renal diseases Flashcards by Eilidh Edmiston

what is nephrotic syndrome

collection of symptoms due to glomerular disease

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what are the symptoms of nephrotic syndrome

proteinuria
hypoalbuminaemia
oedema
(hyperchloesterolaemia)

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what does nephrotic syndrome indicate

non-proliferative process affecting podcytes

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what is nephritic syndrome

signs and symptoms of glomerulonephritis

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what does nephritic syndrome indicate

proliferative process affecting endothelial cells

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what are the symptoms of nephritic syndrome

AKI
oliguria 
haematuria 
hypertension 
active urinary sediments

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what is chronic kidney disease

abnormal kidney function and/or structure

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what are the causes of chronic kidney disease

diabetes
hypertension
glomerulonephritis

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what are the symptoms of chronic kidney disease

anaemia
fatigue/muscle weakness
weight loss
hypertension

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what are the symptoms of advanced uraemia found in chronic kidney disease

uraemic frost
twitching
conffusion
pericardial rub/effusion

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what are the investigations of chronic kidney disease

U&amp;Es
eGFR
creatinine
ACR
GFR:Creatinine

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what are the stages of chronic kidney disease

G1 = eGFR >90
G2 = eGFR 60-89
G3a = eGFR 45-59
G3b = eGFR 30-44
G4 = eGFR 15-29
G5 = eGFR <15

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what is the treatment of chronic kidney disease

control BP
lower lipids 
RAAS inhibition 
correct anaemia
lifestyle

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what is the BP target in chronic kidney disease

<140/90

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what is the BP target in chronic kidney disease with diabetes

<130/80

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what is used to lower lipids in chronic kidney disease

statin (atorvastin 20mg)

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what is used to control BP in chronic kidney disease

ACEI or ARB

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what is the target iron levels in chronic kidney disease

100-120g/L

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what is the iron therapy given in chronic kidney disease

venofer or ferinject

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what is an acute kidney injury

abrupt (<48hrs) reduction on kidney function

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what must be done before diagnosis of acute kidney injury

fluid resus

exclusion of obstruction

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what must be present to be classed as an acute kidney injury

serum creatinine >26.4
OR increase in creatinine by 50%
OR reduction in urine output

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what medications can cause an acute kidney injury

gentamicin
metformin
ACEI/ARBs
trimethoprim

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what are the 3 categories of acute kidney injury causes

pre-renal
renal
post-renal

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summarise the pre-renal causes of acute kidney injury

anything that reduces the circulating volume to kidney

give examples of pre-renal causes of acute kidney injury

hypovolaemic: - haemorrhage - volume depletion (D&V, burns) hypotension: - cardiogenic shock (HF) - sepsis renal hypofusion - NSAIDs - ACEL/ARBSs

summarise renal causes of acute kidney injury

inflammation or damage to the kidney cells

give examples of renal causes of acute kidney injury

vasculitis glomerulonephritis interstitial nephritis tubular injuries

what could cause a tubular injury in the kidneys

ischaemia gentamicin contrast rhadbomyolysis

what could cause interstitial nephritis

drugs infection e.g. TB sarcoidosis

give examples of post-renal causes of acute kidney injury

stones cancer strictures extrinsic pressure

summarise post-renal causes of acute kidney injury

obstruction of urine flow causing back pressure

what are the symptoms of a pre-renal acute kidney injury

oliguria | acute tubular necrosis

what are the symptoms of a renal acute kidney injury

``` eosinophilia vascular bruits non-specific - itch - Nausea & vomiting - fluid overload ```

what are the investigations of acute kidney injury

