Week 14 - Nephrology

Card Set Information

Author:
mewinstanley@googlemail.com
ID:
131975
Filename:
Week 14 - Nephrology
Updated:
2012-01-31 12:26:09
Tags:
Nephrology
Folders:

Description:
kidney stuff, glomerulonephritis, nephrotic, nephritic etc.
Show Answers:

Home > Flashcards > Print Preview

The flashcards below were created by user mewinstanley@googlemail.com on FreezingBlue Flashcards. What would you like to do?


  1. What are the Pc of Glomerulonephritis?
    • Hypertension
    • Haematuria
    • Reduced GFR
    • Nephrotoc syndrome
    • Nephritic Syndrome
    • Rapid progressing GN → 6wks to ESKD
  2. What are the features if NEPHROTIC syndrome?
    • Nephrotic Syndrome
    • Heavy proteinuria
    • Hypoalbuminaemia
    • Oedema
    • Hyperlipidaemia → side effect of liver ^^protein

    • HOHO?
    • Hypoalbuminaemia, prOteinuria, Hyperlipidaemia, Oedema
  3. What are the features of the NEPHRITIC syndrome?
    • Nephritic
    • Haematuria [with casts]
    • Oliguria [<400ml/day]
    • Hypertension
    • Ureamia

    • A.k.a PHARAOH
    • Proteinuria
    • Hematuria
    • Azotemia
    • RBC casts
    • Anti-strep titres (if post-strep)
    • Oliguria
    • Hypertension
  4. Give 4 types of GN?
    • IgA nephropathy → commonest
    • Membraneous GN
    • Minimal Change Disease
    • RPGN [Rapidly progressing GN]
    • Wegeners Granulomatosis
    • Post infectious GN
  5. Outline the clinical & pathological features of IgA nephropathy?
    • CF
    • Haematuria, Proteinuria, hypertension & renal impairment
    • ~Nephrotic Syndrome

    • Patho
    • Deposition of IgA in mesangium → activation of mesangial
    • scar formation
    • loss of capillary integrity
  6. What is the CF & Patho of Membraneous GN?
    • CF
    • Proteinuria, Nephrotic syndrome, hypertension, renal impairment
    • Commonest cause of nephrotic syndrome in adults

    • Patho
    • Deposition of immune complexes in GBM & Mesangium [tumours, lupus]
    • Alters GBM charge
    • Altered permeable selectivity
    • Thickens GBM
  7. What are the CF & patho of minimal change disease?
    • CF
    • Acute, Normal GFR, Nephrotic syndrome [puffy eyes]
    • commonesst cause of nephrotic in kids

    • Patho
    • EM shows podicyte fusion, T cell associated
  8. For Rapidly progressing glomerulonephritis give the CF & pathology.
    • CF
    • Rapid onset, haematuria, roteinuria, hypertension, renal impairment, haemoptysis, systemic symptoms [malaise, fever]
    • e.g. Wegeners/ Goodpastures

    • Patho
    • Goodpastures → anti GBM disease, cellular destruction & crescent formation
    • Wegeners Granulomatosis → necrotising vasculitis, nasal, pulmonary & renal symptoms ANCA +ve
  9. Outline the features f a GN screen?
    • Serum biochem → Cr & Albumin
    • FBC → Hb, CRP, WCC
    • Immunology → antibodises & electrophoreisis → ANCA, RhF, ANF & Anti-GBM
    • U/O → Dipstix, PCR, Microscopy & MSSU
    • Imaging → CXR, Renal U/S
  10. Give 5 risk factors for UTI?
    • Infancy [<1yo]
    • Abn Urinary tract [congenital malformation]
    • Female → esp pregnant
    • Bladder dysfunction/ incomplete emptying → ^^prostate
    • Foreign bodies in tract → stones, catheters
    • DM
  11. What are the CF of Pyelonephritis?
    • Bacteruria & fever >38 = Pyelonephritis
    • Systemic symptoms [fever, malaise, lethargy]
    • vomiting, loin pain
  12. What are the CF of a lower UTI/ Cystitis?
    • Bacteruria & abscence of systemic features = cystitis
    • Non-specific abdo pain
    • urgency, frequency, wetting, frank haematuria
  13. Outline the pathology of Pyelonephritis?
    • Ascending infection
    • urethral colonisation by infective org
    • multiplication in bladder
    • reflux to kidneys [pathophysiological]
    • VUR → vesicoureteral reflux
    • Female > male

    • Haematogenous Infection
    • Infection includes renal parenchyma
    • Gram +ve infection more common

    Chronic can lead to scarring
  14. Outline the diagnostic tests for suspected UTI?
    • Dx
    • Urinalysis → leucocytes + Nitrites = UTI
    • Microscopy/ Flow cytometry → neutrophils & bacteria
    • Urine C+S
  15. What are the common orgs for UTI?
    • Usually single org infection
    • ?multiple → change catheter

    • Gram neg → Proteus, E coli, Klebsiella & psuedomonas
    • Gram pos → enterococcus, staph aureus [red flag]

    ?anaerobes → bladder cancer
  16. How would a UTI be treated?
    • 3-7d course of;
    • Amoxicillin
    • or trimethoprim
    • or Nitrofurantoin
  17. For renal cell carcinoma give
    -Pathology
    -Pc
    -Mx
    • Renal [Clear] cell Ca
    • Patho → adenocarcinoma of PCT, can ascend IVC

