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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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| Ultrasound diagnostic criteria (in patients with positive family history) ADPKD | show 🗑
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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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| Normal anion gap ( = hyperchloraemic metabolic acidosis) | show 🗑
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| show |
1. Rise in creatinine of 26 micromol/L or more in 48 hours OR
2. >= 50% rise in creatinine over 7 days OR
3. Fall in urine output to less than 0.5ml/kg/hour for more than 6 hours in adults (8 hours in children) OR
4. >= 25% fall in eGFR in children / you
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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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| show | : male gender, proteinuria (especially > 2 g/day), hypertension, smoking, hyperlipidaemia, ACE genotype DD
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| show | Common (>1 in 10)
diuretics, caffeine & alcohol
diabetes mellitus
lithium
heart failure
Infrequent (1 in 100)
hypercalcaemia
hyperthyroidism
Rare (1 in 1000)
chronic renal failure
primary polydipsia
hypokalaemia
Very rare (<1 in 10 000)
diabetes insipi
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| Nephrotic syndrome: complications | show 🗑
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| show | CMV infection presents with a mononucleosis-like syndrome with fever, myalgia and arthralgia. There is often a leukopaenia, atypical lymphocytosis with a mild rise in transaminases and graft dysfunction.
Specific organ involvement can lead to hepatitis,
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| complications of AV fistula | show 🗑
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| show |
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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| Rhabdomyolysis causes | show 🗑
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| Rhabdomyolysis features | show 🗑
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| Causes of nephrogenic DI | show 🗑
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| Dialysis disequilibrium syndrome | show 🗑
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| Amyloidosis: types | show 🗑
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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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| show |
smoking
lower respiratory tract infection
pulmonary oedema
inhalation of hydrocarbons
young males
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| Acute interstitial nephritis Causee | show 🗑
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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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| show |
Goodpasture's syndrome
Wegener's granulomatosis
others: SLE, microscopic polyarteritis
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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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| show |
the evidence base currently supports the use of intravenous 0.9% sodium chloride at a rate of 1 mL/kg/hour for 12 hours pre- and post- procedure. There is also evidence to support the use of isotonic sodium bicarbonate
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| show | ADPKD: features
hypertension
recurrent UTIs
abdominal pain
renal stones
haematuria
chronic kidney disease
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| show |
liver cysts (70% - the commonest extra-renal manifestation): may cause hepatomegaly
berry aneurysms (8%): rupture can cause subarachnoid haemorrhage
cardiovascular system: mitral valve prolapse, mitral/tricuspid incompetence, aortic root dilation, aortic
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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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| Haemolytic uraemic syndrome is generally seen in young children and produces a triad of: | show 🗑
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| show |
classically Shiga toxin-producing Escherichia coli (STEC) 0157:H7
pneumococcal infection
HIV
rare: systemic lupus erythematosus, drugs, cancer
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| sevelamer | show 🗑
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| Features of renal cell carcinoma | show 🗑
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| Causes of Fanconi syndrome | show 🗑
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| HIV-associated nephropathy (HIVAN) | show 🗑
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| show |
more common in middle-aged men
smoking
von Hippel-Lindau syndrome
tuberous sclerosis
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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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| electron microscopy: subendothelial and mesangium immune deposits of electron-dense material resulting in a 'tram-track' appearance | show 🗑
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| electron microscopy: intramembranous immune complex deposits with 'dense deposits | show 🗑
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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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| show | FSGN
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| show |
Lower back/flank pain is the most common presenting feature. Fever and lower limb oedema is also seen in some patients.
Associations
Riedel's thyroiditis
previous radiotherapy
sarcoidosis
inflammatory abdominal aortic aneurysm
drugs: methysergide
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| Renal papillary necrosis Causes | show 🗑
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| GOLDMARK | show 🗑
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| show |
chronic kidney disease who have accelerated progression of chronic kidney disease, have persistent haematuria, have symptoms of urinary tract obstruction, have a family history of polycystic kidney disease (if older than 20 years), have a estimated GFR
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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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| Management of Cystinuria | show 🗑
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| Diagnosis of Cystinuria | show 🗑
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