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| show | (FSGS) is a cause of nephrotic
young adults.
Causes
idiopathic
other renal pathology e.g. IgA nephropathy, reflux nephropathy
HIV
heroin
Alport's syndrome
sickle-cell
Investigations
renal biopsy
focal and segmental sclerosis and hyalinosis on light mi
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two cysts, unilateral or bilateral, if aged < 30 years
two cysts in both kidneys if aged 30-59 years
four cysts in both kidneys if aged > 60 years
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| show | epithelial crescents in the majority of glomeruli.
Causes
Goodpasture's syndrome
Wegener's granulomatosis
SLE, microscopic polyarteritis
Features
nephritic syndrome: haematuria with red cell casts, proteinuria, hypertension, oliguria
features specific
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gastrointestinal bicarbonate loss: diarrhoea, ureterosigmoidostomy, fistula
renal tubular acidosis
drugs: e.g. acetazolamide
ammonium chloride injection
Addison's disease
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| criteria for diagnosing AKI | show 🗑
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| Refer to a nephrologist if any of the following apply: | show 🗑
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| IgA GN associated conditions | show 🗑
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| markers of poor prognosis in IgA nephritis | show 🗑
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| Causes of Polyuria | show 🗑
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| Nephrotic syndrome: complications | show 🗑
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| CMV in transplanted | show 🗑
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| show |
infection
thrombosis
may be detected by the absence of a bruit
stenosis
may present with acute limb pain
steal syndrome
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idiopathic
post head injury
pituitary surgery
craniopharyngiomas
histiocytosis X
DIDMOAD is the association of cranial Diabetes Insipidus, Diabetes Mellitus, Optic Atrophy and Deafness (also known as Wolfram's syndrome)
haemochromatosis
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| show | seizure
collapse/coma (e.g. elderly patients collapses at home, found 8 hours later)
ecstasy
crush injury
McArdle's syndrome
drugs: statins (especially if co-prescribed with clarithromycin)
overexertion, compartment syndrome, drugs eg. statins, neurolepti
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acute kidney injury with disproportionately raised creatinine
elevated creatine kinase (CK)
myoglobinuria
hypocalcaemia (myoglobin binds calcium)
elevated phosphate (released from myocytes)
hyperkalaemia (may develop before renal failure)
metabolic acido
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| Causes of nephrogenic DI | show 🗑
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| Dialysis disequilibrium syndrome | show 🗑
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| show |
AL amyloidosis
the most common form of amyloidosis
L for immunoglobulin Light chain fragment
due to myeloma, Waldenstrom's, MGUS
features include: nephrotic syndrome, cardiac and neurological involvement, macroglossia, periorbital eccymoses
AA amyloid
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| ADPKD: features | show 🗑
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| show | The peak incidence for teratomas is 25 years and seminomas is 35 years. Risk factors include:
infertility (increases risk by a factor of 3)
cryptorchidism
family history
Klinefelter's syndrome
mumps orchitis
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| Acute interstitial nephritis causes | show 🗑
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smoking
lower respiratory tract infection
pulmonary oedema
inhalation of hydrocarbons
young males
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| show | drugs: cephalosporin, penicillin, clarithromycin, rifampicin, NSAIDs, allopurinol, furosemide
systemic disease: SLE, sarcoidosis, and Sjögren's syndrome
infection: Hanta virus , staphylococci, legionella, CMV, streptococcal)
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| show |
fever, rash, arthralgia
eosinophilia in the urinalysis
mild renal impairment
hypertension
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| Treatment of Goodpasture's has three main principles: | show 🗑
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| Plasmapheresis in Goodpasture's is indicated in the following: | show 🗑
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| Rapidly progressive glomerulonephritis Causes | show 🗑
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| ECG features hypokalamia | show 🗑
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| show |
known renal impairment (especially diabetic nephropathy)
age > 70 years
dehydration
cardiac failure
the use of nephrotoxic drugs such as NSAIDs
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| Prevention of nephrotoxicity due to contrast media | show 🗑
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| show | ADPKD: features
hypertension
recurrent UTIs
abdominal pain
renal stones
haematuria
chronic kidney disease
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| Extra-renal manifestations of ADPKD | show 🗑
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| Prevention of renal stones | show 🗑
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| what increases the risk of AKI: | show 🗑
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| It also defines the criteria for diagnosing AKI | show 🗑
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| show |
1. Renal tranplant
2. ITU patient with unknown cause of AKI
3. Vasculitis/ glomerulonephritis/ tubulointerstitial nephritis/ myeloma
4. AKI with no known cause
5. Inadequate response to treatment
6. Complications of AKI
7. Stage 3 AKI (see guideline for
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| show |
acute kidney injury
microangiopathic haemolytic anaemia
thrombocytopenia
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| causes of secondary (termed 'typical HUS'): | show 🗑
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| sevelamer | show 🗑
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| show |
classical triad: haematuria, loin pain, abdominal mass
pyrexia of unknown origin
left varicocele (due to occlusion of left testicular vein)
endocrine effects: may secrete erythropoietin (polycythaemia), parathyroid hormone (hypercalcaemia), renin, ACTH
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| Causes of Fanconi syndrome | show 🗑
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| HIV-associated nephropathy (HIVAN) | show 🗑
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| Renal cell cancer Associations* | show 🗑
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| is the commonest type of glomerulonephritis in adults and is the third most common cause of end-stage renal failure (ESRF). | show 🗑
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| show |
hypocalcaemia: due to the presence of citrate used as an anticoagulant for the extracorporeal system
metabolic alkalosis
removal of systemic medications
coagulation factor depletion
immunoglobulin depletion
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| Indications for plasma exchange (also known as plasmapheresis) | show 🗑
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| show | mesangiocapillary glomerulonephritis type 1
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| show | mesangiocapillary glomerulonephritis type 2
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| show |
Next question
Calciphylaxis
Calciphylaxis is a rare complication of end-stage renal failure.
Due to deposition of calcium within arterioles causing microvascular occlusion and necrosis of the supplied tissue.
The risk is linked to hypercalcaemia, h
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| renal biopsy focal and segmental sclerosis and hyalinosis on light microscopy effacement of foot processes on electron microscopy | show 🗑
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| Retroperitoneal fibrosis Associations | show 🗑
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| show |
Renal papillary necrosis
severe acute pyelonephritis
diabetic nephropathy
obstructive nephropathy
analgesic nephropathy
phenacetin was the classic cause but this has now been withdrawn
NSAIDs
sickle cell anaemia
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| show |
The causes of a raised anion gap can be remembered using the mnemonic GOLDMARK: glycol (ethylene glycol), oxoproline, L-lactate, D-lactate, methanol, aspirin, renal failure, ketoacidosis.
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| Renal ultrasound is recommended by NICE guidance for patients with? | show 🗑
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| show | is the volume of fluid filtered from the glomerular capillaries into the Bowman's capsule per unit time. GFR is a key measure of renal function in clinical practice
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| renal clearance | show 🗑
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| show |
hydration
D-penicillamine
urinary alkalinization
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| show | cyanide-nitroprusside
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