what is the presentation of renal vein thrombosis?
- loin/flank pain
- deterioration in renal function
- palpable kidney
what are the causes/RF for renal vein thrombosis?
- extrinsic compression by tumour
- invasion by tumour e.g. renal cell carcinoma
- nephrotic syndrome - hypercoagulable state
how is renal vein thrombosis diagnosed?
- renal angiography in venous phase
- also do doppler US, CT, MRI
what is the treatment of renal vein thrombosis?
- anticoagulant with warfarin for 3-6 months
- INR 2-3
what are the advantages of indapamide over bendroflumethiazide?
- less hypoNa
- no effect on insulin resistance so can use better in DM
why is PTH high in CRF?
- 1. low calcium as low active vitD as less 1alpha hydrox
- 2. high phosphate levels as kidneys fail to excrete
- 3. low 1.25(OH)2vitD3
how is hyperPTH in CRF managed?
- give calcium carbonate with meals
- alpha calcidiol (active vitD analogue)
- calcichew - phosphate binders in gut
- normally start on vitamin D supplement alone and this may normalise PTH alone
what is the commonest type of GN in the world?
IgA nephropathy (Berger's disease)
how does Berger's disease typically present?
- young man
- episodic macro/microscopic haematuria
- few days after URTI - pharyngitis
- recovery is rapid between attacks
- overproduction of IgA forms immune complex and deposits in mesangial cells
what does renal biopsy of IgA nephropathy show?
- mesangial proliferation
- IF: IgA and C3 deposits
if patients with IgA nephropathy have HTN, what is Rx?
what is medullary sponge kidney characterised by?
- dilatation of collecting ducts in papillae
- so stasis or urine
what is the appearance of medullary sponge kidney on AXR?
- multiple pre-calyceal calcifications affecting both kidneys
- bunch of grapes appearance
what are the clinical features of medullary sponge kidney?
- intermittent colic - renal stones: costovertabral angle pain
- unlike PKD - cysts are not seen elsewhere in the body and renal failure is uncommon
- metabolic acidosis due to RTA
how is medullary sponge kidney diagnosed?
what is the management of medullary sponge kidney?
prevent complications - so increase fluid intake if get recurrent UTI/stones
if an IVDU has systemic vasculitis and cryoglobulins in blood. what is the likely cause
where do cholesterol emboli usually come from and where do they lodge?
- from: atheromatous plaques in aorta
- lodge: distal microcirculation e.g. renal vessels, peripheral circulation, GIT to cause ischaemia
What are the signs of cholesterol emboli?
- livedo reticularis
- GI bleed
- renal failure
- inflam response: fever, myalgia, high eosinophils
what are the risk factors for cholesterol emboli?
- high cholesterol
- arterial catheterisation
if a patient has renal failure, raised CK and raised K+ and been immobile what is diagnosis?
why do you get renal failure in rhabdomyolysis?
skeletal muscle breakdown release myoglobin which is filtered by glomeruli and precipitates and therefore obstructs renal tubules
what are the causes of rhabdomyolysis?
- prolonged immobilisation after faul
- crush injury
- excessive exercise
- uncontrolled seizures
in renal artery stenosis, which drug (antiHTN) is specifically CI and why?
- ACEi as angiotensin II is required for vasoconstriction of efferent arteriole to maintain GFR especially in states of reduced renal perfusion such as RAS.
- without angiotensinII, get decrease in GFR
which drug needs to be given in SAH to prevent a severe complication?
- nimodipine - CCB
- prevent vasospasm
why do you get polycythaemia in PKD?
why are ACEi useful in nephrotic syndrome?
what defines oliguria?
< 400ml urine/day
what are the 3 main biochem/urine features of ARK?
- inc creatinine (>130)
- inc urea (> 6.7)
- oliguria (<400ml/day)
what are the symptoms of ARF? (categorise)
- Cardiopulmonary: SOB due to pulm oedema and anaemia, uraemic pericarditis - pericardial effusion and tamponade, palpitations, arrhythmia (inc K+)
- Systemic metabolic acidosis: Kussmaul's respiration
- Neuro: uraemic encephalopathy, weak, faituge, mental confusion, seizure, coma
- Skin: pallor (anaemia), pruritis, pigmentation, bruising (plt func down)
- GI: N+V, anorexia
- Haem: anaemia. impaired platelet function - bruise and GI bleed, frank haematuria, prolonged nosebleeds, purpura
what are the signs/symptoms of hypoNa?
- oedema (heavy legs)
- cardiac failure
what are the signs/symptoms of hyperNa?
- signs of dehydration: dry skin, reduced skin turgor, post hypo, oliguria
what is the treatment of uraemia pericarditis/enceph?
what are the symptoms of raised ICP?
- behavioural change
what is the treatment for raised ICP? and its SE?
name 2 types of loop diuretics
what is nephritic syndrome?
what are the associated features of nephritic syndrome?
what is the main cause of nephritic syndrome?
immune response leading to glomerular inflammation
name 5 causes of nephritic syndrome
- Berger's (IgA nephropathy)
- Wegener's granulomatosis
- post strep GN
middle aged patient, oedema, HTN, 2 sinus drainage this yr. whats the diagnosis?
pt < 20yo, URTI, frank haematuria. whats the diagnosis?
Berger's disease IgA nephropathy
age < 40, deafness, cataracts, kidney probs. whats the diagnosis?
20yo, haemoptysis, hypertension, oedema (kidney probs). whats the diagnosis?
Goodpastures (haemoptysis is central feature) - young male
young man, after sore throat/skin infection get nephritic. whats the diagnosis?
Post strep GN
what increases the risk of goodpastures?
smoking, young male
what is the treatment of wegener's?
what is the treatment of goodpastures?
- plasmapheresis - remove autoAb
what are the features of alports on biopsy?
- focal segmental glomerulosclerosis
- thickened and split BM
- IgM C3 deposits in affected (focal) areas
what type of GN do Wegeners and goodpastures cause?
rapidly progressive GN
what is the main cause of proliferative GN and how does it present?
- post strep GN (after sore throat or skin infec - e.g. impetigo)
- presents as nephritic syndrome
middle aged man, oedema, periorbital darkness, haematuria. whats the diagnosis?
- membranous nephropathy
- (most common cause of nephrotic syndrome in adults)
- biopsy: thick BM, IgG, C3 deposits
what are the complications of nephrotic syndrome, why? how Rx?
- loss of proteins - albumin and Ig so
- 1. more infections - abx prophylaxis
- 2. liver compensates and makes more lipoproteins - more chol and TG - statins
- 3. liver makes more clotting factors - DVT, PE
- 4. renal vein thrombosis - prophylactic heparin and early mobilisation
which Ix need to be done in nephrotic syndrome?
- 24 hour urine collection to determine protein loss
- then biopsy after assessment of possible causes
which anti complement Ab is specific for SLE?