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Year 3 Medicine Block > RENAL: nephrotic and nephritic syndrome > Flashcards

RENAL: nephrotic and nephritic syndrome Flashcards

1
Q

What triad of signs are characteristic of nephrotic syndrome?

A

Oedema
Albumin <30
Unine PCR (protien:creatinine ratio) >350 aka more than 3.5g/24hrs

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2
Q

What are the complications of nephrotic syndrome?

A
  • increased risk of VTE related to loss of antithrombin III and plasminogen in the urine
    ( can also get renal vein thrombosis, resulting in a sudden deterioration in renal function)
  • hyperlipidaemia
  • increasing risk of acute coronary syndrome, stroke etc
  • ckd
  • increased risk of infection due to urinary immunoglobulin loss
  • hypocalcaemia (vitamin D and binding protein lost in urine)
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3
Q

Causes of nephrotic syndrome?

A

Minimal change disease
Focal segmental glomerulosclerosis
Membranous nephropathy
Membranoproliferative glomerulonephritis
Amyloidosis, Myeloma, DM

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4
Q

Who does minimal change disease affect?

A

Children under 6yrs.

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5
Q

Describe the pathophysiology of membranous glomerulonephritis

(AR of Urinary module)

A

Subepithelial deposition of immune complexes - i.e. these deposit between the basement membrane and podocytes.

This causes thickening of the BM

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6
Q

What conditions can predispose to secondary focal segmental glomerulosclerosis?

A

Sickle cell disease
HIV
Heroin abuse
Kidney hyper perfusion
Alport’s syndrome

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7
Q

What are features of nephritic syndrome?

A

Haematuria
Oliguria
Proteinuria <3.5g/24hr
Fluid retention
Its may also have hypertension

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8
Q

What is the most common cause of primary glomerulonephritis?

A

IgA nephropathy aka Berger’s disease

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9
Q

What is the most common cause of nephrotic syndrome in:

a) children?
b) adults?

A

a) Minimal change disease
b) Focal segmental glomerulosclerosis or in older people = diabetes

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10
Q

A patient with post-streptococcal glomerulonephritis may have ____what?____ in their recent PMH?

Hint: there are 2.

A

1-2 weeks after tonsillitis/pharyngitis
3-4 weeks after impetigo/cellulitis

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11
Q

What are main treatments for most types of glomerulonephritis?

A

Immunosupression using steroids
Blood pressure control - ACEi/ARBs

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12
Q

A patient has IgA nephropathy. What may be present in their PMH?

A

URTI: 1-2 days ago
GI infection
Strenuous exercise

Associated with: alcoholic cirrhosis

coeliac disease/dermatitis herpetiformis

Henoch-Schonlein purpura

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13
Q

In what age groups do Goodpastures syndrome incidence peak?

A

30s - usually male
60+ - usually female

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14
Q

What is the pathophyisology of Goodpastures Syndrome?

A

Antibodies against type 4 collagen (in glomerular basement membrane) develop .

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15
Q

What are complications of Goodpastures?

A

Pulmonary haemorrhage
Rapidly progressive glomerulonephritis

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16
Q

A patient has haematuria. What are your differentials?

A

Bladder cancer, prostate cancer, CKD, kidney stones, UTI, pylenonephritis, period, acute protastitis, BPH, trauma (depends on context of hx)

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17
Q

How does Anti-glomerular basement membrane disease (Goodpastures) present?

A

Typically with haemoptysis + AKI/proteinuria/haematuria

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18
Q

What part of the kidney does Nephrotic syndrome affect?

A

Glomerulus or Bowman’s capsule

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19
Q

What does proteinuria and/or haematuria indicate?

A

Damage to the glomerulus

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20
Q

A patient is losing > to 3g in 24hrs of protein in their urine. what conditions could it be?

A

Diseases that cause Nephrotic syndrome:
Diabetes
Minimal changes disease
Membranous
Focal segmental glomerular sclerosis
Amyloid

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21
Q

What is nephrotic syndrome symptoms?

A

Oedema- often periorbital swelling
Proteinaemia (> 3g in 24hrs)
Hypoalbuminaemia

Hyperlipidaemia
Hypercoagulable state

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22
Q

What is nephrotic syndrome proteinuria range?

A

> 3g in 24hrs

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23
Q

What are nephritic syndrome symptoms?

A

Haematuria
Proteinuria (less than 3g over 24hrs)
Hypertension

24
Q

What diseases present with nephritic syndrome?

A

IgA nephropathy
Lupus
Mesangial proliferative glomerulonephritis
Vasculitis

25
Q

What is the difference between nephrotic and nephritic syndrome?

A

Both manifestations of glomerulonephritis, different diseases present as either one but they are both due to damage to the glomerulus/bowmans capsule

26
Q

How is kidney function affected by glomerulonephritis?