    Pc → loin pain, palpable mass, Frank haematuria

    Mx → radical nephrectomy/ nephron sparing surgery
  18. For Prostate Ca give
    -Pc
    -Patho
    -Tx
    Pc → painful micturation, cant initiate urination easily, recurring UTI

    Patho → Adenocarcinoma [peripheral zone of prostate], central zone = benign adenoma

    Tx → watchful waiting, PSA ea 3m [not tumour specific], Rt/ radical prostectomy
  19. For bladder cancer give
    -RF
    -Pc
    -Pathology
    RF → smoking, rubber/ dye industry, schistosomiasis

    Pc → frank haematuria [usually painless]

    Pathology → majority = transitional cell Ca, some SCC

    Tx → transurethral resection, radical cystectomy
  20. Give 4 causes of urinary calculi?
    • OBSTRUCTION
    • Calyceal diverticulum
    • Pelviureteric junction obstruction [congenital]
    • Ureteric stricture
    • Foreign body
    • UTI
    • Proteus infection → urease, change pH ^^stones
  21. Outline the mechanism of calculi formation
    • Obstruction → urine superconcentration
    • particle gets fixed to renal papilla [seed crystal]
    • Growth of stone

    pH dependant → works better at low pH [Proteus infection]
  22. What are the 4 types of calculi?
    • Staghorn → infection, calyceal location
    • Calyceal
    • Renal Pelvis
    • Ureteric Calculi
  23. Outline the Mx of Renal Calculi?
    • Small stones → watch & wait
    • Lithotripsy → shockwave degradation of stone
    • Open surgery → large/complicated stone
    • Laproscopic
  24. Give the histopathology of Diabetic nephropathy?
    • ^^[Glucose] & HBP mediated damage to glomerulus
    • ^^mesangium
    • Sclerosed nodules
    • Thickened Glycated GBM
    • Podocytes absent
  25. Outline the Pc & Mx of diabetic nephropathy?
    • Pc
    • Proteinuria [microalbuminuria]
    • HBP
    • retinopathy
    • worsening oedema
    • Uraemic coma

    • Mx
    • <120sys → ACEi
    • eventually dialysis
  26. What would the signs of renal artery stenosis be?
    • HBP
    • carotid & femoral bruits
    • asymmetrical kidnys
    • excretory renal impairment
  27. What are the renal presentations of myeloma?
    AKI/CKD

    Light chains [Bence-jones protein] are toxic to proximal tubule
  28. What are the causes of AKI?
    [ARF]
    • Pre-renal
    • hypoperfusion → haemorrhage, pump failure, antihypertensives
    • hypovolaemia
    • Sepsis

    • Renal [Intrinsic]
    • Glomerular [vasculitis] → acute GN [e.g. IgA nephropathy etc]
    • Tubular → acute tubular necrosis [ATN], myeloma, rhabdomyolysis
    • Large BV?

    • Post renal
    • obstruction; renal pelvis → urethral meatus
  29. What is ATN?
    What are the histological features of ATN?
    What are the causes of ATN?
    • Acute Tubular necrosis
    • Damage to renal tubular cells by iscaemia [hypoperf/hypovolaemia] or nephrotoxins [contrast, gentamicin, amphotericin B, myoglobin]

    Histological → tubules occluded by cellular debris
  30. Outline the diagnostic process in the Pt w AKI?
    • 1. Acute/ Chronic
    • Comorbidities suggest chronic e.g. DM
    • Previously abn blood tests, small kidneys → chronic
    • Abscence of anaemia, low Ca & ^^phos → acute

    2. Rule out obstruction

    • 3. Rare causes of AKI?
    • GN → urgent renal referral
  31. Outline the management of AKI?
    • Monitor & correct K+ dereangements
    • Restore perfusion
    • remove causes → drugs/ sepsis
    • Exclude obstruction
    • Consider renal causes → GN screen [ANCA, ANA, electrophoreisis, aGBM, urine Bence jones (myeloma)]
  32. What are the stages of Chronic Kidney Disease? [CKD]
    1 → Kidney dam but normal function, GFR>90

    2→ Kidney dam, mild drop in GFR 60-89

    3→ moderate dec in GFR 30-59

    4 → severly low GFR 15-29

    5 → kidney failure/ dialysed, GFR <15
  33. What is a 'salt losing' CKD Pt?
    • Salt loser
    • Medulla [tubular] damage → lose concentration/ acidification
    • salt loss → water loss

    Pc → dehydration, hypotension, acidosis
  34. What is a 'salt retaining' CKD Pt?
    • Salt Retaining
    • Cortex [Glomerular] damage → lose filtration ability
    • Salt retention → water rentention

    Pc → oedema, hypertension
  35. What would the blood results for the following be in a CKD Pt?
    -FBC
    -pH
    -Ca & PO4
    FBC → anaemia [no EPO production]

    pH → Acidotic salt losing Pts

    Ca & PO4 → ^^PO4, low Ca, not hydroxylating vit D cant abs Ca, stim of PTH → release of Ca & phos from bone

What would you like to do?

Home > Flashcards > Print Preview