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Renal Flashcards

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1
Q

Diabetic Nephropathy: Epidemiology (2)

A

Commonest cause of renal failure
30-40% patients require renal replacement

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2
Q

Diabetic Nephropathy: Pathophysiology

A

Hyperglycaemia - increased growth factors, RAAS activation, oxidative stress - Increases glomerular capillary pressure - leads to endothelial dysfunction and podocyte damage

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3
Q

Diabetic Nephropathy: First clinical sign

A

Albuminuria

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4
Q

Diabetic Nephropathy: Later clinical signs (3)

A
  1. Glomerulosclerosis (scarring)
  2. Nodule formation (Kimmelstiel-Wilson lesions)
  3. Fibrosis
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5
Q

Diabetic Nephropathy: Co-morbidity which accelerates disease course

A

Co-existing hypertension

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6
Q

Diabetic Nephropathy: Factor needed for diagnosis

A

Microalbuminuria (A:CR 3-30mg/mmol)
Albumin:Creatitine ratio

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7
Q

Diabetic Nephropathy: Treatment - Diabetes front

A
  1. DM control, HbA1C <53mmol/mol
    Prevents development and progression
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8
Q

Diabetic Nephropathy: Treatment - Blood pressure front

A

BP <130/80
ACEi - Angiotensin receptor blockers
Prevents progression in hypertensive DN

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9
Q

Diabetic Nephropathy: 4 Key treatment steps

A
  1. Diabetes control
  2. Blood pressure control
  3. Sodium restriction (<2g/day)
  4. Statins for CV risk
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10
Q

Glomerulonephritis: Definition (5)

A

Encompasses a number of conditions which:
1. Are caused by pathology in the glomerulus
2. Present with proteinuria, haematuria, or both
3. Are diagnosed with a renal biopsy
4. Cause CKD
5. Can progress to kidney failure

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11
Q

Glomerulonephritis: Where do names of conditions which are encompassed by glomerulonephritis come from? (2)

A

Histological appearance (membranous glomerulonephritis) or the associated systemic condition (lupus membranous)

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12
Q

Glomerulonephritis: Spectrum of disease

A

Ranges from nephrosis to nephritis

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13
Q

Glomerulonephritis: Nephrosis definition

A

Proteinuria due to podocyte pathology

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14
Q

Glomerulonephritis: Nephritis definition

A

Haematuria due to inflammatory damage

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15
Q

Glomerulonephritis: How can proteinuria complicate the clinical picture?

A

If a GN causes scarring, this can cause proteinuria
Can complicate picture of any GN, even if classically nephritic

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16
Q

Glomerulonephritis: Aim of investigations

A

Assess damage and underlying cause

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17
Q

Glomerulonephritis: Key blood tests (5)

A
  1. FBC
  2. U&E
  3. CRP and LFTs
  4. Immunoglobulins
  5. Autoantibodies
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18
Q

Glomerulonephritis: Key urine tests (4)

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A
  1. Microscopy, culture and sensitivity
  2. Bence-jones protein
  3. Protein:Creatinine
  4. Hepatitis
19
Q

Glomerulonephritis: Key imaging techniques/investigations (3)

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A
  1. CXR (pulmonary haemorrhage)
  2. Renal ultrasound
  3. Biopsy
20
Q

Glomerulonephritis: Key possible findings on a biopsy (3)

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A
  1. Confirms GN diagnosis
  2. Proportion and degree of glomeruli involved
  3. Immunohistology and microscopy for any deposits encountered
21
Q

Glomerulonephritis: Management (3)

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A
  1. Treat as CKD
  2. BP control, and inhibit RAAS
  3. May need immunosuppression depending on cause
22
Q

Nephritic glomerulonephritis: IgA Nephropathy Epidemiology

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A

Commonest primary GN in high income countries

23
Q

Nephritic glomerulonephritis: IgA Nephropathy presentation (4)

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A
  1. Asymptomatic non-visible haematuria
    or
  2. Episodic visible haematuria (may be synphagrygitic)
  3. High BP
  4. Slow, indolent disease
24
Q

Nephritic glomerulonephritis: IgA Nephropathy diagnosis

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A

Renal biopsy shows IgA deposition in mesangium

25
Nephritic glomerulonephritis: IgA Nephropathy Treatment (2)
1. ACEi, ARB 2. Corticosteroids and fish oil if proteinuria is persistent after 6 months
26
Nephrotic syndrome: Key consideration
If there is oedema, dipstick urine to avoid missing renal disease
27
Nephrotic syndrome: Definition (3)
Triad of: 1. Proteinuria (>3g) 2. Hypoalbuminuria (<30g) 3. Oedema
28
Nephrotic syndrome: Aetiology (2)
1. Primary renal disease (membranous nephropathy) 2. Secondary causes (DM, SLE, myeloma)
29
Nephrotic syndrome: Pathophysiology
Damage to one of the three structures forming the renal filtration barrier: GBM, endothelial cells and podocytes which results in proteinuria.
30
Nephrotic syndrome: Presentation (1)
Generalised pitting oedema can be rapid and severe
31
Nephrotic syndrome: Key areas affected by oedema (2)
Ankles, Sacrum if bed bound Periorbitally (area of low-tissue resistance)
32
Nephrotic syndrome: Key features of history (2)
1. Systemic symptoms (joint pain) 2. Malignancy or chronic infection
33
Nephrotic syndrome: Key signs on examination
1. Congestive cardiac failure (raised JVP, peripheral oedema) 2. Liver disease (Low albumin)
34
Nephrotic syndrome: 4 Key points of management
1. Reduce oedema 2. Treat underlying cause 3. Reduce proteinuria 4. Treat complications
35
Nephrotic syndrome: How to reduce oedema (2)
1. Fluid (1L/day) and salt restriction 2. Loop diuretics (furosemide) *Add thiazide if resistant to loop*
36
Nephrotic syndrome: Two stages in treatment of underlying cause
1. Biopsy for adults 2. Treat to induce remission (e.g. corticosteroids)
37
Nephrotic syndrome: Treatment to reduce proteinuria
1. ACEi or ARB
38
Nephrotic syndrome: 3 key complications
1. Thromboembolism (high clotting factors, low anti-thrombin) 2. Infection (urine loss of immunoglobulins, high risk after steroids) 3. Hyperlipidaemia (high cholesterol, high LDL)
39
Nephrotic syndrome: Treatment of thromboembolism
1. Prophylaxis with LMWH and warfarin
40
Nephrotic syndrome: Treatment of hyperlipidaemia
Statins *Low evidence but works in CKD*
41
Glomerulonephritis: Lupus Nephritis Definition
Systemic autoimmune disease caused by antibodies against nuclear components - antibody complexes cause inflammation and tissue damage
42
Glomerulonephritis: Lupus Nephritis Presentation (3)
1. Nephropathy is common 2. Nephritis or nephrosis 3. Many systemic symptoms (rash, photosensitive, arthritis)
43
Glomerulonephritis: Lupus Nephritis Diagnosis (2)
Antibody profile (ANA specific and Anti-dsDNA sensitive) Consider biopsy
44
Glomerulonephritis: Lupus Nephritis Treatment (2)
**Class I-II (mild changes)** - ACEi and ARB for renal protection **Class III-V** - Immunosuppression

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