A

V often kidney function is not affected, the damage is to the glomerulus

27
Q

What investigations would you do for a patient with suspected glomerulonephritis?

A

Urine dip- protein:creatinine, 24 hr- nephrotic syndrome: diagnostic criteria is 300. If less than this may be nephritic syndrome
Bloods- U&Es, FBC,Bone, serum glucose
Imaging

28
Q

What is the pathophysiology of minimal change syndrome?

A

Podocytes become flattened- lose ability to control amount of protein that goes into the urine

29
Q

After diabetes and hypertension, what is the most common glomerulonephritis?

A

IgA nephropathy

30
Q

What type of kidney injury can vasculitis cause?

A

Acute

31
Q

What type of kidney injury does glomerulonephritis cause?

A

Mostly chronic, however some may cause acute e.g. vasculitis

32
Q

Name three investigations you would do for suspected glomerulonephritis

A

Urine dip - protein creatinine ratio
Bloods - U&Es, FBC, Bone, Serum glucose
Imaging - USS of renal system

33
Q

What is common clinical presentation of minimal change disease in children/young adults?

A

Swelling - facial - peri-orbital swelling

34
Q

What are ddx for swelling/odema in pt with pmh of proteinuria and angina?

A

Nephrotic syndrome, HF, Liver disease

35
Q

What do patients with nephrotic syndrome need to help find cause?

A

Renal biopsy

36
Q

A lady attends a&e with DVT and oedema. What renal condition must you rule out?

A

Nephrotic syndrome - dvt can be first sign; pts with nephrotic syndrome are at risk of dvt and stroke

37
Q

How can you check pt with MCD is responding to steroids given?

A

Look at serum albumin - should be increasing if steroids are working.

38
Q

What are risks of steriods?

A

Risk of osteoporosis
Risk of DM
Weight gain
Skin thinning
Risk of infection

39
Q

What risk is associated to kidney biopsy?

A
  • Heamatoma - biopsy can damage kidney and pt presents with heamaturia
  • haematuria that may need a blood transfusion
  • Infection
  • Death
  • Formation of atriovenous aneurysm
40
Q

What is the rule of thirds in membranous glomerulonephritis?

A

1/3 get better
1/3 have a relaxing and remitting condition
1/3 progress to ESRD

41
Q

Which protein is lost in nephrotic syndrome?

A

Antithrombin III

42
Q

Why would a patient with Nephrotic syndrome develop a DVT /PE ?

A

Nephrotic syndrome is associated with a hypercoagulable state due to loss of antithrombin III and plasminogen via the kidneys

Antithrombin III inhibits coagulation by inhibiting the action of thrombin while plasminogen is involved in fibrinolysis.

43
Q

Which is higher in nephrotic syndrome LDL or HDL?

A

LDL

44
Q

Who is at risk of diabetic nephropathy?

A

T1 DM or long duration of T2 DM patients

45
Q

A patient has diabetic nephropathy. What 2 additional microvascular complications may be present?

A

Retinopathy
Peripheral neuropathy

46
Q

What is glomerulosclerosis?

A

In Diabetic nephropathy - chronic high levels of glucose pass through glomerulus and cause scarring = glomerulosclerosis

47
Q

What is key feature of diabetic nephropathy?

A

Proteinuria

48
Q

Why do we get proteinuria in diabetic nephropathy?

A

Glomerulus is damaged - so allows protein to be filtered from the blood into the urine.

49
Q

What is involved in screening for diabetic nephropathy ?

A

Urine Albumin:creatinine ratio
U&Es

50
Q

What does albumin:creatinine ration show for patient with diabetic nephropathy?

A

Raised urine albumin:creatinine ratio

51
Q

How is diabetic nephropathy managed?

A

Key: want to optimise blood sugar levels and blood pressure.

ACEi/ARB - reduces proteinuria and controls blood pressure
CVS risk modification (may involve lifestyle changes)
Continue screening for microvascular complication of diabetes e.g. retinal screening, foot checks.

52
Q

Signs present in patient with diabetic nephropathy?

A

Presence of RF: Hyperglycaemia, HTN, FHx of DM, obesity, smoker

Retinopathy, odema, foot ulcers.

53
Q

Drugs that cause acute interstitial nephritis?

A

Penicillin
Rifampicin
NSAIDS
Allopurinol
furosemide

54
Q

What is alport syndrome?

A

X-linked (usually affects males) Mutation in gene coding for Type V collagen
Associated with hearing loss and abnormalities of the eyes
Often leads to ESRF

55
Q

Presentation of alport syndrome?

A
  • Persistent microscopic haematuria with intermittent visible haematura
  • Sensorineural hearing loss
  • Biopsy: splitting of GBM and alternating thickening & thinning of GBM
  • Genetic studies – family history

Year 3 Medicine Block (56 decks)

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