Primary = due to incompetent or inadequate closure of ureterovesical junction 
Secondary = result of abnormally high voiding pressure in bladder

Question 22

How does vesicoureteral reflux present?

Answer 22

Prenatally as antenatal hydronephrosis on prenatal US

Postnatally aft§er initial UTI

Question 23

Imaging to diagnose vesicoureteral reflux

Answer 23

Contrast voiding cystourethrogram (VCUG)

DMSA renal scan

Question 24

Management of vesicoureteral reflux

Answer 24

Abx prophylaxis

Surgery to correct anatomy

Question 25

S+S of glomerulonephritis

Answer 25

``` Haematuria Proteinuria Renal insufficiency HTN Oedema Hypercoagulability ```

Question 26

What are the causes/ pathology of proteinuria?

Answer 26

Glomerular disease - this is picked up as protein on a dipstick Tubular proteinuria Overflow proteinuria (ie multiple myeloma) Postrenal (UTI)

Question 27

What are the causes of proteinuria without nephrotic syndrome?

Answer 27

Orthostatic proteinuria Transient proteinuria Reflux nephropathy Diabetic nephropathy

Question 28

Evaluation of glomerulonephritis

Answer 28

Kidney biopsy C3 + C4 complement levels ANCA, ANA Hep B + C serology

Question 29

How can a diagnosis of thrombotic microangiopathy be made?

Answer 29

Microangiopathic hemolytic anemia Thrombocytopenia Kidney failure

Question 30

What is of orthostatic proteinuria?

Answer 30

Elevated protein excretion while in upright position

Question 31

Management of orthostatic proteinuria

Answer 31

Benign condition, doesn't affect renal function so no intervention needed