``` U&Es FBC urinalysis US/CT immunology = vasculitis ```

what is the treatment of post-renal acute kidney injury

relieve obstruction

what is the treatment of pre-renal acute kidney injury

replace fluids

what is acute tubular necrosis

most common form of acute kidney injury in hospital

what is the cause of acute tubular necrosis

decreased renal perfusion

what is hyperkalaemia, what is it a complication of

>5.5 complication of acute kidney injury

what are the investigations of hyperkalaemia

ECG | K+ levels

what is the treatment of hyperkalaemia

10mls 10% calcium gluconate 10 units insulin with 50ml 50% dextrose salbutamol nebs

what is the treatment of chronic hyperkalaemia

calcium resonium

what is glomerulonephritis

immune mediated disease of the kidneys which affects the glomeruli

what type of inflammation does glomerulonephritis cause

non-infective inflammation

what are the symptoms of glomerulonephritis

``` haematuria proteinuria hypertension impaired renal function (CDK/AKI) nephrotic syndrome nephritic syndrome ```

what symptoms are caused by damage to the endothelial or mesangial cells

``` haematuria proliferative lesion(s) ```

what symptoms are caused by damage to the podocyte

proteinuria | non-proliferative lesion

what are the investigations of glomerulonephritis

urinalysis urine microscopy kidney biopsy

how do you quantify proteinuria

24hr urine collection | urine protein:creatinine ratio

what is the treatment of glomerulonephritis

``` anti-hypertensives (ACEI/ARBs) statins duiretics diet advice immunosuppression ```

what is the immunosuppression treatment of glomerulonephritis

corticosteriods | azathioprine

what is the target BP in glomerulonephritis

<130/80 | <120/75 if proteinuria is present

what are the types of glomerulonephritis (6)

``` minimal change focal segmental membranous nephropathy IgA nephropathy rapidly progressive membranoproliferative ```

what is the treatment of minimal change glomerulonephritis

1st line = oral steroids | 2nd line = cyclophosphamside/CSA

what would expect on a biopsy of minimal change glomerulonephritis

normal

can minimal change glomerulonephritis lead to real failure

nope

what is the most common cause of nephrotic syndrome in children

minimal change glomerulonephritis

what is the most common cause of nephrotic syndrome in adults

Focal segmental glomerulosclerosis

what are the causes of Focal segmental glomerulosclerosis

``` primary secondary: - HIV - heroin - obesity - reflux nephropathy ```

what would you expect on biopsy of Focal segmental glomerulosclerosis

focal and segmental sclerosis (duh)

what is the treatment of Focal segmental glomerulosclerosis

steroids

what is the 2nd most common cause of nephrotic syndrome in adults

Membranous Nephropathy

what is the cause of Membranous Nephropathy

primary secondary: - infections - SLE - cancer = lung, colon, melanoma - drugs

what drugs can cause Membranous Nephropathy

gold penicillamine NSAIDs captopril

what would you expect on biopsy of Membranous Nephropathy

``` thick membranes (duh) subepithelial immune complex deposition in basement membrane ```

what is the treatment of Membranous Nephropathy

steroids alkylating agents B cell monoclonal antibodies

what is the most common glomerulonephritis

IgA nephropathy

what are the symptoms of IgA nephropathy

asymtpomatic microhaematuria ± non-nephrotic range proetinuria

when do symptoms of IgA nephropathy usually occur

after a resp infection

what would you expect on biopsy of IgA nephropathy

mesangial cell proliferation and expansion | IgA deposits in mesangial (duh)

what immune marker would you check for in IgA nephropathy

Anti-TTG

what is the treatment of IgA nephropathy

BP control via ACEI/ARB

what would you expect see on membranoproliferative glomerulonephritis under the microscope

big lobulated hypercellular glomeruli with thick membranes

what does rapidly progressive glomerulonephritis result in

rapid deterioration in renal function over days/weeks

what is the cause of rapidly progressive glomerulonephritis

vasculitis goodpastures SLE HSP

what would you expect to see on biopsy of rapidly progressive glomerulonephritis

glomerular crescents

what is the marker for goodpastures

GMB

what is the marker for vasculitis

ANCA

what is the treatment of rapidly progressive glomerulonephritis

immunosuppresion plasmapheresis dialysis if needed

what drugs are used for immunosuppression in rapidly progressive glomerulonephritis

steroids = IV methylprednisolone or oral prednisolone | cyclophosphamide/mycopheolate/azathioprine

renal diseases Flashcards

(81 cards)