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Terms in this set (34)
Reversivle causes of AKI?
Infection (sepsis, not UTI unless bilateral pyelonephritis)
Drugs (NSAIDs, ABX, PPI)
Renal causes of AKI?
- Acute interstitial nephritis
How to differentiate between pre-renal ATN and renal ATN?
Muddy brown casts will be present in pre-renal but muddy brown casts will be difficult to observe in renal ATN due to background of inflammatory cells
Causes of ATN
How to differentiate AKI from CKD?
- Small shrunken kidneys that are echogenic (similar to liver / spleen)
- Usually have previous abnormal creatinine
- Usually have retinopathy as retinopathy occurs before nephropathy
Features of glomerulopnephritis on urine tests?
Red cell casts
Features of tubulointerstitial causes of AKI on urine tests?
Muddy brown casts may be seen
Features of vascular casues of renal AKI on urine tests?
MAHA on peripheral blood film
Diagnosis of nephrotic syndrome?
Proteinuria > 3.5g/day
Dyslipidaemia (not required)
Causes of nephrotic syndrome
Complications of nephrotic syndrome?
VTE (loss of anti-thrombin III)
Sepsis (loss of Igs)
- Decreased intra-vascular volume
- Renal vein thrombosis
- Tubulointerstitial edema (increased hydrostatric pressure in bowman' space thus decreasing GFR)
Systemic diseases that can cause nephrotic syndrome?
SLE causing membranous nephropathy
Management of minimal change disease
- Sodium and fluid restriction
- Immunosuppressants (calcineurin inhibitors, cyclophosphamide)
- ACEi / ARB (HTN)
- Statins (dyslipidaemia)
- Diuretics (edema)
Secondary causes of MCD?
M - haem malignancies
A - nil
I - nil
D - NSAIDs
Secondary causes of FSGS?
M - nil
A - nil
I - HIV
D - any drugs that cause ischaemia to kidneys
Findings on light microscopy in FSGS?
EM findings in FSGS?
Podocyte foot effacement
Management of primary FSGS?
Immunosuppresants with calcineurin inhibitors or cyclophosphamide
Management of secondary FSGS?
Immunosuppression not helpful
Treat underlying cause
ACE/ARB to decrease proteinuria
Findings on light microscopy in membranous nephropathy?
GBM thickening in all glomeruli
Secondary causes of membranous nephropathy?
M - highly associated with malignancies (1/3 present before, 1/3 with and 1/3 after malignancy diagnosed)
A - SLE
I - Hep B
D - Gold, penicillamine
Findings on electron microscopy in membranous nephropathy?
Effacement of podocyte foot processes
Immunofluoresence findings in membranous nephropathy?
Diffuse IgG and C3 subepithelial deposits
Full house if SLE membranous nephropathy
Management of membranouse nephropathy?
Diagnosis of nephritic syndrome?
Microscopic haematuria with red cell casts
Subnephrotic range proteinuria
Causes of nephritic syndrome?
Post-streptoccoccal GN (rare in singapore)
Causes of membranoproliferative GN?
M - nil
A - SLE
I - Hep C
D - nil
Management of membranoproliferative GN?
Steroids if SLE
Causes of RPGN (based on immunofluorosence staining)
Linear staining - Anti-GBM disease (Goodpasture's) (Haemoptysis)
Granular staining - SLE, HSP, IgA nephropathy
No staining - Pauci immune GN, such as granulomatosis with polyangiitis / eosinophilic granulomatosis with polyangiitis
Management of RPGN
IV methylprednisolone 500-1000mg for 3 days
Daily PO prednisolone
Oral / IV cyclophosphamide
Causes of asymptomatic haematuria / proteinuria
Thin basement membrane disease (benign)
Alport's (ocular abnormalities, sensorineural hearing loss, family history of ESRF)
Classes of lupus nephritis
Class I - minimal mesangial
Class II - mesangial proliferative (asymptomatic haematuria / proteinuria)
Class III - focal proliferative (nephritic)
Class IV - diffuse proliferative (nephritic)
Class V - membranous nephropathy (nephrotic)
Class VI - ESRF
Management of Lupus nephritis (non-RPGN)
Steroids + MMF
Management of class V lupus nephritis?
If nephrotic range