Renal/Uro

Question 1

Nephrotic syndrome triad:

Answer 1

Oedema
Proteinuria (becomes frothy)
Hypoalbuminaemia

NB. Also:
- clot risk due to incr viscosity of blood and leakage of proteins that help prevent clotting (anti thrombin 3, protein C&S)
- high ch / fats (ch made by liver to compensate for low serum oncotic pressure; reduced clearance fats insoluble) -> fatty casts in urine
- hypothyroid (loss of thyroid hormone)
- infections (loss of immunoglobulin proteins)

Question 2

Follow up if renal involvement with HSP (haematuria/proteinuria)

Answer 2

Continue f/u as long as urinalysis abnormal
- weekly urine dips for first month then 2 weekly for 6 months till clear
??
Thereafter –>
No proteinuria:
BP + urine dip D7, 14 and 1, 3, 6, 12m

Proteinuria:
BP + urine dip D7, 14, and monthly 1-6m then 12m

Question 3

What might a biopsy of skin/kidney show in HSP?

Answer 3

High levels of IgA

Question 4

Blood test results in post-strep glomerulonephritis

Answer 4

Low eGFR, raised Cr
ASOT +ve
Low complement (resolves ~1m post onset)

Question 5

Urinalysis + microscopy in PSGN

Answer 5

Haematuria
Proteinuria
Red cell casts, tubular casts –> cola coloured urine

Question 6

Medications in PSGN

Answer 6

Abx for all

Diuresis
- furosemide if significant overload/HTN

Anti-hypertensives
- Ca channel blockers preferred over ACEi due to hyperK+ risk

Question 7

Difference between PSGN and IgA nephropathy

Answer 7

PSGN - haematuria delay after URTI (1-2w)

IgA neph - haematuria at time of URTI

Question 8

Difference between PSGN and C3 glomerulonephritis

Answer 8

Clinically identical
C3GN can also be triggered by URTI

C3GN: persistence of low complement (+ abnormal urinalysis) >6w post onset

Question 9

Cause of primary VUR

Answer 9

Congenitally short passage of ureter through bladder

Question 10

Cause of secondary VUR

Answer 10

Abnormally high pressure in bladder caused by:
- PUV
- neurogenic bladder e.g. spina bifida
- ureterocele