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| Focal segmental glomerulosclerosis | show 🗑
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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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| Normal anion gap ( = hyperchloraemic metabolic acidosis) | show 🗑
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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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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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| 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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| Causes of cranial DI | show 🗑
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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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| show | results in cerebral oedema which can present as focal neurological deficits, papilloedema and a decreased level of consciousness. It can be treated with mannitol or hypertonic saline
likely to occur in patients with very high levels of urea, metabolic a
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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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| show | drugs: the most common cause, particularly antibiotics
penicillin
rifampicin
NSAIDs
allopurinol
furosemide
systemic disease: SLE, sarcoidosis, and Sjögren's syndrome
infection: Hanta virus , staphylococci
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| Factors which increase the likelihood of pulmonary haemorrhage in Goodpasture | show 🗑
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| Acute interstitial nephritis Causee | show 🗑
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| Features Acute interstitial nephritis | show 🗑
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Remove any identifiable cause of antibody production. Exposure to organic solvents, hydrocarbons, metal dust and smoking are known to increase the risk of developing the disease.
Stop further antibody production using immunosuppressive medication (cyclop
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| show | .
anti-GBM disease in patients with pulmonary haemorrhage
those with renal involvement who do not require renal replacement therapy at presentation (the indication in this case)
selected patients who may require dialysis but present acutely, are young an
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| Rapidly progressive glomerulonephritis Causes | show 🗑
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| ECG features hypokalamia | show 🗑
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known renal impairment (especially diabetic nephropathy)
age > 70 years
dehydration
cardiac failure
the use of nephrotoxic drugs such as NSAIDs
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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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| Extra-renal manifestations of ADPKD | show 🗑
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| Prevention of renal stones | show 🗑
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1. Emergency surgery, ie, risk of sepsis or hypovolaemia
2. Intraperitoneal surgery
3. CKD, ie if eGFR < 60
4. Diabetes
5. Heart failure
6. Age >65 years
7. Liver disease
8. Use of nephrotoxic drugs
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| It also defines the criteria for diagnosing AKI | show 🗑
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| Refer to a nephrologist if any of the following apply: | show 🗑
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| Haemolytic uraemic syndrome is generally seen in young children and produces a triad of: | show 🗑
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classically Shiga toxin-producing Escherichia coli (STEC) 0157:H7
pneumococcal infection
HIV
rare: systemic lupus erythematosus, drugs, cancer
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| show |
a non-calcium based binder that is now increasingly used
binds to dietary phosphate and prevents its absorption
also appears to have other beneficial effects including reducing uric acid levels and improving the lipid profiles of patients with chronic ki
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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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cystinosis (most common cause in children)
Sjogren's syndrome
multiple myeloma
nephrotic syndrome
Wilson's disease
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| show | accounts for up to 10% of end-stage renal failure cases in the United State.
features of HIVAN:
massive proteinuria resulting in nephrotic syndrome
normal or large kidneys
focal segmental glomerulosclerosis with focal or global capillary collapse on rena
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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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| Complications of plasma exchange | show 🗑
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Guillain-Barre syndrome
myasthenia gravis
Goodpasture's syndrome
ANCA positive vasculitis if rapidly progressive renal failure or pulmonary haemorrhage
TTP/HUS
cryoglobulinaemia
hyperviscosity syndrome e.g. secondary to myeloma
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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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| show | mesangiocapillary glomerulonephritis type 2
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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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| Retroperitoneal fibrosis Associations | show 🗑
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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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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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| Management of Cystinuria | show 🗑
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| show | cyanide-nitroprusside
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